Decreased fetal movement (DFM) has previously been associated with stillbirth and other adverse perinatal outcomes. Several guidelines highlight the importance of DFM as a sign associated with a risk of stillbirth; however, there is limited national guidance to incorporate this monitoring into stillbirth reduction strategies. The goal of this study was to look at pregnancy outcomes of women with DFM in the third trimester. Secondary outcomes were rates of induction of labor (IOL), planned preterm birth, planned early term birth, vaginal birth, emergency cesarean delivery, infant born small for gestational age (SGA), and severe perinatal outcomes (neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess −12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death).The researchers used data on all births meeting inclusion criteria from 2009 to 2019 at Mater Mothers' Hospital in Brisbane, Australia. Inclusion criteria consisted of pregnant women with a singleton fetus without a known congenital anomaly presenting with DFM after 28 weeks 0 days' gestation. Decreased fetal movement management changed over time. During 2009 to 2016, women with DFM received electronic fetal heart rate monitoring. Starting in 2016, these women received fetal heart rate in addition to a blood test to detect fetomaternal hemorrhage and consideration for ultrasonography scan to assess fetal growth and well-being.One hundred one thousand five hundred ninety-seven women were enrolled in the study. Of these women, 8821 (8.7%) had at least 1 episode of DFM, whereas 92,776 women (91.3%) did not. Women presenting with DFM were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < 0.001), more likely to be nulliparous (4845 women [54.9%] vs 42,210 women [45.5%]; P < 0.001), more likely to have had a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < 0.001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17,444 women [18.8%]; P < 0.001). Decreased fetal movement was not associated with a higher risk of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.23-1.26; P = 0.16). Decreased fetal movement was, however, associated with a higher risk of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P = 0.01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P = 0.02). Decreased fetal movement was also associated with an increased risk of planned early term birth (