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

Robin Cronin, Minglan Li, John Thompson, Adrienne Gordon, Camille Raynes-Greenow, Alexander Heazell, Tomasina Stacey, Vicki Culling, Victoria Bowring, Ngaire Anderson, Louise O'Brien, Edwin Mitchell, Lisa Askie, Lesley McCowan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

LanguageEnglish
Pages49-57
Number of pages9
JournalEClinicalMedicine
Volume10
DOIs
Publication statusPublished - 2 Apr 2019

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Stillbirth
Meta-Analysis
Sleep
Mothers
Pregnancy
Case-Control Studies
Odds Ratio
Small for Gestational Age Infant
Pregnant Women
Cohort Studies
Obesity
Smoking
Prospective Studies

Cite this

Cronin, Robin ; Li, Minglan ; Thompson, John ; Gordon, Adrienne ; Raynes-Greenow, Camille ; Heazell, Alexander ; Stacey, Tomasina ; Culling, Vicki ; Bowring, Victoria ; Anderson, Ngaire ; O'Brien, Louise ; Mitchell, Edwin ; Askie, Lisa ; McCowan, Lesley. / An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. In: EClinicalMedicine. 2019 ; Vol. 10. pp. 49-57.
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abstract = "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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Cronin, R, Li, M, Thompson, J, Gordon, A, Raynes-Greenow, C, Heazell, A, Stacey, T, Culling, V, Bowring, V, Anderson, N, O'Brien, L, Mitchell, E, Askie, L & McCowan, L 2019, 'An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth', EClinicalMedicine, vol. 10, pp. 49-57. https://doi.org/10.1016/j.eclinm.2019.03.014

An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. / Cronin, Robin; Li, Minglan; Thompson, John; Gordon, Adrienne; Raynes-Greenow, Camille; Heazell, Alexander; Stacey, Tomasina; Culling, Vicki; Bowring, Victoria; Anderson, Ngaire; O'Brien, Louise; Mitchell, Edwin; Askie, Lisa; McCowan, Lesley.

In: EClinicalMedicine, Vol. 10, 02.04.2019, p. 49-57.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth

AU - Cronin, Robin

AU - Li, Minglan

AU - Thompson, John

AU - Gordon, Adrienne

AU - Raynes-Greenow, Camille

AU - Heazell, Alexander

AU - Stacey, Tomasina

AU - Culling, Vicki

AU - Bowring, Victoria

AU - Anderson, Ngaire

AU - O'Brien, Louise

AU - Mitchell, Edwin

AU - Askie, Lisa

AU - McCowan, Lesley

PY - 2019/4/2

Y1 - 2019/4/2

N2 - 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.

AB - 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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KW - Sleep

KW - Sleep position

KW - Supine

KW - Fetal vulnerability

KW - Interaction

KW - Individual participant data

KW - Meta-analysis

KW - Fetal death

KW - Perinatal death

KW - Pregnancy

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