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Why Does My Baby Move So Much When Eating

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Fetal response to maternal hunger and satiation – novel finding from a qualitative descriptive study of maternal perception of fetal movements

BMC Pregnancy and Childbirth volume 14, Article number:288 (2014) Cite this commodity

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Abstract

Background

Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with the subjective perception of a subtract on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activeness may be important in identifying the compromised fetus.However, how meaning women perceive and draw fetal activity is under-investigated past qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by significant women.

Methods

Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their start pregnancy, at 2 timepoints in their tertiary trimester. Interview transcripts were subsequently analysed using qualitative content assay and patterns of fetal activity identified were and then considered forth-side the characteristics of the women and their birth outcomes.

Results

This newspaper focuses on a novel finding; the description by pregnant women of fetal behaviour indicative of hunger and satiation. Full findings volition be presented in later on papers. Virtually participants (74% 14 of 19) indicated mealtimes were a time of increased fetal activeness. Eight participants provided detailed descriptions of increased activity around meals, with seven (37% 7 of 19) of these specifying increased fetal activeness prior to meals or in the context of their own hunger. These movements were interpreted equally a fetal need for food frequently prompting the mother to eat. Interestingly, the women who described increased fetal action in the context of hunger afterward gave nascency to smaller infants (hateful departure 364 gm) than those who did non describe a fetal response to hunger.

Conclusions

Food seeking behaviour may accept a pre-birth origin. Maternal-fetal interaction around mealtimes could constitute an endocrine mediated communication, in the interests of maintaining optimal intrauterine weather condition. Further research is warranted to explore this phenomenon and the potential influence of feeding on the temporal organisation of fetal activity in relation to growth.

Peer Review reports

Background

There has been very lilliputian improvement in stillbirth rates in high-income countries, in contempo decades [1]. In more than 50% of cases of stillbirth, the meaning woman has identified decreased fetal activity prior to diagnosis of fetal death [2]. An improved agreement of fetal behaviour in the context of adverse intra-uterine weather is needed, so that new tools may exist adult for identifying the fetus at risk [1]. Monitoring of fetal movements by pregnant women every bit a method of identifying fetal compromise was outset proposed by Sadovsky and Yaffe in 1973 [3]. Despite promising results of fetal movement monitoring studies, none have identified a sufficiently robust method of screening for normal fetal activity to warrant big-calibration introduction to antenatal intendance [4].

A barrier to harnessing the ability of pregnant women'south ability to notice the wellbeing of their fetus is inadequate definitions of normal and pathologic levels of fetal activity [5, six]. There is considerable variation between pregnant women in terms of numbers of fetal movements perceived, making preset numerical move limits difficult to apply in screening tools. Maternal concerns virtually fetal activity, sometimes expressed in vague terms [seven], may chronicle to a reduction in strength of movements [8], a change in movement pattern, or absence of fetal activity in situations the mother might unremarkably expect movement [9, 10].

Qualitative aspects of fetal action warrant consideration when investigating fetal behaviour in the context of adverse intrauterine weather condition. Neurologists have increasingly emphasised quality of fetal movements over quantity every bit an indicator of normal neurological condition [xi, 12]. Maternal perception of fetal movements is a qualitative miracle. Yet, very little enquiry has been conducted in exploring this miracle using qualitative methodologies [13, 14].

To understand the abnormal ane must start understand the normal. The aim of this study was to explore normal fetal activity equally described by significant women, in the promise that insights gained might contribute to meliorate agreement of fetal behaviour in the context of compromise. This study raises the possibility of influence of maternal meals on patterns of fetal activity. In item a circuitous pattern of activity indicative of fetal apprehension of a meal, hunger and satiation is outlined, which was associated in this accomplice with smaller size at birth.

Methods

This study employed a qualitative descriptive methodology [15]. Qualitative description is a straightforward qualitative approach used when a comprehensive summary of an effect or phenomenon in the everyday terms of that issue is required. Information technology is an inductive approach, useful for situations where little is known about the subject or where a 'patient' voice is required [16].

