Patterns of healthcare contacts for decreased fetal movements in Sweden before and during the Covid-19 pandemic: a retrospective population-based cohort study

The Covid-19 pandemic has posed challenges to maternal healthcare systems worldwide, impacting women’s access to and utilisation of reproductive healthcare services, particularly highlighting health inequities among minority populations. Maternal awareness of fetal movements is a measure to evaluate fetal well-being. In Sweden, women are encouraged to contact healthcare if they experience decreased fetal movements. It is unknown whether women in Sweden faced greater challenges accessing such care during the Covid-19 pandemic. The objective of this study was to examine whether the proportion of healthcare contacts for decreased fetal movements changed during the Covid-19 pandemic, and if this varied according to women’s demographic characteristics. This retrospective population-based cohort study included 18,791 who contacted healthcare due to decreased fetal movements before (1 January 2017 to 31 December 2019) and after (13 March 2020 to 31 March 2022) the onset of the Covid-19 pandemic in Region Stockholm. Women with a singleton pregnancy from gestational week 22 were included. Data were retrieved from the Swedish Pregnancy Register and the National Patient Register. There was no significant difference in healthcare contacts for decreased fetal movements before compared to during the Covid-19 pandemic (17.3% vs. 17.7%). Subgroup analyses showed an increase in healthcare contacts for decreased fetal movements after the onset of the pandemic among women born in Sweden, women with a university-level education, and students. In contrast, healthcare contacts among women with BMI ≥ 30.0 kg/m² significantly declined during the pandemic period. Overall, contacts with healthcare due to decreased fetal movements remained consistent before and during the Covid-19 pandemic. However, variations were observed among specific subgroups, defined by BMI, region of birth, occupation, and educational level. These findings underscore the complex interplay between sociodemographic factors and maternal healthcare utilisation. To ensure equitable access to essential prenatal care during future health crises, healthcare services and communication strategies must be adapted to reflect the needs and circumstances of all demographic groups.