Journal
ECLINICALMEDICINE
Volume 10, Issue -, Pages 49-57Publisher
ELSEVIER
DOI: 10.1016/j.eclinm.2019.03.014
Keywords
Stillbirth; Pregnancy; Sleep; Sleep position; Supine; Fetal vulnerability; Interaction; Individual participant data; Meta-analysis; Fetal death; Perinatal death
Categories
Funding
- NHMRC Career Development Fellowship [1087062]
- NHMRC Early Career Fellowship [1089898]
- Cure Kids
- American Sleep Medicine Foundation
- ResMed Foundation
- National Health and Medical Research Council of Australia [1087062, 1089898] Funding Source: NHMRC
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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. (C) 2019 Published by Elsevier Ltd.
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