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\begin{document}

\title{Pregnancy, birth and neonatal outcomes associated with reduced fetal
movements: A systematic review and meta-analysis of non-randomised
studies}



\author[1]{Lorraine Carroll}%
\author[2]{Louise Gallagher}%
\author[2]{Valerie Smith}%
\affil[1]{University College Dublin}%
\affil[2]{Trinity College Dublin}%


\vspace{-1em}



  
  \date{June 12, 2024}


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\begin{abstract}
\textbf{Background} Several studies exploring the associations of
reduced fetal movements (RFM) with adverse perinatal outcomes have been
published in recent years. \textbf{Objectives} To synthesise the
evidence on pregnancy, birth and neonatal outcomes in women who
presented with RFM to ascertain associations between RFM and pregnancy
outcomes. \textbf{Search Strategy} PubMed, EMBASE, CINAHL complete,
Maternity and Infant Care, PsycINFO, and Science Citation Index
databases were searched from inception dates to 8th July 2021
\textbf{Selection Criteria} Non-randomised studies involving pregnant
women [?]24 weeks' gestation, who presented with a primary complaint of
RFM compared to women who did not present with RFM were included.
\textbf{Data Collection and Analysis} Two authors independently
extracted data and assessed risk of bias using the Quality in Prognosis
studies (QUIPs) tool. Data were meta-analysed using a random-effects
model and presented as Odds Ratios (OR) or Standard Mean Differences
(SMD) with 95\% Confidence Intervals (CI). \textbf{Main Results}
Thirty-nine studies were included. Women with RFM were more likely to
have a stillbirth (OR 3.44, 95\% CI 2.02-5.88) and small for gestational
age (OR 1.36, 95\% CI 1.15-1.61) when compared with women who did not
have RFM. Associations were also found for induction of labour,
instrumental birth and caesarean section but not for preterm birth (OR
0.92, 95\% CI 0.71-1.19) or neonatal death (OR 0.99; 95\% CI 0.51-1.91).
\textbf{Conclusion} RFM are associated with increased odds of stillbirth
and small for gestational age, induction of labour, instrumental birth
and caesarean section but not neonatal death.%
\end{abstract}%



\sloppy


Title Page

\textbf{Title}

Pregnancy, birth and neonatal outcomes associated with reduced fetal
movements: A systematic review and meta-analysis of non-randomised
studies

Corresponding Author Name and contact details (address, telephone number
and email address) of the corresponding author

Lorraine Carroll, Assistant Professor in Midwifery,

School of Nursing, Midwifery and Health Systems,

Health Science Centre,

University College Dublin,

Belfield,

Dublin 4,

Ireland

D04 V1W8

Email:\emph{Lorraine.carroll@ucd.ie}

Telephone: 00353872547174

Authors

\begin{enumerate}
\tightlist
\item
  Lorraine Carroll, Assistant Professor in Midwifery, School of Nursing,
  Midwifery and Health Systems, University College Dublin, Ireland and
  PhD candidate of School of Nursing and Midwifery, Trinity College
  Dublin, 24 D'Olier Street, Dublin 2, Ireland, Lorraine.carroll@ucd.ie
\item
  Louise Gallagher, Assistant Professor in Midwifery, School of Nursing
  and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2,
  Ireland, gallagl8@tcd.ie
\item
  Valerie Smith, Professor in Midwifery, School of Nursing and
  Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2,
  Ireland, smithv1@tcd.ie
\end{enumerate}

\subsection*{Conflict of Interest
Declaration}

{\label{conflict-of-interest-declaration}}

There are no conflicts of interest to declare

Acknowledgements

We would like to thank Librarian Greg Sheaf for assistance with search
strategy for this review. This work has been conducted as part of a
programme of doctoral study being undertaken by the lead author (LC). LC
would like to acknowledge the School of Nursing, Midwifery and Health
Systems, University College Dublin for their support with PhD
registration fees.

Contribution to authorship

LC, LG and VS conceived the study. LC conducted the database searches
and imported the citations into Covidence. LC, LG and VS screened and
selected studies for inclusion, extracted data and assessed risk of bias
using the Quality in Prognosis Studies tool. LC led the meta-analysis
and manuscript writing. LG and VS contributed to the critical revision
of the manuscript. All authors reviewed and approved the final
manuscript.

\textbf{Hosted file}

\verb`Final_Main_Manuscript.docx`  available at \url{https://authorea.com/users/473590/articles/563749-pregnancy-birth-and-neonatal-outcomes-associated-with-reduced-fetal-movements-a-systematic-review-and-meta-analysis-of-non-randomised-studies}

\textbf{Hosted file}

\verb`Figure 1 PRISMA Flow Chart.docx`  available at \url{https://authorea.com/users/473590/articles/563749-pregnancy-birth-and-neonatal-outcomes-associated-with-reduced-fetal-movements-a-systematic-review-and-meta-analysis-of-non-randomised-studies}

\textbf{Hosted file}

\verb`Figure 2 Quality of included studies.docx`  available at \url{https://authorea.com/users/473590/articles/563749-pregnancy-birth-and-neonatal-outcomes-associated-with-reduced-fetal-movements-a-systematic-review-and-meta-analysis-of-non-randomised-studies}

\textbf{Hosted file}

\verb`Figure 3 Association between RFM and adverse primary outcomes.docx`  available at \url{https://authorea.com/users/473590/articles/563749-pregnancy-birth-and-neonatal-outcomes-associated-with-reduced-fetal-movements-a-systematic-review-and-meta-analysis-of-non-randomised-studies}

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