UniSA BackOff! Study: Adelaide PrenaBelt Trial

UniSA BackOff! Study: A Randomized, Controlled, Five-way, Cross-over Trial to Evaluate the Effect of a Positional Therapy Device on Maternal Sleeping Position in the Third Trimester of Pregnancy

Stillbirth (SB) is a devastating complication of pregnancy and contributes to over 2 million deaths globally every year. Over 20 million infants are born every year with low birth weight (LBW), which is associated with a twenty times increased risk of death in the first year of life and high rates of short- and long-term illnesses. Sleeping on one's back during pregnancy has recently emerged as a potential risk factor for LBW and SB in the medical literature. In high-income countries, SB rates have mostly remained the same in the past two decades and targeting modifiable risk factors could help reduce the number of SB and LBW in the population.

When a pregnant woman sleeps on her back, her body position compresses underlying blood vessels and reduces blood flow to the developing baby. This body position could cause unpleasant symptoms for the mother and result in LBW or SB of her baby. Lying on her side or with a slight lateral tilt helps relieve this compression. One way to keep people off their back while sleeping is by using positional therapy (PT). It is a simple, safe, inexpensive and effective intervention for preventing people who snore or people who's breathing pauses during sleep from sleeping on their back. Reducing the amount of time pregnant women sleep on their back could help reduce SB and LBW rates. The investigators developed a PT device (PrenaBelt) and tested it in three clinical trials, which demonstrated that it significantly decreases the number of time women spend sleeping on their back. Using feedback from our previous research, the investigators developed five additional devices that will be tested in this study.

The purpose of this study is to evaluate the new PrenaBelt (PB2) prototypes' ability to reduce the amount of time pregnant women sleep on their backs in the third trimester of pregnancy, validate the Ajuvia Sleep Monitor, and collect feedback on the devices.

Demonstrating that the sleeping position of pregnant women can be modified through the use of a simple, inexpensive PT intervention may be one of the keys to achieving significant reductions in LBW and late SB rates in Australia and worldwide.

Study Overview

• Status: Terminated
• Conditions: Pregnancy Complications; Fetal Growth Retardation; Sleep-Disordered Breathing; Infant, Very Low Birth Weight; Stillbirth; Infant, Small for Gestational Age; Fetal Hypoxia; Infant, Low Birth Weight
• Intervention / Treatment: Device: Ajuvia-Passive; Device: PB2-1 prototype; Device: PB2-2 prototype; Device: PB2-3 prototype; Device: PB2-4 prototype; Device: PB2-5 prototype; Device: Ajuvia-Active

Detailed Description

The ability of the PB2 prototypes to reduce the amount of time pregnant women spend sleeping on their backs at night in the home setting in the third trimester of pregnancy will be evaluated via a consecutive, six-night, in-home, controlled, cross-over sleep study in third trimester pregnant women where the Ajuvia Sleep Monitor is validated against infrared video on the first night.

Six nights: the first night is a control night with infrared video recording where only the Ajuvia is worn in passive mode to collect data on the participant's body position and is followed by five nights with the five different prototypes.

Randomization: The order in which the different devices will be worn on the second night through fourth night, inclusive, will be determined by simple randomization. This will minimize the potential impact of changes to sleep across the nights resulting from familiarization with the equipment as the sleep tests proceed through the five non-control nights, which could bias the results. For logistical reasons, the sixth night is non-randomized and will include the Ajuvia in 'active' mode Cross-over: After the first night, on each of the subsequent four nights, the participants will "cross over" to a different PB2 device (depending on their randomization order) and "cross over" to the Ajuvia in 'active' mode on the sixth night to allow each participant to act as her own control for comparison of treatment effect on outcomes.

In home: conducting this study in the home setting will allow for a more accurate representation of sleep patterns as the participants will be in the comfort of their own bed.

Sleep test: The maternal pelvis position will be recorded while the participants are sleeping using the Ajuvia device. Going to bed- and wake-times, as well as experience with each device will be recorded daily in a sleep diary.

• Study Type: Interventional
• Enrollment (Actual): 6
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • South Australia
    • Adelaide, South Australia, Australia, 5000
      • UniSA Clinical & Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• ≥18 years old
• low-risk singleton pregnancy
• in the last trimester of pregnancy (at least 28 weeks + 0 days but not more than 36 weeks + 0 days of gestation)
• access to and ability to use iPhone (for downloading and using Ajuvia app)
• residing in the Greater Adelaide Area.