In contrast to the more interpretive methods, larger sample sizes might exist employed in Qualitative Description, in society to embrace variation. Penetration of the data is broad rather than deep so that greater transferability of the data to other clinical settings may be achieved. In interpreting the data, the researcher is exhorted to stick close to the data, emphasising description over interpretation. Inductive approaches are useful where little is known most a subject, equally is the case with qualitative aspects of maternal perception of fetal movements. Qualitative methodologies are rarely employed in their purest form and researchers often work every bit bricoleur, fashioning the methodological arroyo from more than than ane subject area to conform the detail requirements of the investigation at mitt [17]. Health care researchers are increasingly finding combining approaches useful for complex problems in health care [18]. Qualitative description is well suited for use in studies that combine qualitative and quantitative methods. The purpose when conducting a report using qualitative description is not to press-on to a univocal position but instead to encompass variation. When reporting on findings obviously-language participant accounts are used and quasi-statistical analyses may exist provided to summarise numerically the patterns emerging from the qualitative data [xv].

It has been established that in that location is considerable variation between pregnant women in levels of fetal movement perceived [19–21]. For this reason a purposive sampling strategy was used whereby women in their first pregnancy were recruited. A sample size of 20 women was chosen, existence small enough to manage the intensive process of qualitative data analysis and large enough that some variation might exist captured. For this study, 21 low-hazard women in their first pregnancy were recruited, via five community-based midwifery practices in a provincial city in the N Island of New Zealand. Eligible women had a singleton pregnancy, were under the care of a Atomic number 82 Motherhood Care (LMC) Midwife, and had practiced spoken English. Women, who had weather condition warranting transfer of care to a specialist obstetrician at the time of enrolment, were non eligible. Ii participants interviewed were later excluded as not meeting eligibility criteria (one due to parity, one due to high BMI at booking), leaving the last sample for analysis at 19.

Interviews were conducted at 2 fourth dimension points in the 3rd trimester: early (28-32 weeks) and late (37-41 weeks). Early first trimester interviews were conducted with xv participants and term interview were conducted with 18 participants 13 were interviewed at both fourth dimension points. This immune for inter-pregnancy comparisons of fetal movements descriptions within the accomplice and intra-pregnancy comparisons at each time indicate. Additional term participants were recruited in anticipation of a loss to follow-up of participants recruited for the first interview which only occurred in two cases. Recruitment was stopped when a sense of saturation was achieved in that no new data emerged from the final interviews.

Questions were both semi-structured and open-ended and primarily asked women to describe how their baby's movements felt, patterns of movements over the solar day and any factors they noticed that appeared to increase or decrease their baby'due south movements. An inductive approach to questioning was employed where responses were followed upwards with clarifying or expanding questions such as 'what do yous mean by…?' or 'how did that feel?' in order to gain descriptions that were as detailed as possible. Interesting or unusual participant responses prompted additional questions to exist added to the interview schedule, to exist asked of afterwards participants. Early third trimester interviews were conducted contiguous in the setting of their usual antenatal care, and an audio recording fabricated of the interview for afterward transcribing and analysis. Late third trimester interviews were conducted equally described higher up, or in some instances past telephone. Analysis of the information involved qualitative content analysis [22] of the transcribed interviews, which were coded, organised into themes and and then checked and rechecked confronting original recordings and transcripts. The last phase of information analysis involved consideration of the distribution of patterns emerging from the qualitative data co-ordinate to participant characteristics and their birth outcomes. In particular patterns of movement reported were considered in relation to babe birthweight, as birthweight is an important retrospective indicator of fetal wellbeing. For these analyses the Abound programme (Gestation Related Optimal Weight), which adjusts for maternal tiptop, weight, parity and ethnicity, equally well as the sex activity and gestational age of the baby was used [23]. Some descriptive statistics were undertaken for this final part of the data assay.

Ideals approving was obtained from the New Zealand Health and Inability Ethics Committee (Primal Region), and locality approving for the various community sites was obtained prior to approaching participants. Written permission was obtained from the participants to record the interviews and as well to access pregnancy, labour and birth records, in order to consider nascence outcomes in relation to the descriptive accounts. This enquiry has adhered to the guidelines for qualitative inquiry review (RATS) [24]. Pseudonyms take been used to protect participants' identity.

