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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.


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?InterpretationThis 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.

SUBMITTER: Cronin RS 

PROVIDER: S-EPMC6543252 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Cronin Robin S RS   Li Minglan M   Thompson John M D JMD   Gordon Adrienne A   Raynes-Greenow Camille H CH   Heazell Alexander E P AEP   Stacey Tomasina T   Culling Vicki M VM   Bowring Victoria V   Anderson Ngaire H NH   O'Brien Louise M LM   Mitchell Edwin A EA   Askie Lisa M LM   McCowan Lesley M E LME  

EClinicalMedicine 20190402


<h4>Background</h4>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.<h4>Methods</h4>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  ...[more]

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