BACKGROUND AND PURPOSE:

• There is a long history of using kick counts to monitor fetal wellbeing but data is conflicting as to whether there is benefit vs harm from generating undue concern
• ‘Mindfetalness’ encourages women to lie on their side for 15 min each day while the fetus is awake and monitor the overall character of the movement, but not to count each kick
• Akselsson et al. (BJOG, 2020) assessed whether using Mindfetalness could affect pregnancy outcomes

METHODS:

• Cluster-randomized controlled trial
• Setting
  • 67 maternity clinics in Sweden
• Participants
  • Singleton pregnancy
  • >32 weeks’ gestation
• Intervention
  • Guidance on using Mindfetalness
  • Standard care
• Study design
  • If randomized to Mindfetalness, patient received a leaflet about Mindfetalness at 24 weeks | Structured observation began at 28 weeks
  • Data collected from a population-based registry
• Mindfetalness instructions
  • Lie down on side for 15 minutes per day when baby was awake
  • Monitor the character, strength, and frequency of the fetal movements
  • Do not count each movement
  • Use/trust intuition and to seek care if worried about fetal wellbeing
• Primary outcomes
  • Apgar score <7 at 5 minutes after birth
  • Healthcare contact due to decrease in fetal movements
• Secondary outcomes
  • Apgar score <4 at 5 minutes
  • SGA
  • Mode of delivery

RESULTS:

• 39,865 women included
  • Mindfetalness: 19, 639
  • Standard care: 20,226
• There was no difference in 5-minute Apgar score <7 for infants
  • Mindfetalness: 1.1%
  • Standard care: 1.1%
  • Relative risk (RR) 1.0 (95% CI, 0.8 to 1.2)
• Women in the Mindfetalness group contacted a healthcare professional more often due to decreased fetal movements
  • Mindfetalness: 6.6%
  • Standard care: 3.8%
  • RR 1.72 (95% CI, 1.57 to 1.87)
• Mindfetalness was associated with a reduction in the number of
  • Infants born SGA
    • RR 0.95 (95% CI, 0.90 to 1.00)
  • Infants born >41w6d
    • RR 0.91 (95% CI, 0.83 to 0.98)
  • Cesarean birth
    • Mindfetalness: 19.0%
    • Standard care: 20.0%
    • RR 0.95 (95% CI, 0.91 to 0.99)

CONCLUSION:

• The use of Mindfetalness during pregnancy was not associated with a reduction in the number of infants born with an Apgar score <7
• However, the use of Mindfetalness was associated with a decrease in the number of cesarean birth and infants born SGA
• The authors acknowledge limitations to the study, including the fact that some women in the Mindfetalness group may not have received their leaflet or chose not to follow the instructions on the leaflet | However, this reflects a pragmatic ‘real world’ study

Learn More – Primary Sources:

Mindfetalness to increase women’s awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women

Related ObG Topics:

Does Fetal Movement Counting Reduce Risk of Stillbirth?

How Well Can Perceived Changes in Fetal Movements Predict Stillbirth?

The AFFIRM Trial: Does Maternal Awareness of Fetal Movement Counts Reduce Stillbirth Risk