Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight: A Secondary Analysis of an Individual Participant Data Meta-analysis

Abstract

Importance: Supine maternal position in the third trimester is associated with reduced uterine blood flow and increased risk of late stillbirth. As reduced uterine blood flow is also associated with fetal growth restriction, this study explored the association between the position in which pregnant women went to sleep and infant birth weight.

Objective: To examine the association between supine position when going to sleep in women after 28 weeks of pregnancy and lower birth weight and birth weight centiles.

Design, setting, and participants: Prespecified subgroup analysis using data from controls in an individual participant data meta-analysis of 4 case-control studies investigating sleep and stillbirth in New Zealand, Australia, and the United Kingdom. Participants were women with ongoing pregnancies at 28 weeks' gestation or more at interview.

Main outcomes and measures: The primary outcome was adjusted mean difference (aMD) in birth weight. Secondary outcomes were birth weight centiles (INTERGROWTH-21st and customized) and adjusted odds ratios (aORs) for birth weight less than 50th and less than 10th centile (small for gestational age) for supine vs nonsupine going-to-sleep position in the last 1 to 4 weeks, adjusted for variables known to be associated with birth size.

Results: Of 1760 women (mean [SD] age, 30.25 [5.46] years), 57 (3.2%) reported they usually went to sleep supine during the previous 1 to 4 weeks. Adjusted mean (SE) birth weight was 3410 (112) g among women who reported supine position and 3554 (98) g among women who reported nonsupine position (aMD, 144 g; 95% CI, -253 to -36 g; P = .009), representing an approximate 10-percentile reduction in adjusted mean INTERGROWTH-21st (48.5 vs 58.6; aMD, -10.1; 95% CI, -17.1 to -3.1) and customized (40.7 vs 49.7; aMD, -9.0; 95% CI, -16.6 to -1.4) centiles. There was a nonsignificant increase in birth weight at less than the 50th INTERGROWTH-21st centile (aOR, 1.90; 95% CI, 0.83-4.34) and a 2-fold increase in birth weight at less than the 50th customized centile (aOR, 2.12; 95% CI, 1.20-3.76). Going to sleep supine was associated with a 3-fold increase in small for gestational age birth weight by INTERGROWTH-21st standards (aOR, 3.23; 95% CI, 1.37-7.59) and a nonsignificant increase in small for gestational age birth weight customized standards (aOR, 1.63; 95% CI, 0.77-3.44).

Conclusions and relevance: This study found that going to sleep in a supine position in late pregnancy was independently associated with reduced birth weight and birth weight centile. This novel association is biologically plausible and likely modifiable. Public health campaigns that encourage women in the third trimester of pregnancy to settle to sleep on their side have potential to optimize birth weight.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gordon reported receiving grants from Stillbirth Foundation Australia during the conduct of the study; and support from a National Health and Medical Research Council Early Career Fellowship outside the submitted work. Dr Li reported receiving grants from Health Research Council of New Zealand, Cure Kids, Mercia Barnes Trust, Nurture Foundation, and University of Auckland Faculty Research Development Fund during the conduct of the study. Mrs Cronin reported receiving grants from Health Research Council of New Zealand, Cure Kids, Mercia Barnes Trust, Nurture Foundation, University of Auckland Faculty Research Development Fund, and the Sir John Logan Campbell Medical Trust during the conduct of the study. Dr Thompson reported receiving grants from Cure Kids, Nurture Foundation, Auckland District Health Board Charitable Trust, Health Research Council of New Zealand, Mercia Barnes Trust, Nurture Foundation, and University of Auckland Faculty Research Development Fund during the conduct of the study. Dr Raynes-Greenow reported receiving grants from Stillbirth Foundation Australia during the conduct of the study; and support from a National Health and Medical Research Council Career Development Fellowship outside the submitted work. Dr Heazell reported receiving grants from Action Medical Research during the conduct of the study; and grants from Tommy's and the National Institute for Health Research outside the submitted work. Dr Stacey reported receiving grants from Cure Kids, Nurture Foundation, Auckland District Health Board Charitable Trust, Health Research Council of New Zealand, Mercia Barnes Trust, and University of Auckland Faculty Research Development Fund during the conduct of the study. Dr McCowan reported receiving grants from Cure Kids, Nurture Foundation, Auckland District Health Board Trust, Health Research Council of New Zealand, Mercia Barnes Trust, and University of Auckland Faculty Research Development Fund during the conduct of the study. No other disclosures were reported.

Figures

Figure.. Flowchart of Study Population

The eligible population of 3108 excluded women with gestation less than 28 weeks. IPD indicates individual participant data.