Results

Maternal descriptions of fetal movements in this study inverse over the class of the third trimester, with early third trimester movements being characterised by their bang-up variation in both type and force of movements. By term jerky or jolting movements had subsided and kicks were reduced in favour of rolling, stretching and pushing movements. Strength of movements was likely to be increased at term. Patterns of movement at both fourth dimension points were commonly influenced past environmental factors such every bit; time of day, maternal position and ambulation, noises and maternal meals. Ane novel finding; a complex fetal response to maternal hunger, eating and satiation is discussed in this paper. Full findings will be presented in afterward papers.

During interviews, participants were asked whether there was a blueprint to their infant'due south movements and if so, to describe it. Mealtimes were identified by the bulk of participants (73.6%, 14/19) as times when fetal activity was probable to be increased in some cases (six) no farther item was offered. In viii cases however participants explicitly recounted increased fetal movements interpreted by the female parent as a response to hunger or eating. Of these eight, vii women (36.8% 7/19) described increased fetal action in association with maternal hunger or the catamenia prior to meals. Five of the women who had described increased fetal movement with hunger (26.3%) described a notable catamenia of quieting following a repast which they interpreted as their infant being sated and content. The remaining 2 described a continuation of the increased activeness afterwards eating that had been noted with hunger. But one woman described increased fetal activity after a meal, without having first described increased movements with hunger. Thus where fetal action in relation to meals was described in particular by participants in this written report, the predominant blueprint was one of increased fetal activity prior to meals and decreased fetal action post-obit meals with a transition period during which some fetuses might continue their increased activity during and immediately after the meal and others might settle quickly into a quiescent period.

In describing changes in fetal activity around mealtimes participants usually 'voiced' their babe in an attempt to convey the 'mental attitude' expressed past the fetal movements. The character of the increased activity prior to a meal was interpreted past the pregnant women equally a fetal expression of anticipation of food, giving way to frustration when the meal was delayed. Whilst, the nature of the movements perceived post-obit a repast were interpreted equally indicating happiness or delectation. In this way fetal movements appeared to function every bit a grade of advice between mother and baby, finer prompting the female parent to eat when she had gone for longer than usual without a repast and then indicating to the mother when the fetus was sated.

These changes in activity were outlined by participants primarily in response to the question "Is there anything that makes your baby motility more or less than usual?" A typical example of increased fetal activity prior to meals is as below:

Sometimes if I haven't eaten for a while. It could merely be me [suspension], but you but feel that sometimes she'll make her presence known and become "I need some nutrient here" or something, well that's what information technology feels similar. And until you take something to consume and and so she'll settle downwards again. (Bridget, 37 weeks)

Increasing fetal activity in advance of meals was further intensified where a meal was delayed. These descriptions were normally independent of sitting equally the mother was often too busy to get a meal as in the case below;

She gets very excited just before dinner fourth dimension, like merely before any repast time; and information technology'southward non even when I'thousand cooking. Sometimes I can merely walk past the room that has food in it and if I'g not eating inside xx minutes then she starts getting quite irate! Similar I must have somehow triggered that I was out to eat and so when I didn't she was hugely disappointed. (Ruth, 39 weeks)

Two women reported increased action in association with hunger and the period following eating, describing the movements as changing qualitatively during the course of meal, every bit in the following example.

So if I'm either hungry… I notice if I oasis't eaten, like that's what happened this afternoon, she was not impressed. And she just gets really wriggly and really squirmy. And and then afterward I've eaten, you know, so similar, although information technology doesn't [pauses] it feels a lot more than comfy after I've eaten, just she goes through a similar affair where she gets quite active. (Roimata, 39 weeks).

For the remaining five of the seven women who had described increased activity with hunger the post-prandial period was associated with a marked quieting of fetal action.

