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Table of Contents
Table of Contents
Research Question: Are there relationships between objectively measured fetal movement and maternal characteristics?
Research Question: Are there relationships between objectively measured fetal movement and maternal characteristics?
Background
Background
Decreased fetal movement has been connected to poorer postnatal outcomes in infants with typical development. Past studies have found correlations between maternal characteristics (e.g. work status, age) and subjective maternal perceptions of fetal movement; however, because fetal movement was measured by asking the mother how much movement she perceived, it is unclear whether confounding variables may have played a role in that conclusion. The purpose of this project was to investigate associations between maternal characteristics and objectively quantified fetal movement.
We developed a novel method of quantifying fetal movements objectively using cine MRI scans. Our aim is to examine the relationship between objective measures of fetal movements and maternal socioeconomic, physical, and behavioral characteristics.
Methods
Methods
What is Cine MRI?
What is Cine MRI?
Cine MRI is a type of MRI (magnetic resonance imaging) that captures successive images as a series of frames (like the ones seen below) that can be converted into a continuous video.
What do fetuses look like in Cine MRI? (slide show)
What do fetuses look like in Cine MRI? (slide show)
What does fetal motion look like in a Cine MRI video?
What does fetal motion look like in a Cine MRI video?
Movement was measured as the total number of seconds of movement observed across 2 Cine MRI videos per subject for 35 fetuses.
More about getting an objective measure of fetal movement from an MRI
More about getting an objective measure of fetal movement from an MRI
Cine MRI data was converted into mp4 video files, with each video lasting about 1 minute and 23 seconds. Movement was quantified as the total number of seconds of movement observed across 2 Cine MRI videos per subject (total length of videos per fetus = 166 s) for 35 fetuses. Videos were uploaded into ELAN 6.4, an open-source software that allowed us to capture and record fetal movement in each video frame-by-frame. The image belows demonstrates how behavioral coding in ELAN works: for every movement, coders were able to see how long the movement took place in the timeline of the video, and use annotations to describe which body parts were moving.
Data on eight maternal characteristics—age, income, employment status, physical activity, race-ethnicity, and highest degree attained— was self-reported in surveys given at the time of MRI collection. Descriptive characteristics were generated using Excel and statistical analyses were calculated in R.
More about the survey questions
More about the survey questions
Physical activity was measured in minutes per week, based on responses to the questions "Do you play sports or exercise during this pregnancy? If yes, how many minutes in a week do you spend on the activity?“ and “Do you perform any other physical activity related to housekeeping, caregiving or work? If yes, how many minutes in a week do you spend on these?”
Educational level was based on responses to the question: "How many years of education does mom have? Circle one:
a) Elementary/middle school only
b) Some high school
c) High school diploma
d) Some college
e) Associate degree (AA)
f) Bachelor’s degree (BA/BS)
g) Master’s degree(MA/MS)
h) Doctorate (MD/PhD)".
Maternal race was measured based on choices from the following categories: "American Indian, Alaska Native, White, African American, Asian, Native Hawaiian or Pacific Islander" . Hispanic ethnicity was based on whether mothers selected "Hispanic" or "Non-Hispanic" on data collection forms.
Maternal employment status was determined based on responses to the question “Were you (mom) working outside the home during your pregnancy (prior to giving birth)? "
Household income was measured based on responses to the question "What is your current household income?
a) less than $25,000
c) $50,000-$100,000
e) $150,000-$250,000 b) $25,000 - $50,000
d) $100,000-$150,000
f) Greater than $250,000 "
Height, age, and pre-pregnancy weight were collected on the same survey form.
Results
Results
Maternal Age
Maternal Age
Spearman’s rank correlation was computed to assess the relationship between maternal age and fetal movement (r(33) = -0.01, p = .947).
Physical Activity
Physical Activity
Spearman’s rank correlation was computed to assess the relationship between maternal weekly physical activity and fetal movement (r(27) = -0.12, p = .588).
Work Status
Work Status
A Wilcoxon–Mann–Whitney U Test was used to assess the relationship between maternal age and fetal movement (W = 133.5, p= 0.715).
Education
Education
A linear regression model was used to assess the relationship between fetal movement and education (R2 = -0.06, F(7, 25) = 0.74, p = .642).
Race
Race
The ethno-racial distribution of the sample was not equally distributed; a larger sample size is needed before any interpretations are made.
Income
Income
The income distribution of the sample were not equally distributed; a larger sample size is needed before any interpretations are made.
Limitations and Discussion
Limitations and Discussion
We did not find a statistically significant association between maternal age, physical activity, educational attainment, or work status. The ethno-racial and income distributions of the sample were not equally distributed; a larger sample size is needed before any interpretations are made.
We were not able to calculate the exact p value for maternal age, physical activity, or work status due to ties in the data. Most variables were self-reported, and missing data and covariates were not adjusted for. Fetal movement duration during MRI may have been impacted by variables not considered here (e.g., maternal comfort).
These results can serve as an impetus for future studies investigating the social, physiological, and economic determinants of maternal and child health.
References and Sources for Further Study
References and Sources for Further Study
Elan. (n.d.). BytesIn. Retrieved March 31, 2023, from https://www.bytesin.com/software/ELAN/
Hayat, T. T. A., Martinez-Biarge, M., Kyriakopoulou, V., Hajnal, J. V., & Rutherford, M. A. (2018). Neurodevelopmental correlates of fetal motor behavior assessed using cine mr imaging. American Journal of Neuroradiology, ajnr;ajnr.A5694v1. https://doi.org/10.3174/ajnr.A5694
Hijazi, Z. R., & East, C. E. (2009). Factors affecting maternal perception of fetal movement. Obstetrical & Gynecological Survey, 64(7), 489–497. https://doi.org/10.1097/OGX.0b013e3181a8237a
Manders, M. A. M., Sonder, G. J. B., Mulder, E. J. H., & Visser, G. H. A. (1997). The effects of maternal exercise on fetal heart rate and movement patterns. Early Human Development, 48(3), 237–247. https://doi.org/10.1016/S0378-3782(96)01858-0
Pressman, E. K., DiPietro, J. A., Costigan, K. A., Shupe, A. K., & Johnson, T. R. B. (1998). Fetal neurobehavioral development: Associations with socioeconomic class and fetal sex. Developmental Psychobiology, 33(1), 79–91. https://doi.org/10.1002/(SICI)1098-2302(199807)33:1<79::AID-DEV7>3.0.CO;2-P
Sheikh, M., Hantoushzadeh, S., & Shariat, M. (2014). Maternal perception of decreased fetal movements from maternal and fetal perspectives, a cohort study. BMC Pregnancy and Childbirth, 14(1), 286. https://doi.org/10.1186/1471-2393-14-286
Winn, H., Hess, O., Goldstein, I., Wackers, F., & Hobbins, J. (1994). Fetal responses to maternal exercise: Effect on fetal breathing and body movement. American Journal of Perinatology, 11(04), 263–266. https://doi.org/10.1055/s-2007-994588
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