National Journal of Physiology, Pharmacy and Pharmacology

RESEARCH ARTICLE
Effect of antenatal corticosteroids on daily fetal movement count in
pregnant women

Nazia Ishrat1, Shahina Perween1, Gul Ar Navi Khan2

1
Department of Obstetrics and Gynecology, J. N. Medical College, Aligarh, Uttar Pradesh, India, 2Department of Physiology,
J. N. Medical College, Aligarh, Uttar Pradesh, India
Correspondence to: Gul Ar Navi Khan, E-mail: dr.gular@rediffmail.com

Received: August 01, 2023; Accepted: August 23, 2023

ABSTRACT

Background: Fetal well-being is reflected in the fetal movements perceived by the mother. Corticosteroids are the most common
therapy in clinical practice which can affect fetal activity. Aims and Objectives: The aim of this study was to evaluate the effect of
dexamethasone administration on daily fetal movement count (DFMC) in pregnant women. Materials and Methods: A prospective
and cohort study was performed in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and
Hospital. A total of 100 pregnant women between gestational ages of 28 weeks and 38 weeks were enrolled in the study. They
were asked to count DFMC on day 0, that is, before administration of injection dexamethasone, on day 2 (after 48 h of first
dose), and during day 4 to 7. Women received injection dexamethasone 6 mg i.m. 4 doses at an interval of 12 h for various
indications such as pre-term pre-labor rupture of membranes, placenta previa, pre-term labor, and previous cesarean. Outcome
measures were changes in DFMC before and after dexamethasone administration. Results: DFMC was significantly reduced on
day 2 of injection dexamethasone administration and returned to baseline values after 4th–7th days of receiving dexamethasone.
Conclusion: Dexamethasone administration resulted in transient reduction in DFMC that mimics fetal compromise; hence,
clinicians should be aware of this phenomenon to prevent iatrogenic pre-term birth of the fetus.

KEY WORDS: Antenatal Corticosteroid; Daily Fetal Movement Count; Dexamethasone

INTRODUCTION Corticosteroids are the most common therapy in clinical

practice which can affect DFMC. As counting of fetal
Antenatal fetal assessment has a novel role and its significance movements by the mother is the oldest and most commonly
is emerging in modern obstetrics. Fetal well-being can be used method of antenatal care. The mother counts fetal “kicks”
assessed by techniques based on the fetal biophysical activity as a method of antepartum fetal surveillance. Sadovsky and
but still in developing countries perception of fetal movement Polishuk[1] stated that reduced fetal movement may be an
by pregnant woman remains the mainstay of antenatal care. alarming sign of intrauterine death of fetus.
Daily fetal movement count (DFMC) is one of the methods
to evaluate fetal well-being. Clinical methods to evaluate fetal movements are uterine
tocodynamometer, visualization using sonography, and
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maternal subjective perception. Many researchers found
Quick Response code
a significant correlation between fetal movements felt by
the mother and those assessed by instruments. In the study
DOI: 10.5455/njppp.2023.13.08403202322082023 by Rayburn depicted 80% of association between fetal
movements sensed by mother and fetal movement assessed
on ultrasonography.[2]

National Journal of Physiology, Pharmacy and Pharmacology Online 2024. © 2024 Gul Ar Navi Khan, et al. This is an Open Access article distributed under the terms of the Creative
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Ishrat et al. Antenatal corticosteroids and daily fetal movement count

Antenatal corticosteroid therapy for the prevention of pre- interpreted as decreased fetal movements.[13] Few researchers
term delivery is the most common therapy to minimize fetal describe that corticosteroid therapy given for fetal lung
complications. The National Institute of Health Consensus maturation leads to decreased fetal movements after 48 h.[14]
Development Conference (1995) recommends either two
doses of 12 mg of betamethasone given i.m. 24 h apart or The pathophysiology of corticosteroid how it changes
four doses of 6 mg of dexamethasone given i.m. 12 h apart fetal movement is still unclear and has not been definitely
between 24 and 34 weeks of gestation in pregnancies at risk proven.[15-17] Despite benefits of corticosteoirds as an
of pre-term delivery. Corticosteroids therapy may be given important antenatal therapy, it affects DFMC. Magee et al.,[14]
between 34 0/7 weeks and 36 6/7 weeks in pregnant women recorded a decrease in fetal movement perception on 1st day
who are at risk of pre-term birth within 7 days, and who have of corticosteroid administration while Rotmensch et al.[18]
not received a previous course of antenatal corticosteroid recorded on the 2nd day.
(ACOG 2017).[3]
The aim of present study is to observe the influence of
Corticosteroid therapy decreases the complications of pre- antenatal corticosteroids on DFMC and to see when this
term babies such as respiratory distress syndrome, necrotizing effect weans off.
enterocolitis, intraventricular hemorrhage,and periventricular
leukomalacia.
MATERIALS AND METHODS

