Fetal movement trials: Where is the evidence in settings with a high burden of stillbirths?

Fetal movement (FM) is a sign of fetal life and wellbeing that is felt by the pregnant woman, and reduced FM is known to precede stillbirths.1, 2 Therefore, healthcare providers may advise women to monitor and report if their babies’ movements are fewer than usual. In high-income countries (HICs), there has been a renewed interest in FM with a recent wave of large-scale randomised controlled clinical trials investigating its potential to reduce stillbirths. The My Baby’s Movement trial in Australia and New Zealand and the Mindfetalness trial in Sweden have investigated the effects of intervention aimed at increasing women’s awareness of FM.3, 4 In the UK, the AFFIRM trial investigated the effects of an FM awareness package coupled with a standardised management protocol.5 The ongoing CEPRA study in the Netherlands, UK and Australia aims to evaluate Cerebro Placental Ratio as an indicator for delivery in women with reduced FM.6 None of the completed trials, however, found significant reductions in stillbirths. Moreover, they showed conflicting results on some potential harmful consequences, such as increased rates of obstetric interventions. In this commentary, we reflect on these trials through a global lens, and we urgently call for more trials – but this time in settings suffering the majority (98%) of the world’s 2 million annual stillbirths