It seems to happen several times a day; like I suppose it is more effectually repast times, like before breakfast, she starts getting a scrap excited, only yeah, afternoon tea fourth dimension; any of those times as well, she's all the same, she goes: "Oh yep, nutrient's on the way, yay." … afterwards a meal she's completely silent.... usually for, even upward to an hr she'll non, similar I won't feel a single movement 'cause it's almost just similar she'southward but chowing downward and happy. (Ruth, 39 weeks)Fetal activity as described by women in relation to hunger and eating demonstrated a developmental blueprint over the class of a mealtime episode, with staged responses interpreted past mothers every bit beingness indicative of anticipation, hunger, appreciation of food and satiation, as represented in Figure ane.

Effigy one
figure 1

Staged fetal responses to maternal hunger and eating, equally described by participants. Typical descriptions of fetal activity in relation to meal stage, with numbers of participants making a statement of this type.

Full size image

In this written report, but 7 of the nineteen participants reported increased activity with maternal hunger, whilst 12 did non. When a theme is identified in a qualitative study it is important to consider the negative cases. When participants who reported increased fetal activity in association with maternal hunger were compared to those who did non it was noted that those women in the written report who had provided the most complex and detailed descriptions of their babe'south movements were more likely to depict their babies as 'very active' or equally 'moving all the time' recounted increased fetal activeness with hunger. As the cohort went on to nascence information technology was noted that babies born to mothers who described increased fetal movements with hunger were smaller than those that did not describe this pattern (3221.75 g vs. 3583.75 g) with a mean birthweight difference betwixt groups of 364 gm. This difference was compared using a two tailed t test and did reach statistical significance (t(17) = -2.295, p = 0.035). Some assay of other factors such as maternal BMI at booking, fetal sex and birth consequence was besides conducted only is not reported hither as no significant differences were identified in this small sample.

When infant birth weights are represented on a scatterplot as shown in Figure two, it can be seen that there is a preponderance of smaller babies in the hunger group. When birthweights were converted to customised birthweight centile scores every bit shown in Figure 3 a similar distribution tin can be seen. Birthweight has a normal distribution, with the majority of newborns in whatever given sample expected to fall betwixt the 25th and 75th centiles [25]. An clan between patterns of fetal movement reported by pregnant women and fetal growth may help to explain why women frequently report apropos changes in fetal movements prior to stillbirth. However, this association must be interpreted with caution in a small-scale sample such as this. In the quest to meliorate understand normal and pathologic fetal activity, this study raises more than questions than answers.

Figure 2
figure 2

Birthweight according to maternal report of increased fetal movements with hunger and no report of increased fetal movements with hunger. Scatterplot of birthweight in grams of babies whose mothers reported increased fetal move in the context of hunger (diamonds) and those who did non report increased fetal movement in the context of hunger (squares). Nb There are two babies of the same weight (2990 gm) in the hunger serial.

Full size image

Figure 3
figure 3

Customised birthweight centile according to maternal report of increased fetal movements with hunger and no report of increased fetal movements with hunger. Scatterplot of customised birthweight centile of babies whose mother reported increased fetal movements in the context of hunger (diamonds) compared to those who did not (squares). The 25th centile is marked by a dashed line.

Full size image

Discussion

To the all-time of our knowledge man fetal behaviour commensurate with hunger and satiation has not previously been described in the literature. Anecdotal reports of increased fetal activity in association with meals are not new and a number of studies explored this possibility in the 1970s through until the early 1990s. The majority of such studies proposed that fetal activity was increased following a meal, failing to consider that the opposite may be true. Some investigators have ended that increased fetal activity is seen with maternal glucose ingestion [26, 27], whilst others alleged no such association [28–xxx]. At this time reviewers consider that at that place is either, no association between fetal activity and maternal meals [31] or that the effect is confounding and remains unresolved [32, 33].

Anecdotal reports of increased fetal movements with eating prompted the practice of offer women orange juice to stimulate fetal movement and expedite reactive cardiotocography (CTG) nevertheless a Cochrane review of this do has concluded that there is no evidence that glucose or orange juice administered to the mother increases fetal movements or reduces not-reactive CTG [34].

