Abstract
ObjectiveOur 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).MethodsA 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.ResultsSupine 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).ConclusionsSupine 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%.
Highlights
Stillbirth remains one of few potentially avoidable maternal and child health problems and is approximately twice as common as neonatal death [1, 2]
Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%
The risk associated with supine-going-to-sleep position was greater for term than preterm stillbirths
Summary
Stillbirth remains one of few potentially avoidable maternal and child health problems and is approximately twice as common as neonatal death [1, 2]. The 2016 Lancet “Ending Preventable Stillbirth Series” highlighted differences in rates of late stillbirth (at !28 weeks’) between high-income countries ranging from #1.3/1000 to 8.8/1000 births [2]. Disparities exist between ethnic groups within high-income countries [1, 3]. Such variations suggest it should be possible to further reduce late stillbirth rates in many settings. A number of studies have examined risk factors for stillbirth, many have only been able to use routinely collected data [5, 6] or have been systematic reviews [7] and have been unable to explore detailed relationships with maternal lifestyle and personal habits
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