NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Maternal sleep position during pregnancy
Review question
Is there an association between sleep position on going to sleep and stillbirth or having a small for gestational age baby?
Introduction
It is possible that sleep position may affect the likelihood of stillbirth or having a small for gestational age (SGA) baby. If there is an effect of sleep position, it is important for women to be made aware of this association so that they can try and modify their sleeping position accordingly. It is also important to clarify which sleeping positions are not associated with worse outcomes to reduce unnecessary sleep pattern restriction, worry and anxiety for women. The aim of this review is to determine what the associations are between maternal sleeping positions and stillbirth or SGA.
Summary of the protocol
Please see Table 1 for a summary of the Population, Intervention, Comparison, Outcomes, Timing and Setting (PICOTS) characteristics of this review.
Table 1
Summary of the protocol (PRO table).
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual 2014. Methods specific to this review question are described in the review protocol in appendix A.
In the first iteration of this evidence review, only primary evidence was identified and fully extracted. Between the first iteration and the update of this evidence review, two individual patient data (IPD) meta-analyses were published and identified. This report includes both the IPD meta-analysed outcomes and the original primary study outcomes, which were not meta-analysed at a study level.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Clinical evidence
Included studies
One systematic review and meta-analysis of individual patient data (IPD) (Cronin 2019) including data from 5 case control studies (Gordon 2015, Heazell 2018, McCowan 2017, O’Brien 2019, Stacey 2011) reporting on the association between sleep position and stillbirth was included in this report.
One of the included primary studies was a phase 1 investigation whose aim was to identify modifiable risk factors for late-pregnancy stillbirth (Gordon 2015), whilst the remaining 4 studies were phase 2 investigations that examined whether specific going-to-sleep positions were associated with stillbirth. One study defined late stillbirth as fetal death after and including 32 weeks gestation (Gordon 2015), whilst the remaining 4 studies defined it as fetal death after and including 28 weeks gestation. One study was retrospective (O’Brien 2019), whilst the remaining studies were prospective. Four of the studies were multicentre studies, two of which were conducted in New Zealand (McCowan 2017, Stacey 2011), one in Australia (Gordon 2015), and one in the UK (Heazell 2018), whilst one study was an international online-based study (O’Brien 2019). All the studies used left lateral going-to-sleep position as the control arm to compare against the odds of stillbirth with other sleeping positions. Data on going-to-sleep position was reported relative to the participants’ recollection of their going-to-sleep position on the last month (Gordon 2015), last night (Heazell 2018, Stacey 2011), and last night and last week (McCowan 2017, O’Brien 2019). One of the studies (McCowan 2017) only reported data according to whether late stillbirth occurred pre-term (between 28 and 36 weeks gestation) or term (greater and including 37 weeks gestation), whilst the remaining four studies reported data for still birth regardless of term status.
Linked to the analysis reported in Cronin 2019, a secondary analysis (Anderson 2019) used IPD from 4 of the included studies (Heazell 2018, Stacey 2011, McCowan 2017, Gordon 2015) and explored the association between the position in which pregnant women went to sleep and infant birth weight.
The included studies are summarised in Table 2 and Table 3. See also the literature search strategy in appendix B and the study selection flow chart in appendix C.
Excluded studies
Studies not included in this review and reasons for their exclusions are provided in appendix K.
Summary of clinical studies included in the evidence review
A summary of the studies that were included in this review is presented in Table 2 and Table 3.
Table 2
Characteristics of included studies for the association between maternal sleep position and stillbirth.
Table 3
Characteristics of included studies for the association between maternal sleep position and small for gestational age.
See the full evidence tables in appendix D.
Quality assessment of studies included in the evidence review
See the evidence profiles in appendix F.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
A single economic search was undertaken for all topics included in the scope of this guideline. See supplementary material 2 for details.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of studies included in the economic evidence review
No economic studies were identified which were applicable to this review question.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.
Clinical evidence statements
Individual patient data meta-analysis results
Association between going-to-sleep position (last available position, within last 2 weeks) and stillbirth in comparison to left lateral going-to-sleep position
- High quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found an important association between supine going-to-sleep position and stillbirth: aOR 2.63 (95% CI 1.72 to 4.04).