Exclusion Criteria:

• musculoskeletal disorder that prevents sleeping supine or on a certain side (e.g., arthritic shoulder)
• non-English speaking and reading

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control; The first night will be a control night with infrared video recording where only the Ajuvia sleep monitor is worn in passive mode so that each participant can act as her own control for comparison of treatment effect on outcomes.	Device: Ajuvia-Passive; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the passive mode, it measures and records the position of the pelvis but does not alert the woman.
Experimental: PB2-1; During this night, the PB2-1 prototype will be worn with the Ajuvia in passive mode.	Device: Ajuvia-Passive; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the passive mode, it measures and records the position of the pelvis but does not alert the woman.; Device: PB2-1 prototype; PB2-1 prototype is a belt-like wearable device similar to the original PrenaBelt designed for pregnant women that permits supine positioning of the pelvis but, when in this position, provides subtle pressure points to the user's body and thereby activates the body's natural mechanism to reposition itself to relieve discomfort. It is expected to significantly decrease the amount of time a pregnant woman's pelvis is in the supine position overnight while promoting comfortable sleep.
Experimental: PB2-2; During this night, the PB2-2 prototype will be worn with the Ajuvia in passive mode.	Device: Ajuvia-Passive; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the passive mode, it measures and records the position of the pelvis but does not alert the woman.; Device: PB2-2 prototype; PB2-2 prototype is a belt-like wearable device designed for pregnant women. When placed on the woman's back, this device prevents the pelvis from achieving a supine orientation by maintaining at least fifteen degrees of right or left lateral pelvic tilt. It is expected to significantly decrease the amount of time a pregnant woman's pelvis is in the supine position overnight while promoting comfortable sleep.
Experimental: PB2-3; During this night, the PB2-3 prototype will be worn with the Ajuvia in passive mode.	Device: Ajuvia-Passive; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the passive mode, it measures and records the position of the pelvis but does not alert the woman.; Device: PB2-3 prototype; PB2-3 prototype is a belt-like wearable device designed for pregnant women. When placed on the woman's back, this device prevents the pelvis from achieving a supine orientation by maintaining at least fifteen degrees of right or left lateral pelvic tilt. It is expected to significantly decrease the amount of time a pregnant woman's pelvis is in the supine position overnight while promoting comfortable sleep.
Experimental: PB2-4; During this night, the PB2-4 prototype will be worn with the Ajuvia in passive mode.	Device: Ajuvia-Passive; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the passive mode, it measures and records the position of the pelvis but does not alert the woman.; Device: PB2-4 prototype; PB2-4 prototype is a belt-like wearable device designed for pregnant women that prevents the user from achieving a supine position as the device allows right and left lateral pelvic tilt but prevents the user's pelvis from settling supine due to virtue of its design. It is expected to significantly decrease the amount of time a pregnant woman's pelvis is in the supine position overnight while promoting comfortable sleep.
Experimental: PB2-5; During this night, the PB2-5 prototype will be worn with the Ajuvia in active mode.	Device: PB2-5 prototype; PB2-5 prototype is a belt-like wearable device designed for pregnant women that does not provide positional therapy. It can be worn anytime as a maternity support belt.; Device: Ajuvia-Active; Ajuvia Sleep Monitor senses the user's body position and can be used in passive or active mode with or without the PB2 prototypes. In the active mode, it alerts the woman when her pelvis is in the supine position through a gentle vibratory alarm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sensitivity of Ajuvia for supine position	The sensitivity(%) of the Ajuvia in determining the pelvic supine position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for supine position	The specificity(%) of the Ajuvia in determining the pelvic supine position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Sensitivity of Ajuvia for prone position	The sensitivity(%) of the Ajuvia in determining the pelvic prone position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for prone position	The specificity(%) of the Ajuvia in determining the pelvic prone position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Sensitivity of Ajuvia for left tilt position	The sensitivity(%) of the Ajuvia in determining the left pelvic tilt position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for left tilt position	The specificity(%) of the Ajuvia in determining the left pelvic tilt position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Sensitivity of Ajuvia for left lateral position	The sensitivity(%) of the Ajuvia in determining the left lateral pelvic position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for left lateral position	The specificity(%) of the Ajuvia in determining the left lateral pelvic position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Sensitivity of Ajuvia for right tilt position	The sensitivity(%) of the Ajuvia in determining the right pelvic tilt position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for right tilt position	The specificity(%) of the Ajuvia in determining the right pelvic tilt position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Sensitivity of Ajuvia for right lateral position	The sensitivity(%) of the Ajuvia in determining the right lateral pelvic position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Specificity of Ajuvia for right lateral position	The specificity(%) of the Ajuvia in determining the right lateral pelvic position during night sleep against the gold-standard of position as determined by review of infrared video will be calculated using a two-by-two contingency table.	1 night (approximately 8 hours)