Fetal Movement Assessment A prospective and cohort study performed in the Department
of Obstetrics and Gynaecology, Jawaharlal Nehru Medical
Fetal well-being can be evaluated by fetal movements sensed
College and hospital. One hundred antenatal women who
by the mother.[4] Various studies framed different admissible
were admitted for premature uterine contractions (pre-term
protocol regarding duration in between movement and
labor), mild anemia, placenta previa, or pre-term pre-labor
average number of movement count. Mother first feels
rupture of membranes and those who were electively planned
movement around 18–20 weeks of pregnancy which then
for cesarean section between 28 weeks and 37 weeks of
develops a regular pattern. Fetal movements can be in the
gestation were given four intramuscular injections of 6 mg
form of discrete kick, flutter, swish, or roll.[5] Decreased
dexamethasone. The women were excluded from study
or no fetal movement alarms the clinician about danger of
who were on any medical therapy like antihypertensive
stillbirth.[6]
drugs or benzodiazepines. All women had DFMC records
Before diagnosis, most of the women who experience a before administration of dexamethasone, 48 h after and then
stillbirth have reported diminished fetal movements.[7] during 4th–7th days after the first injection of corticosteroids.
Standardized conditions were applied during the study.
First-time pregnant women feel fetal movements late around
20 weeks of pregnancy while multiparous women sense Study procedure and data collection protocol was done on
early at around 16 weeks of pregnancy. This perception of day 0, that is, before receiving dexamethasone, on day 2, that
fetal movements increases up to 32 weeks of gestation then is, after the completion of steroid course and in between day
it remains static till delivery.[8] However, type of movement 4 and 7 when the effect of steroid had gone.
changes from somersaulting to just kicks.[9] The frequency
of fetal movements is 31/h (ranging between 16 and 45) at Ethics Committee Approval
term. The longest duration in between movements can range
The study protocol was approved from the Institutional
from 50 to 75 min. Frequency and type of fetal movements
Ethical Committee, Faculty of Medicine, AMU, Aligarh.
changes with gestation is a sign of normal neurological
(D.No- 2114/FM, Dated May 11, 2019).
development of the fetus.

These fetal movements exhibit diurnal variation. The highest Informed Consent
activities are seen at afternoon and evening.[10,11] During fetal
Informed consent was taken from all the participants before
sleep, these activities diminish to become absent. In a normal
enrollment in the study.
healthy fetus, sleep cycle is 20–40 min rarely exceeding
90 min and regular in day and night.[12]
RESULTS
Perception of fetal movements is affected by many factors
such as maternal posture and activity. Mother perceives Descriptive data (n = 100) of the patients are summarized in
less movement in the standing position then lying down. Table 1. In our study, 100 women were subjected to assess
Mother can ignore fetal movements when she is busy and not DFMC before administration of injection dexamethasone
focused to count these movements which can be erroneously (day 0) and after 48 h (day-2) of first dose. Same group of

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Ishrat et al. Antenatal corticosteroids and daily fetal movement count

