TY - JOUR
T1 - Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth
T2 - Findings from the New Zealand multicentre stillbirth case-control study
AU - McCowan, Lesley ME
AU - Thompson, John MD
AU - Cronin, Robin S
AU - Li, Minglan
AU - Stacey, Tomasina
AU - Stone, Peter R
AU - Lawton, Beverley A
AU - Ekeroma, Alec J
AU - Mitchell, Edwin A
PY - 2017/6/13
Y1 - 2017/6/13
N2 - Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation).
Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n = 569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going-to-sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders.
Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to-sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05).
Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%.
AB - Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation).
Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n = 569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going-to-sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders.
Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to-sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05).
Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%.
UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-85020719462&origin=resultslist&sort=plf-f&src=s&st1=Going+to+sleep+in+the+supine+position+is+a+modifiable+risk+factor+for+late+pregnancy+stillbirth%3b+Findings+from+the+New+Zealand+multicentre+stillbirth+case-control+study&st2=&sid=6070c5625ae0f4710fbb42f807093fe5&sot=b&sdt=b&sl=183&s=TITLE-ABS-KEY%28Going+to+sleep+in+the+supine+position+is+a+modifiable+risk+factor+for+late+pregnancy+stillbirth%3b+Findings+from+the+New+Zealand+multicentre+stillbirth+case-control+study%29&relpos=0&citeCnt=13&searchTerm=
U2 - 10.1371/journal.pone.0179396
DO - 10.1371/journal.pone.0179396
M3 - Article
VL - 12
SP - 1
EP - 14
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 6
M1 - e0179396
ER -