Supine Sleep Time - Control	The time (in minutes) spent sleeping in the supine position with Ajuvia in passive mode	1 night (approximately 8 hours)
Supine Sleep Time - PB2-1	The time (in minutes) spent sleeping in the supine position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Supine Sleep Time - PB2-2	The time (in minutes) spent sleeping in the supine position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Supine Sleep Time - PB2-3	The time (in minutes) spent sleeping in the supine position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Supine Sleep Time - PB2-4	The time (in minutes) spent sleeping in the supine position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Supine Sleep Time - PB2-5	The time (in minutes) spent sleeping in the supine position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)
Prone Sleep Time - Control	The time (in minutes) spent sleeping in the prone position with Ajuvia in passive mode	1 night (approximately 8 hours)
Prone Sleep Time - PB2-1	The time (in minutes) spent sleeping in the prone position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Prone Sleep Time - PB2-2	The time (in minutes) spent sleeping in the prone position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Prone Sleep Time - PB2-3	The time (in minutes) spent sleeping in the prone position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Prone Sleep Time - PB2-4	The time (in minutes) spent sleeping in the prone position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Prone Sleep Time - PB2-5	The time (in minutes) spent sleeping in the prone position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - Control	The time (in minutes) spent sleeping in the left pelvic tilt position with Ajuvia in passive mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - PB2-1	The time (in minutes) spent sleeping in the left pelvic tilt position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - PB2-2	The time (in minutes) spent sleeping in the left pelvic tilt position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - PB2-3	The time (in minutes) spent sleeping in the left pelvic tilt position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - PB2-4	The time (in minutes) spent sleeping in the left pelvic tilt position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-tilt Sleep Time - PB2-5	The time (in minutes) spent sleeping in the left pelvic tilt position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - Control	The time (in minutes) spent sleeping in the left lateral position with Ajuvia in passive mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - PB2-1	The time (in minutes) spent sleeping in the left lateral position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - PB2-2	The time (in minutes) spent sleeping in the left lateral position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - PB2-3	The time (in minutes) spent sleeping in the left lateral position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - PB2-4	The time (in minutes) spent sleeping in the left lateral position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Left-lateral Sleep Time - PB2-5	The time (in minutes) spent sleeping in the left-lateral position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - Control	The time (in minutes) spent sleeping in the right pelvic tilt position with Ajuvia in passive mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - PB2-1	The time (in minutes) spent sleeping in the right pelvic tilt position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - PB2-2	The time (in minutes) spent sleeping in the right pelvic tilt position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - PB2-3	The time (in minutes) spent sleeping in the right pelvic tilt position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - PB2-4	The time (in minutes) spent sleeping in the right pelvic tilt position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-tilt Sleep Time - PB2-5	The time (in minutes) spent sleeping in the right pelvic tilt position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - Control	The time (in minutes) spent sleeping in the right lateral position with Ajuvia in passive mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - PB2-1	The time (in minutes) spent sleeping in the right lateral position with PB2-1 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - PB2-2	The time (in minutes) spent sleeping in the right lateral position with PB2-2 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - PB2-3	The time (in minutes) spent sleeping in the right lateral position with PB2-3 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - PB2-4	The time (in minutes) spent sleeping in the right lateral position with PB2-4 and Ajuvia in passive mode	1 night (approximately 8 hours)
Right-lateral Sleep Time - PB2-5	The time (in minutes) spent sleeping in the right lateral position with PB2-5 and Ajuvia in active mode	1 night (approximately 8 hours)

