ABSTRACT: By identifying a change in fetal activity state, fetal movement counting may help to reduce the possibility of stillbirth. Concern has arisen that such a focus on fetal activity may cause undue maternal anxiety. A prospective, controlled trial was conducted to determine whether fetal movement counting induced anxiety or other deleterious psychological effects in low-risk primigravidas. A sample of 613 healthy pregnant women was randomly assigned at 28 weeks' gestation to fetal movement counting, sleep recording, or a nonrecording control group. State and trait of anxiety, belief in sources of personal control, and attitudes toward pregnancy and infant were assessed at 28 and 37 weeks' gestation. Participation rates were high (91.4%) across all groups. Most women (90%) assigned to count fetal movements did so on a daily basis (95% of days). No significant changes in psychological status occurred in the three groups as a result of self-monitoring conditions. Independent of group assignment, all women showed a slight increase in transient state and decrease in trait of anxiety from 28 to 37 weeks. Internal locus of control and positive attitudes toward the infant increased slightly, and feelings of well-being decreased slightly for all women. It was concluded that women are willing to record fetal activity, and that fetal movement counting does not cause deleterious psychological effects in low-risk pregnant women.