women was also assessed on day 4–7 days of the first dose. decreases as stated in the above tables and from the P-values
Changes in DFMCs were recorded and compared between day on day 2 of treatment and returns to its pre-exposure values
0 and day 2, between day 0 and day 4–7. As shown in Table 2, after 4–7 days of dexamethasone administration.
the mean DFMC was 15.52 ± 2.98 before dexamethasone
administration which decreased to 13.12 ± 2.31 after 48 h of Paired Samples Statistics
the first dose. P < 0.05 indicating that dexamethasone injection
is responsible for decreases in DFMC after 48 h of the first All the data was presented by means and standard deviation.
dose. Changes in mean DFMC after 48 h of dexamethasone The statistical analysis was carried out for the study
injection in various gestational age groups are shown in the parameters using student T-test (paired sample statistics).
Table 3. The P-value was measured using the paired sample
t-test and was found to be <0.05 in all gestational age groups, DISCUSSION
indicating that there is decrease in DFMC after 48 h of
dexamethasone administration. The DFMC before injection In our study population of 100 pregnant women, we
of dexamethasone was 15.5 ± 2.9, as shown in Table 4, and observed DFMC changes before and after 48 h of injection
was 15.8 ± 2.9 after 4–7 days. The P-value was calculated and dexamethasone which showed DFMC decreased significantly.
came out to be >0.05 which was not significant, and thus DFMC The mean DFMC was 15.52 ± 2.98 before dexamethasone
after 4–7 days of injection dexamethasone was comparable to administration which decreased to 13.12 ± 2.31 after 48 h of the
the pre exposure values. The effect of dexamethasone may first dose. P < 0.05, indicating that dexamethasone injection is
therefore be seen to diminish within 4–7 days of the first responsible for decreases in DFMC after 48 h of the first dose. It
dose. Figure 1 indicates changes in DFMC over the course returned to 15.88 ± 2.47 after 4–7 days of first dose of injection
of injection dexamethasone, which shows that the DFMC dexamethasone suggesting that the effect of dexamethasone
weans after 4–7 days following steroid administration. Further
Table 1: Descriptive data (n=100) study population was categorized on the basis of gestational
Variables P‑value (%) age and each category population showed the similar results as
Age (years) 26.10±4.53 DFMC was decreased after 48 h of injection dexamethasone.
Gestational age at dexamethsone administration 34.16±2.34
Significant changes in fetal count was not communicated
Parity
by studies except Derks et al.,[19] Magee et al.,[14]
Primigravida 37 Rotmensch et al.,[18] Wahby et al.[20], and Ali et al.[21] These
Multigravida 63 studies have the similar results with ours finding where
Indications of injection dexamethasone appreciable changes occurs at 2nd day. Our study follows
PPROM 26 the Sadovsky and Polishuk[1] method where fetal kick count
PTL 38 is considered. In addition to fetal kick, Magee et al.[14]
Placenta previa 16 found decrease in fetal count on 1st day based on maternal
Others (prev cs, mild anemia) 20
assessment during CTG recording and Rotmensch et al.[18]
observed dip on 2nd day based on ultrasonographic guided
PPROM: Pre‑term pre‑labor rupture of membranes, PTL: Pre‑term labor
fetal movement count. Wahby et al.[20] did a cohort study
on 50 pregnant women who were followed up for daily
Table 2: Comparison of DFMC before and after 48 h of
fetal movement count for 5 days after dexamethasone
dexamethasone administration administration and reported decrease in the fetal movement
DFMC Mean n SD P‑value count on day 2 (P < 0.001) which gave the results consistent
Pre dexa DFMC 15.52 100 2.986 <0.05 with our study. In the study of Ali et al.,[21] observations were
Post dexa day 2 13.12 100 2.56 similar to our study. They found remarkable decrease in fetal
DFMC: Daily fetal movement count, SD: Standard deviation count on day 2 after 1st and 2nd dose of dexamethasone, then

Table 3: Changes in DFMC after injection of 48 h in different gestational age group

Gestational age DFMC (Mean±SD) Standard P‑value
(in weeks) Before After 48 h Error
injection of of injection
dexamethasone dexamethasone
28w to 31+6w 14.3±2.6 12.4±1.9 0.602 <0.05
32w to 33+6w 15.3±2.6 12.9±2.7 0.605 <0.05
34w to 36+6w 16.0±3.0 13.3±2.3 0.337 <0.05
>37 weeks 15.2±3.1 13.2±2.3 0.853 <0.05
DFMC: Daily fetal movement count, SD: Standard deviation

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Ishrat et al. Antenatal corticosteroids and daily fetal movement count

Table 4: Comparison of DFMC before and 4–7 days after CONCLUSION

injection of dexamethasone
The present study revealed the minor diminution in DFMC due
DFMC Mean n SD P‑value
to corticosteroid therapy during antenatal period. Although
Pre dexa DFMC 15.52 100 2.986 >0.05 these changes are little but significant; hence, during fetal
Post dexa 4–7 days 15.88 100 2.475 surveillance, obstetrician should know the pharmacological
DFMC: Daily fetal movement count, SD: Standard deviation side effect of dexamethasone to prevent premature birth of
healthy fetuses. It is therefore suggested that to minimize
18.00 iatrogenic pre-term birth, fetal surveillance should be done
16.00 using Doppler studies and biophysical profile with DFMC in
14.00 high-risk pregnancy who have given corticosteroid therapy.
12.00
10.00
DFMC

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Source of Support: Nil, Conflicts of Interest: None declared.
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