In attempting to testify that fetal movements increment with maternal glucose investigators have often reported the opposite. Fetal activity levels in relation to maternal blood carbohydrate were evaluated in 10 diabetic women in the 36th to 40th week of pregnancy by Holden and colleagues [35]. Contrary to their hypothesis a statistically significant increase in fetal activity was seen during episodes of hypoglycaemia [35]. Some other group investigated the effects of hyperglycaemia on the fetus in a group of nine healthy significant women when compared to six controls. Maternal blood glucose was maintained at set levels via intravenous infusion as per the glucose clamp technique developed past DeFranzo and colleagues [36]. A meaning subtract in fetal movements was seen with sustained maternal hyperglycaemia [37].

A study of fetal cyclic motor activity in in relation to claret sugar level of mothers with Type 1 or gestational diabetes demonstrated that fetal cyclic motor activity became faster when maternal blood carbohydrate levels decreased and slower when maternal blood carbohydrate levels increased [38]. Devoe and colleagues [39] investigated the effects of maternal fasting and oral glucose on fetal biophysical parameters in 30 meaning women at term. They reported that incidence of gross fetal body movements and fetal eye charge per unit accelerations was lower following administration of 100 m of oral glucose when compared to fasting [39].

Patrick and colleagues [30] observed the gross fetal body movements of 31 pregnant women betwixt 30 and 39 weeks gestation by continuous ultrasound recording over a 24 60 minutes period. Women rested in a repose room from 8 am to eight pm during continuous ultrasound examination with interruptions for toilet breaks only. Meals were provided at prepare intervals and hourly maternal blood glucose measures were taken. Fetal activeness levels were highest at the starting time of the recording when women were fasted and were seen to increment over the late evening, peaking at midnight, the same time period in which maternal claret glucose levels progressively dropped as the women went into their dark time fast [30].

Controlled studies take demonstrated that administration of a glucose load to pregnant women results in an almost two-fold increase in fetal animate movements [28, forty]. Fetal breathing movements are more than ofttimes observed during a resting land, whilst gross fetal body movements occur more often in periods of apnoea [41]. Increased fetal breathing movements in association with college maternal claret glucose levels, provides support in principle with the notion of gross fetal body movement quiescence post-prandially reported in this study.

Findings from these studies suggest an changed relationship between maternal glucose and fetal action, which is commensurate with the design of movements described by participants in the present study. Further the pattern of fetal movements in relation to meals described by women in this study is homologous to that established in animal studies in relation to feeding. In creature studies the period prior to meals is characterised by increased locomotor activity [42, 43]. Foraging animals may spend a considerable period of time actively procuring food in this phase [43, 44]. Following consumption of a meal, animals will generally become distracted from eating one time they are sated and may spend a short flow grooming or engaged in other activities before settling down for a sleep [43, 44]. The time period for this transition varies between individuals only is generally 1 of increased action in the pre-prandial stage and residuum in the mail-prandial stage.

Mood and food

Maternal descriptions of fetal activeness at mealtimes in this report emphasised that fetal activity was indicative of fetal mood in relation to prandial country, especially 'frustration' at being hungry and 'excitement' or 'contentment' at existence fed. It is not unreasonable that deportment in relation to hunger and satiation be interpreted equally emotions. The connexion betwixt feeding and the brain has been acknowledged since the Russian Physiologist Pavlov demonstrated apprehension of food by salivation in dogs exposed to the stimulus of a ringing bell [45]. Hormones involved in hunger and satiety take known primal nervous organization furnishings, including interim on parts of the encephalon decision-making learning and emotion [46].

The empathy displayed in the participant's appreciation of their infant's perceived emotional country in relation to hunger and satiation might be considered an case of pre-birth formation of a female parent-infant bond. Maternal-baby interaction and especially maternal responsiveness to infant cues, is essential to growth and development of infants afterwards nativity [47]. DiPietro (2010) asserts that the development of a female parent-infant bond begins well before birth and is mediated by the hormonal milieu, with active inputs into the shaping of the intra-uterine environment coming from both the mother and the fetus, "while the uterus is the developmental niche of the fetus, it has go increasingly clear that the fetus is also an active inhabitant of that niche." P 35 [48]. Maternal-fetal interaction around mealtimes could be considered an example of such a bond.

Fetal food-seeking; an evolutionary adaptation?

