Assessing how healthy babies are when they start moving less than normal (FEMINA2)

Dr Lucy Higgins, Prof Alexander Heazell, Dr Edward Johnstone, Dr Mark Wareing, Professor Colin Sibley

Reduced fetal movements are a common reason for women to go to hospital in the last 12 weeks of pregnancy. There is currently no way to know which women will have a normal pregnancy and which have problems.

This study is now completed

Feeling her baby move is one of the simplest ways of a mother being aware of her baby’s wellbeing. If a baby starts moving less than normal, this can be the first sign of a problem with the placenta, and there may be a significant risk of stillbirth. The FEMINA2 study looked at 300 women whose babies’ movements had decreased to develop a new way of finding which babies are at risk.

Women are advised to be aware of their baby’s movements and to go to a maternity unit if they notice their baby start moving less. We know that in women whose babies start moving less, the placenta is often smaller and less healthy, stopping it from giving the baby the food and oxygen it needs. We think that the baby stops moving as a survival strategy: they can save energy when food and oxygen are in short supply.

Many women attend maternity services for this reason in the last 12 weeks of pregnancy, however around three-quarters continue to have healthy pregnancies. At the moment there is no accurate way to tell which women have babies that are at risk of growth restriction or stillbirth. Doctors need to know this as early as possible in case the baby is struggling and needs to be delivered: a test is urgently needed to find babies at risk.

For each woman in the study, we collected 187 different pieces of information, many relating to the structure and function of the placenta.

We were then able to see which of these were related to pregnancy complications such as growth restriction, stillbirth, and admission to the neonatal intensive care unit. Using this information, we have developed a test based on ultrasound and blood tests that could find 30% more babies with at risk than our current standard tests.

We are continuing to test this in another group of women – the FEMINA3 group – in our PAPPO study

Research papers

  • Higgins LE, Johnstone ED, Heazell AEP. Management of Reduced Fetal Movements Fetal and Maternal Medicine Review 2013; 24(4):201-231.
  • Higgins LE, Sibley CP, Wareing M, Johnstone ED, Heazell AEP. Umbilical Artery PI/RI Fail to Detect Aberrant Placental Arterial Function in Reduced Fetal Movement Pregnancies. Reproductive Sciences 2014;21(3 Suppl):182A.
  • Higgins LE, Johnstone ED, Wareing M, Sibley CP, Heazell AEP. Identifying the Placental Phenotype of adverse pregnancy outcome: Potential novel biomarkers of the at-risk pregnancy. Baby Survival Conference, Amsterdam, 2014.
  • Higgins LE, Johnstone ED, Wareing M, Sibley CP, Heazell AEP. Placental arterial Doppler surveillance in pregnancy can distinguish normal from abnormal placental vascular structure. Baby Survival Conference, Amsterdam 2014.
  • Higgins LE, Johnstone ED, Wareing M, Sibley CP, Heazell AEP. Identifying the Placental Phenotype of Adverse Pregnancy Outcome: Potential Novel Biomarkers of the At-Risk Pregnancy. Fetal Growth, Oxford, 2014.
  • Higgins LE, Johnstone ED, Wareing M, Sibley CP, Heazell AEP. Placental circulation arterial Doppler resistance is higher in fetal growth restriction. Blair Bell Research Society, London, 2013.
  • Third trimester placental biometry is biologically accurate and relevant. Blair Bell Research Society, London, 2013
  • Placental assessment aids identification of pregnancies with RFM experiencing adverse pregnancy outcome. BJOG 2015;122(S2):8-17 PPP.4
  • Placental assessment aids identification of pregnancies with RFM experiencing adverse pregnancy outcome. Blair Bell Research Society, London, 2015. In Press; BJOG 2015
  • Placental features of Late-onset adverse pregnancy outcome. PLoS ONE 2015;10(6):e0129117.
  • Maternal perception of fetal movements in late pregnancy is affected by type and duration of fetal movements. J Matern Fetal Neonatal Med 2015 (epub ahead of print).

Timescale: 2011-2015

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Funding

This study took place in a Tommy's centre and was funded by Tommy's and Action Medical Research

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