The effect of fetal movement awareness on birth outcomes among Somali migrant women - findings from a non-randomised intervention study in Sweden.

BACKGROUND: Women born in Somalia who have migrated to Sweden have increased risks of complications related to pregnancy and childbirth. Swedish-Somali women are, compared to women born in Sweden, less likely to contact healthcare for decreased fetal movements, which can be a sign of fetal distress. This study aimed to evaluate the effect of a Mindfetalness-based intervention in increasing awareness of fetal movements and its impact on birth outcomes among Swedish-Somali migrant women. METHODS: An intervention study with a non-randomised control group, encompassing Swedish-Somali migrant women, with a singleton pregnancy, giving birth from gestational week 32 + 0 between June 2022 and June 2024. Data was collected from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. The intervention group consisted of 1,251 women who, in addition to routine information about fetal movements, also received information about Mindfetalness, a concept supporting women to become familiar with the baby’s movement pattern. The control group consisted of 1,555 women who only received routine information about fetal movement. Outcome measures included Apgar score at five minutes after birth, birth weight, neonatal intensive care unit admission, fetal death, onset of labour, mode of birth, and gestational age at birth. Log-binomial regression analyses were applied to assess associations between the intervention and selected outcomes. RESULTS: There was a statistically significant increase in spontaneous vaginal births in the intervention group (RR 1.06, CI 1.01–1.11). No statistically significant differences between the intervention and control groups were observed for any other outcomes. Nearly one-third of women in both groups experienced a prolonged or post-term birth, while two-thirds were overweight or obese. The overall stillbirth rate ranged between 0.3% and 0.4%. CONCLUSIONS: The Mindfetalness intervention was associated with an increased incidence of spontaneous vaginal births, but no effect on other birth outcomes was observed. Implementing health interventions in a high-quality healthcare setting present challenges. When designing interventions to improve birth outcomes, it is essential to consider demographic data and the prevalence of risk factors within the target population. Further research involving stakeholders representing Swedish-Somali women is needed to understand the implications of this intervention. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov: NCT05540639, 30/06/2022.