Collaborators and Investigators

• Sponsor: Shiphrah Biomedical Inc.
• Collaborators: University of South Australia
• Investigators: Principal Investigator: Jane Warland, PhD, University of South Australia

Publications and helpful links

General Publications

• Owusu JT, Anderson FJ, Coleman J, Oppong S, Seffah JD, Aikins A, O'Brien LM. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women. Int J Gynaecol Obstet. 2013 Jun;121(3):261-5. doi: 10.1016/j.ijgo.2013.01.013. Epub 2013 Mar 15.
• Stacey T, Thompson JM, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LM. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ. 2011 Jun 14;342:d3403. doi: 10.1136/bmj.d3403.
• Gordon A, Raynes-Greenow C, Bond D, Morris J, Rawlinson W, Jeffery H. Sleep position, fetal growth restriction, and late-pregnancy stillbirth: the Sydney stillbirth study. Obstet Gynecol. 2015 Feb;125(2):347-355. doi: 10.1097/AOG.0000000000000627.
• Platts J, Mitchell EA, Stacey T, Martin BL, Roberts D, McCowan L, Heazell AE. The Midland and North of England Stillbirth Study (MiNESS). BMC Pregnancy Childbirth. 2014 May 21;14:171. doi: 10.1186/1471-2393-14-171.
• Warland J, Mitchell EA. A triple risk model for unexplained late stillbirth. BMC Pregnancy Childbirth. 2014 Apr 14;14:142. doi: 10.1186/1471-2393-14-142.
• O'Brien LM, Warland J. Typical sleep positions in pregnant women. Early Hum Dev. 2014 Jun;90(6):315-7. doi: 10.1016/j.earlhumdev.2014.03.001. Epub 2014 Mar 21.
• Kember AJ, Scott HM, O'Brien LM, Borazjani A, Butler MB, Wells JH, Isaac A, Chu K, Coleman J, Morrison DL. Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial. BMJ Open. 2018 Aug 29;8(8):e020256. doi: 10.1136/bmjopen-2017-020256.
• Coleman J, Okere M, Seffah J, Kember A, O'Brien LM, Borazjani A, Butler M, Wells J, MacRitchie S, Isaac A, Chu K, Scott H. The Ghana PrenaBelt trial: a double-blind, sham-controlled, randomised clinical trial to evaluate the effect of maternal positional therapy during third-trimester sleep on birth weight. BMJ Open. 2019 May 1;9(4):e022981. doi: 10.1136/bmjopen-2018-022981.
• Cronin RS, Li M, Thompson JMD, Gordon A, Raynes-Greenow CH, Heazell AEP, Stacey T, Culling VM, Bowring V, Anderson NH, O'Brien LM, Mitchell EA, Askie LM, McCowan LME. An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. EClinicalMedicine. 2019 Apr 2;10:49-57. doi: 10.1016/j.eclinm.2019.03.014. eCollection 2019 Apr.
• O'Brien LM, Warland J, Stacey T, Heazell AEP, Mitchell EA; STARS Consortium. Maternal sleep practices and stillbirth: Findings from an international case-control study. Birth. 2019 Jun;46(2):344-354. doi: 10.1111/birt.12416. Epub 2019 Jan 18.
• Anderson NH, Gordon A, Li M, Cronin RS, Thompson JMD, Raynes-Greenow CH, Heazell AEP, Stacey T, Culling VM, Wilson J, Askie LM, Mitchell EA, McCowan LME. Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight: A Secondary Analysis of an Individual Participant Data Meta-analysis. JAMA Netw Open. 2019 Oct 2;2(10):e1912614. doi: 10.1001/jamanetworkopen.2019.12614.
• Warland J, Dorrian J, Morrison JL, O'Brien LM. Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis. Sleep Med Rev. 2018 Oct;41:197-219. doi: 10.1016/j.smrv.2018.03.004. Epub 2018 Mar 27.
• Warland J, Dorrian J, Kember AJ, Phillips C, Borazjani A, Morrison JL, O'Brien LM. Modifying Maternal Sleep Position in Late Pregnancy Through Positional Therapy: A Feasibility Study. J Clin Sleep Med. 2018 Aug 15;14(8):1387-1397. doi: 10.5664/jcsm.7280.
• McCowan LME, Thompson JMD, Cronin RS, Li M, Stacey T, Stone PR, Lawton BA, Ekeroma AJ, Mitchell EA. Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PLoS One. 2017 Jun 13;12(6):e0179396. doi: 10.1371/journal.pone.0179396. eCollection 2017.

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2020
• Primary Completion (Actual): June 10, 2021
• Study Completion (Actual): June 15, 2021

Study Registration Dates

• First Submitted: June 16, 2020
• First Submitted That Met QC Criteria: June 16, 2020
• First Posted (Actual): June 18, 2020

Study Record Updates

• Last Update Posted (Actual): September 2, 2021
• Last Update Submitted That Met QC Criteria: August 27, 2021
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Keywords: Pregnancy; Sleep; Maternal
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Respiratory Tract Diseases; Apnea; Respiration Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Signs and Symptoms, Respiratory; Fetal Diseases; Death; Growth Disorders; Fetal Death; Sleep Apnea Syndromes; Body Weight; Birth Weight; Fetal Growth Retardation; Hypoxia; Pregnancy Complications; Stillbirth; Fetal Hypoxia
• Other Study ID Numbers: 202902

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No