Survey of maternal sleep practices in late pregnancy in a multi-ethnic sample in South Auckland, New Zealand

Cronin, Robin; Chelimo, Carol; Mitchell, Edwin A.; Okesene-Gafa, Kara; Thompson, John M. D.; Taylor, Rennae S.; Hutchison, Barbara; McCowan, Lesley

doi:10.1186/s12884-017-1378-5

Cited by 16 publications

(9 citation statements)

References 20 publications

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“…This study suggests that a high proportion of women change their sleeping habits in pregnancy, suggesting that going‐to‐sleep position could be modified. This is consistent with the findings of a study of 377 women from a diverse multi‐ethnic population in New Zealand, in which 68% had received advice about sleep position and 87% felt they would have minimal difficulty changing their going‐to‐sleep position if it were recommended . In common with other aspects of pregnancy information, a high proportion of women used the internet to obtain advice about sleeping position.…”

Section: Resultssupporting

confidence: 86%

“…This is consistent with the findings of a study of 377 women from a diverse multi-ethnic population in New Zealand, in which 68% had received advice about sleep position and 87% felt they would have minimal difficulty changing their going-to-sleep position if it were recommended. 31 In common with other aspects of pregnancy information, 32 a high proportion of women used the internet to obtain advice about sleeping position. Such programmes should therefore include internet-based strategies to inform women about sleep position that can be reinforced by contact with health care professionals.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultssupporting

confidence: 86%

Section: Resultsmentioning

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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“…It may now be timely to advise women that going-to-sleep on the side in the third trimester is associated with an approximate halving of the odds of late stillbirth compared to going-to-sleep on the back. Swapping from the supine to the side-lying going-to-sleep position in late pregnancy is a simple intervention that women report can be self-managed by women with minimal difficulty in the home [8], [24], requires no technology or equipment [24], is not known to cause harm, is applicable to all pregnant women, and most importantly could reduce late stillbirth.…”

Section: Discussionmentioning

confidence: 99%

“…Findings from epidemiological studies and the physiological and anatomical evidence [11], [19] suggest that the association between supine going-to-sleep position and late stillbirth is likely to be causal. Therefore, informing pregnant women about optimal going-to-sleep position in late pregnancy may be a feasible strategy [24] to reduce stillbirth. However, there is a need to assess the accumulated evidence from the existing studies to inform public health interventions.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, it is necessary to determine if there are specific groups of pregnant women who are more vulnerable when they go-to-sleep supine and if the odds of stillbirth differ between right and left side going-to-sleep position. This need is urgent, because pregnant women are already modifying their going-to-sleep position based on inconsistent advice [8], [24].…”

Section: Introductionmentioning

confidence: 99%

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An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth

Cronin

Thompson

et al. 2019

EClinicalMedicine

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Background Maternal supine going-to-sleep position has been associated with increased risk of late stillbirth (≥ 28 weeks), but it is unknown if the risk differs between right and left side, and if some pregnancies are more vulnerable. Methods Systematic searches were undertaken for an individual-level participant data (IPD) meta-analysis of case–control studies, prospective cohort studies and randomised trials undertaken up until 26 Jan, 2018, that reported data on maternal going-to-sleep position and stillbirth. Participant inclusion criteria included gestation ≥ 28 weeks', non-anomalous, singleton pregnancies. The primary outcome was stillbirth. A one-stage approach stratified by study and site was used for the meta-analysis. The interaction between supine going-to-sleep position and fetal vulnerability was assessed by bi-variable regression. The multivariable model was adjusted for a priori confounders. Registration number: PROSPERO, CRD42017047703. Findings Six case–control studies were identified, with data obtained from five (cases, n = 851; controls, n = 2257). No data was provided by a sixth study (cases, n = 100; controls, n = 200). Supine going-to-sleep position was associated with increased odds of late stillbirth (adjusted odds ratio [aOR] 2.63, 95% CI 1.72–4.04, p < 0.0001) compared with left side. Right side had similar odds to left (aOR 1.04, 95% CI 0.83–1.31, p = 0.75). There were no significant interactions between supine going-to-sleep position and assessed indicators of fetal vulnerability, including small-for-gestational-age infants (p = 0.32), maternal obesity (p = 0.08), and smoking (p = 0.86). The population attributable risk for supine going-to-sleep position was 5.8% (3.2–9.2). Interpretation This IPD meta-analysis confirms that supine going-to-sleep position is independently associated with late stillbirth. Going-to-sleep on left or right side appears equally safe. No significant interactions with our assessed indicators of fetal vulnerability were identified, therefore, supine going-to-sleep position can be considered a contributing factor for late stillbirth in all pregnancies. This finding could reduce late stillbirth by 5.8% if every pregnant woman ≥ 28 weeks' gestation settled to sleep on her side.

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Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight

Anderson

Gordon

et al. 2019

JAMA Netw Open

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IMPORTANCE Supine maternal position in the third trimester is associated with reduced uterine blood flow and increased risk of late stillbirth. As reduced uterine blood flow is also associated with fetal growth restriction, this study explored the association between the position in which pregnant women went to sleep and infant birth weight. OBJECTIVE To examine the association between supine position when going to sleep in women after 28 weeks of pregnancy and lower birth weight and birth weight centiles. DESIGN, SETTING, AND PARTICIPANTS Prespecified subgroup analysis using data from controls in an individual participant data meta-analysis of 4 case-control studies investigating sleep and stillbirth in New Zealand, Australia, and the United Kingdom. Participants were women with ongoing pregnancies at 28 weeks' gestation or more at interview. MAIN OUTCOMES AND MEASURES The primary outcome was adjusted mean difference (aMD) in birth weight. Secondary outcomes were birth weight centiles (INTERGROWTH-21st and customized) and adjusted odds ratios (aORs) for birth weight less than 50th and less than 10th centile (small for gestational age) for supine vs nonsupine going-to-sleep position in the last 1 to 4 weeks, adjusted for variables known to be associated with birth size. RESULTS Of 1760 women (mean [SD] age, 30.25 [5.46] years), 57 (3.2%) reported they usually went to sleep supine during the previous 1 to 4 weeks. Adjusted mean (SE) birth weight was 3410 (112) g among women who reported supine position and 3554 (98) g among women who reported nonsupine position (aMD, 144 g; 95% CI, −253 to −36 g; P = .009), representing an approximate 10-percentile reduction in adjusted mean INTERGROWTH-21st (48.5 vs 58.6; aMD, −10.1; 95% CI, −17.1 to −3.1) and customized (40.7 vs 49.7; aMD, −9.0; 95% CI, −16.6 to −1.4) centiles. There was a nonsignificant increase in birth weight at less than the 50th INTERGROWTH-21st centile (aOR, 1.90; 95% CI, 0.83-4.34) and a 2-fold increase in birth weight at less than the 50th customized centile (aOR, 2.12; 95% CI, 1.20-3.76). Going to sleep supine was associated with a 3-fold increase in small for gestational age birth weight by INTERGROWTH-21st standards (aOR, 3.23; 95% CI, 1.37-7.59) and a nonsignificant increase in small for gestational age birth weight customized standards (aOR, 1.63; 95% CI, 0.77-3.44). CONCLUSIONS AND RELEVANCE This study found that going to sleep in a supine position in late pregnancy was independently associated with reduced birth weight and birth weight centile. This novel association is biologically plausible and likely modifiable. Public health campaigns that (continued)

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Survey of maternal sleep practices in late pregnancy in a multi-ethnic sample in South Auckland, New Zealand

Cited by 16 publications

References 20 publications

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

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

An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth

Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight

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