For much of our existence as a species, humans have survived in environments of food scarcity. It is plausible that a fetal response to low energy-supply may take evolved as a machinery for ensuring optimum availability of nutrients to maintain pregnancy. John Bowlby (1969) in his study of female parent-infant bonding coined the term 'Environs of Evolutionary Adaptedness' (EEA), tracing many infant responses to the conditions for survival in our nomadic hunter-gather past [49]. In Bowlby'south theories of zipper, maternal and infant interests are oft dovetailed [50]. Maternal receptiveness to a fetal mechanism for prompting eating where energy supplies are low, could arguably serve not just the interests of the growing fetus merely likewise the pregnant woman, who optimally nourished will amend withstand labour, nascency and the subsequent demands of lactation.

Fetal activity, fetal growth and stillbirth

In this study maternal reports of increased fetal activity in the context of hunger were associated with smaller size of the baby at nascence. Both small and large fetal size is associated with increased risk of stillbirth [51] and the potential relationships between fetal activity and birthweight warrants further exploration. Animal studies demonstrate that in the context of placental insufficiency fetal metabolic changes such every bit increased insulin precede a drop-off in fetal growth [52]. In intra-uterine growth restricted (IUGR) pregnancies there is a larger maternal-fetal glucose concentration gradient, with the IUGR fetus being relatively hypoglycaemic [53]. It may be that fetal responses to maternal hunger and satiation were preferentially reported in this written report by women who later delivered pocket-sized babies as these fetuses were more sensitive to changes in maternal glucose due to metabolic adaptations to an environs of reduced energy supply via the placenta. A larger sample size would be needed to explore this hypothesis.

The relationship betwixt IUGR, stillbirth and decreased fetal movements, is well documented [54, 55]. It has been hypothesised that decreased fetal movements might be a compensatory measure out to reduce energy expenditure in the context of placental insufficiency [54]. The minor infants in this study were well newborns, with normal Apgar scores who followed a normal neonatal course. Hypothetically, fetal food-seeking behaviour might exist a compensatory machinery employed by a healthy fetus in response to low fuel-supply. Decreased fetal movements in the context of IUGR or severe malnutrition might thus correspond a de-compensation or loss of nutrient-seeking response where energy supply has go severely diminished. In a study of 26 women who had experienced stillbirth, 22 reported a premonition that something had happened to their baby prior to diagnosis of fetal death. A central category emerging from interviews with those mothers was 'losing contact with the baby'. Losing contact was frequently exemplified by mothers as absence of expected movements at mealtimes [10].

Fetal movement patterns

Temporal fluctuations in fetal activity in this written report were described by nigh participants (fourteen/19) as existence closely related to meals. Temporal aspects of fetal activity are of interest equally a possible source of clues as to how fetal activity changes perceived by the mother might warn of impending stillbirth [56]. It has been established that human fetal activity has a complex temporal nature in that alternate bouts of activeness and remainder occur throughout the twenty-four hours and night with increased action over the evening menstruum and increased incidence of quiescent periods during the twenty-four hours [57]. Yet the mechanisms for controlling these fluctuations are not understood. The possibility that maternal meals may influence these fluctuations should exist considered. The diurnal fetal action pattern is periodically abolished following administration of steroids to meaning women for fetal lung maturation [58], a response that may well exist due to the disruption to maternal glucose regulation that occurs with this therapy.

Patterns of fetal activity are known to be contradistinct in pregnancy pathologies which also involve alterations in free energy supply to the fetus including IUGR and diabetes. Abnormalities in behavioural land cycling precede abnormalities in general movement quality in IUGR fetuses [59], whilst fetuses of diabetic women exhibit delayed behavioural country system [60] and changes in fetal behaviour are seen on ultrasound prior to bear witness of 'brain-sparing' [61]. It has been hypothesised that these changes are indicative of neurodevelopmental filibuster in these fetuses, nonetheless they might just as likely exist indicative of contradistinct metabolic environment [62].

