Association between maternal sleep practices and late stillbirth – findings from a stillbirth case‐control study

Abstract

ObjectiveTo report maternal sleep practices in women who experienced a stillbirth compared with controls with ongoing live pregnancies at similar gestation.DesignProspective case‐control study.SettingForty‐one maternity units in the United Kingdom.PopulationWomen who had a stillbirth after ≥ 28 weeks’ gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733).MethodsData were collected using an interviewer‐administered questionnaire that included questions on maternal sleep practices before pregnancy, in the four weeks prior to, and on the night before the interview/stillbirth.Main outcome measuresMaternal sleep practices during pregnancy.ResultsIn multivariable analysis, supine going‐to‐sleep position the night before stillbirth had a 2.3‐fold increased risk of late stillbirth [adjusted Odds Ratio (aOR) 2.31, 95% CI 1.04–5.11] compared with the left side. In addition, women who had a stillbirth were more likely to report sleep duration less than 5.5 hours on the night before stillbirth (aOR 1.83, 95% CI 1.24–2.68), getting up to the toilet once or less (aOR 2.81, 95% CI 1.85–4.26), and a daytime nap every day (aOR 2.22, 95% CI 1.26–3.94). No interaction was detected between supine going‐to‐sleep position and a small‐for‐gestational‐age infant, maternal body mass index, or gestational age. The population‐attributable risk for supine going‐to‐sleep position was 3.7% (95% CI 0.5–9.2).ConclusionsThis study confirms that supine going‐to‐sleep position is associated with late stillbirth. Further work is required to determine whether intervention(s) can decrease the frequency of supine going‐to‐sleep position and the incidence of late stillbirth.Tweetable abstractSupine going‐to‐sleep position is associated with 2.3× increased risk of stillbirth after 28 weeks’ gestation.Plain Language SummaryStillbirth, the death of a baby before birth, is a tragedy for mothers and families. One approach to reduce stillbirths is to identify factors that are associated with stillbirth. There are few risk factors for stillbirth that can be easily changed, but this study is looking at identifying how mothers may be able to reduce their risk.In this study, we interviewed 291 women who had a stillbirth and 733 women who had a live‐born baby from 41 maternity units throughout the UK. The mothers who had a stillbirth were interviewed as soon as practical after their baby died. Mothers who had a live birth were interviewed during their pregnancies at the same times in pregnancy as when the stillbirths occurred. We did not interview mothers who had twins or who had a baby with a major abnormality.Mothers who went to sleep on their back had at least twice the risk of stillbirth compared with mothers who went to sleep on their left‐hand side. This study suggests that 3.7% of stillbirths after 28 weeks of pregnancy were linked with going to sleep lying on the back. This study also shows that the link between going‐to‐sleep position and late stillbirth was not affected by the duration of pregnancy after 28 weeks, th...

Maternal sleep practices and stillbirth: Findings from an international case‐control study

“…Indeed, the Auckland study 4 reported higher odds of long sleep duration, one or fewer times getting up to use the bathroom, and regular daytime naps in the stillbirth group compared with controls, although short sleepers were also more common in the stillbirth group. This latter study was remarkably similar to the recent Midlands and North of England Stillbirth Study, 7 which also reported frequent daytime napping, one or fewer awakenings to use the bathroom, and both long and short sleep as being more common in the stillbirth group. Short sleep-but not long sleep-was more common in the stillbirth group in the New Zealand multicenter stillbirth case-control study, 6 which also found a higher odds for not getting up to go to the toilet.…”

“…4 This case-control study demonstrated that women who reported settling to sleep in the supine position on the last night of pregnancy were significantly more likely to experience stillbirth, even after accounting for other factors (aOR 2.54 [95% CI 1.04-6.18]). [5][6][7] These studies have also noted differences in maternal sleep duration and number of awakenings between stillbirths and live births. This finding has now been observed in three further studies using similar methodologies with similar effect sizes.…”

“…This finding has now been observed in three further studies using similar methodologies with similar effect sizes. [5][6][7] These studies have also noted differences in maternal sleep duration and number of awakenings between stillbirths and live births.…”

Effects of maternal sleep position on fetal and maternal heart rate patterns using overnight home fetal ECG recordings

“…A cross‐sectional study in Ghana reported similar outcomes, with supine position associated with an increased risk for low birth weight and stillbirth . The Midland and North of England Stillbirth Study also reported that going to sleep in the supine position significantly increased the risk of stillbirth …”

“…12 The Midland and North of England Stillbirth Study also reported that going to sleep in the supine position significantly increased the risk of stillbirth. 13 This is particularly relevant in the context of the triple risk model proposed by Warland and Mitchell,14 which describes stillbirth as the outcome of interactions among: (1) maternal factors, such as age, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), smoking, or alcohol consumption; (2) fetal and placental influences, such as intrauterine growth restriction The aim of the study was to assess if maternal sleep position during pregnancy had an effect on maternal and/or fetal autonomic regulation, as measured by HRV parameters.…”