Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study

McCowan, Lesley; Thompson, John M. D.; Cronin, Robin; Li, Minglan; Stacey, Tomasina; Stone, Peter; Lawton, Beverley; Ekeroma, Alec; Mitchell, Edwin A.

doi:10.1371/journal.pone.0179396

Cited by 73 publications

(93 citation statements)

References 30 publications

(46 reference statements)

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“…In our study, a PT intervention was implemented in a population of healthy, third-trimester, pregnant women during sleep in a clinical sleep laboratory environment over two nights. This study extends the work of Stacey et al ,2 Gordon et al ,3 McCowan et al ,4 and Warland and Mitchell52 by finding that supine sleep position in late pregnancy can be reduced with PT.…”

Section: Discussionsupporting

confidence: 86%

“…Women in our study preferentially settled to sleep on their left for 73% of the nights and right for 20% of the nights. This is corroborated by McCowan et al 4 who reported a significant increase in left-sided going-to-sleep position (43% to 58%) and small decrease in supine going-to-sleep position (5% to 3.8%) in New Zealand over an approximate 5-year period following publicity of The Auckland Stillbirth Study by Stacey et al 2. If the supine sleeper is to be identified by history taking and stratified for targeted education or intervention, obstetricians, midwives and nurses should be aware that despite sleep-on-side knowledge and high rates of lateral going-to-sleep position, most pregnant women continue to spend a significant amount of time supine during sleep in late pregnancy per our study and previous studies 6–8.…”

Section: Discussionsupporting

confidence: 76%

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Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial

et al. 2018

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ObjectiveTo evaluate whether the percentage of time spent supine during sleep in the third trimester of pregnancy could be reduced using a positional therapy device (PrenaBelt) compared with a sham device.DesignA double-blind, randomised, sham-controlled, cross-over pilot trial.SettingConducted between March 2016 and January 2017, at a single, tertiary-level centre in Canada.Participants23 participants entered the study. 20 participants completed the study. Participants were low-risk, singleton, third-trimester pregnant women aged 18 years and older with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known fetal abnormalities, pregnancy complications or medical conditions complicating sleep.InterventionsA two-night, polysomnography study in a sleep laboratory. Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either a PrenaBelt or a sham-PrenaBelt on the first night and were crossed over to the alternate device on the second night. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants, the recruiter and personnel involved in setting up, conducting, scoring and interpreting the polysomnogram were blinded to allocation.Primary and secondary outcome measuresThe primary outcome was the percentage of time spent supine during sleep. Secondary outcomes included maternal sleep architecture, respiration, self-reported sleep position and feedback.ResultsThe median percentage of sleep time supine was reduced from 16.4% on the sham night to 3.5% on the PrenaBelt night (pseudomedian=5.8, p=0.03). We were unable to demonstrate differences in sleep architecture or respiration. Participants underestimated the time they spent sleeping supine by 7.0%, and six (30%) participants indicated they would make changes to the PrenaBelt. There were no harms in this study.ConclusionsThis study demonstrates that the percentage of sleep time supine during late pregnancy can be significantly reduced via positional therapy.Trial registration numberNCT02377817; Results.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 76%

Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial

et al. 2018

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“…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.…”

Section: Introductionmentioning

confidence: 89%

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

O’Brien

Warland

Stacey

et al. 2019

Birth

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Background: Late stillbirth, which occurs ≥28 weeks' gestation, affects 1.3-8.8 per 1000 births in high-income countries. Of concern, most occur in women without established risk factors. Identification of potentially modifiable risk factors that relate to maternal behaviors remains a priority in stillbirth prevention research. This study aimed to investigate, in an international cohort, whether maternal sleep practices are related to late stillbirth. Methods: An Internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days before completing the survey (n = 153) and women with an ongoing third-trimester pregnancy or who had delivered a live born child within 30 days (n = 480). Bivariate and multivariate logistic regressions were used to determine unadjusted and adjusted odds ratios (OR and aOR, respectively) with 95% confidence intervals (95% CIs) for stillbirth. Results: Sleeping >9 hours per night in the previous month was associated with stillbirth (aOR 1.75 [95% CI 1.10-2.79]), as was waking on the right side (2.27 [1.31-3.92]). Nonrestless sleep in the last month was also found to be associated with stillbirth (1.73 [1.03-2.99]), with good sleep quality in the last month approaching significance (1.64 [0.98-2.75]). On the last night of pregnancy, not waking more than one time was associated with stillbirth (2.03 [1.24-3.34]). No relationship was found with going to sleep position during pregnancy, although very few women reported settling in the supine position (2.4%). Conclusions: Long periods of undisturbed sleep are associated with late stillbirth. Physiological studies of how the neuroendocrine and autonomic system pathways are regulated during sleep in the context of late pregnancy are warranted. K E Y W O R D S maternal sleep, sleep duration, stillbirth | 345 O'BRIEN Et al.

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“…The accompanying editorial and responses to this study highlighted potential confounding factors, including fetal compromise and a small‐for‐gestational‐age fetus, and also raised the possibility of recall bias . Since publication of the Auckland Stillbirth Study, there have been two further studies reporting an association between supine sleep position and late stillbirth that reported aORs of 3.67 and 8.0 . However, these studies were not sufficiently large to test for interactions.…”

Section: Introductionmentioning

confidence: 98%

“…4 A series of case-control studies has been conducted in Australia and New Zealand to investigate modifiable factors associated with late stillbirth (≥ 28 weeks' gestation). [5][6][7] The first of these, the Auckland Stillbirth Study, reported an association between a supine going-to-sleep position and late stillbirth risk [adjusted Odds Ratio (aOR) 2.54, 95% CI 1.04-6.18]. 5 This study also found an association between stillbirth and prolonged sleep duration (>8 hours; aOR 1.71, 95% CI 0.99-2.95) and having a regular daytime sleep (aOR 2.04, 95% CI 1.…”

Section: Introductionmentioning

confidence: 99%

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

Heazell

Budd

et al. 2017

BJOG

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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...

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Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study

Cited by 73 publications

References 30 publications

Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial

Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial

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

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

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