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To determine whether snoring, sleep position, and other sleep practices in pregnant women are associated with risk of late stillbirth (≥28 weeks gestation)
Maternal snoring, daytime sleepiness (measured with the Epworth sleepiness scale), and sleep position at the time of going to sleep and on waking (left side, right side, back, and other) was assessed in 155 women with a singleton late stillbirth (≥28 weeks’ gestation) without congenital abnormality born between July 2006 and June 2009 and booked to deliver in Auckland, New Zealand. This was matched to 310 control women with single ongoing pregnancies and gestation at which the stillbirth occurred. Multivariable logistic regression adjusted for known confounding factors.
The prevalence of late stillbirth in this study was 3.09/1000 births. No relation was found between snoring or daytime sleepiness and risk of late stillbirth. However, women who slept on their back or on their right side on the previous night (before stillbirth or interview) were more likely to experience a late stillbirth compared with women who slept on their left side (adjusted odds ratio for back sleeping 2.54 (95% CI 1.04 to 6.18), and for right side sleeping 1.74 (0.98 to 3.01)). The absolute risk of late stillbirth for women who went to sleep on their left was 1.96/1000 and was 3.93/1000 for women who did not go to sleep on their left. Women who got up to go to the toilet once or less on the last night were more likely to experience a late stillbirth compared with women who got up more frequently (adjusted odds ratio 2.28 (1.40 to 3.71)). Women who regularly slept during the day in the previous month were also more likely to experience a late stillbirth than those who did not (2.04 (1.26 to 3.27)).
The study identified a potentially modifiable risk factor for late stillbirth; women who did not sleep on their left side on the last night had a doubled risk of late stillbirth compared with those who slept on their left side. This is the first study to report maternal sleep related practices as risk factors for stillbirth, and these findings require urgent confirmation in further studies but if our findings are confirmed, promoting optimal sleep position in late pregnancy may have the potential to reduce the incidence of late stillbirth.
Were enough women studied to draw such conclusions about sleeping on the left? Will you bear this paper in mind when advising women on sleep practices in late pregnancy in the future or is the evidence too inconclusive to warrant a change in your clinical practice?