Fetal quiescence postprandially

Reporting of fetal quiescence in the context of maternal postprandial state past some participants in this study raises the possibility that increased glucose supply might accept a suppressive outcome on fetal activity. Glucose metabolism requires consumption of oxygen. A report of glucose metabolism in fetal lambs demonstrated that fetal oxygen consumption is almost entirely accounted for in the metabolism of glucose supplied past the female parent [53]. Oxygen requirements for glucose metabolism, either in the postprandial period or where maternal glucose is chronically elevated might therefore compete with oxygen requirements for movement in the fetus.

Decreased fetal movements are more frequently reported past overweight or obese pregnant women [half dozen, 63]. Although the cause for this is unknown, it has been postulated that obese women have decreased sensitivity to fetal movements due to excess adipose tissue, reducing the impact of any fetal move impulse on maternal skin [64]. The possibility of actual reduction in fetal movements in obese women during pregnancy, as opposed to reduced perception has not been ruled out. Studies have shown fetal activity is reduced in pregnancies complicated by diabetes [62, 65]. In diabetic pregnancies, resulting in fetal hyperglycaemia and hyperinsulinaemia, the risk of fetal hypoxemia and acidaemia are increased due to competing oxygen requirements [33]. Maternal obesity is known to be associated with increased blood glucose levels in pregnancy [66, 67]. Where the obese adult female'southward metabolic disturbances do not meet levels diagnostic of gestational diabetes, the fetus may withal be exposed to an augmented glucose supply and an increased oxygen demand, with a potentially suppressive effect on movements.

In a study of 46 diabetic pregnant women a human relationship betwixt fetal action levels and subsequent birthweight was established [68]. Glucose mediated macrosomia was seen exclusively amongst fetuses determined to be 'inactive' before nascence. The authors postulated that the reason for the observed relationship between fetal activeness and birthweight in babies of their participants may exist an intrinsic tendency for the smaller babies in their study to be more active (the fidgety fetus hypothesis), which protected them from macrosomia [68]. All the same, they besides demonstrated that college birthweight of the infants in their study was correlated with higher maternal post-prandial blood glucose levels (r = 0.704). An alternative or supplementary explanation for their finding is that fetal action levels provided a sensitive indicator of the glucose supply to fetuses in the study; a relationship borne out in the infant's later on birthweights.

Determination

This written report involved a pocket-sized group of low-risk primiparous women from one provincial city in New Zealand and findings cannot therefore be applied to a broader significant population without further investigation of the hypotheses generated. The study was not designed to exam whatever hypothesis only rather had an inductive or exploratory design, seeking to explore outset-manus qualitative accounts of normal fetal activity by pregnant women. The finding of a fetal movement pattern in relation to meals thus emerged unsolicited. Larger carefully-planned studies would be needed to plant the nature of fetal responses to maternal hunger and eating including any potential implications in relation to fetal growth.

In this study increased fetal activity was commonly reported by participants to be associated with mealtimes. Fetal action in association with maternal hunger in this study was preferentially reported past women who later delivered pocket-sized infants, suggesting these movements are a compensatory response for low fuel-supply. The virtual discontinuation of enquiry into human fetal responses to maternal blood glucose levels during the 1990s may take been premature. Further investigation of the fetal response to maternal meals as a circuitous multi-stage miracle is warranted given the potential for improving understanding of disorders of fetal growth and development of food-seeking behaviour before nascence.

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Acknowledgments

Pseudonyms take been used for participants with the exception of Ruth who has given permission for her first name to exist used.

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  1. Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, P O Box 7625, 6242, Newtown Wellington, New Zealand

    Billie Bradford & Robyn Maude

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Authors' contributions

BB conceived the idea for a qualitative descriptive study of maternal perception of fetal action, with analysis of variation according to outcomes. Both BB and RM were involved in the planning, report design, and analysis. BB prepared the first draft and both authors reviewed and approved various drafts and the final paper.

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Bradford, B., Maude, R. Fetal response to maternal hunger and satiation – novel finding from a qualitative descriptive study of maternal perception of fetal movements. BMC Pregnancy Childbirth fourteen, 288 (2014). https://doi.org/x.1186/1471-2393-14-288

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Keywords

  • Fetal development
  • Fetal movement
  • Maternal-fetal commutation
  • Hunger

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