- Low quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found no important association between right sided going-to-sleep position and stillbirth: aOR 1.04 (95% CI 0.83 to 1.31).
- Very low quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found no important association between prone going-to-sleep position and stillbirth: aOR 0.63 (95% CI 0.12 to 3.25).
- Very low quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found no important association between variable side going-to-sleep position and stillbirth: aOR 0.97 (95% CI 0.70 to 1.35).
- Very low quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found no important association between propped up going-to-sleep position and stillbirth: aOR 1.30 (95% CI 0.68 to 2.49).
- Moderate quality evidence from an IPD meta-analysis of 5 case control studies (N=3108) found an important association between not remembering going-to-sleep position and stillbirth: aOR 2.26 (95% CI 1.48 to 3.46).
Association between going-to-sleep position (last available position, within last 2 weeks) and small for gestational age in comparison to left lateral going-to-sleep position
- High quality evidence from an IPD meta-analysis of 4 case control studies (N=1760) found an important association between supine going-to-sleep position and babies being born small for gestational age: aOR 3.23 (95% CI 1.37 to 7.59).
- Very low quality evidence from an IPD meta-analysis of 4 case control studies (N=1760) found no important association between right sided going-to-sleep position and babies being born small for gestational age: aOR 1.05 (95% CI 0.58 to 1.90).
- Very low quality evidence from an IPD meta-analysis of 4 case control studies (N=1760) found no important association between other going-to-sleep position and babies being born small for gestational age: aOR 1.14 (95% CI 0.62 to 2.09).
Primary study results
Association between going-to-sleep position on last night and stillbirth in comparison to left lateral going-to-sleep position on last night
- Very low quality evidence from 1 phase 2 prospective population-based case-control study (N=1024) examined whether there was an association between prone going-to-sleep position on last night and stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 1.01 (95%CI 0.13 to 7.81)
- Very low quality evidence from 3 phase 2 case-control studies (N=2122) - 2 non-nested prospective population-based studies and 1 retrospective nested study in an online cohort of known size - examined whether there was an association between right-lateral going-to-sleep position on last night and stillbirth compared to left lateral going-to-sleep position on last night. However, none of the 3 studies found any such association: aOR 0.67 (95%CI 0.44 to 1.02); aOR 1.11 (95%CI 0.70 to 1.77); aOR 1.74 (95%CI 0.98 to 3.01)
- Very low quality evidence from 2 phase 2 case-control studies - 1 non-nested prospective population-based study and 1 retrospective nested study in an online cohort of known size (N=1657) - examined whether there was an association between sitting/propped going-to-sleep position on last night and stillbirth compared to left lateral going-to-sleep position on last night. However, none of the studies found any such association: aOR 0.44 (95%CI 0.13 to 1.49); aOR 0.71(95%CI 0.22 to 2.30).
- Very low quality evidence from 3 phase 2 case-control studies (N=2122) - 2 non-nested prospective population-based studies and 1 retrospective nested study in an online cohort of known size - examined whether there was an association between supine going-to-sleep position on last night and stillbirth compared to left lateral going-to-sleep position on last night. Two studies found that supine going-to-sleep position was associated with an increase in stillbirth compared to left lateral going-to-sleep position (aOR 2.31 [95%CI 1.04 to 5.11]; aOR 2.54 [95%CI 1.04 to 6.18]) whereas no association was found in another study: aOR 1.05 (95%CI 0.32 to 3.50). However this latter study, which was powered to detect an association between supine going-to-sleep position and stillbirth assuming a 20% exposure frequency, reported an exposure frequency of only 2.3%.
- Very low quality evidence from 2 phase 2 case-control studies - 1 non-nested prospective population-based study and 1 retrospective nested study in an online cohort of known size (N=1657) - examined whether there was an association between variable-lateral going-to-sleep position on last night and stillbirth compared to left lateral going-to-sleep position on last night. However, none of the studies found any such association: aOR 0.93 (95%CI 0.51 to 1.69); aOR 0.75 (95%CI 0.34 to 1.64).
Association between going-to-sleep position on last month of pregnancy and late stillbirth in comparison to left lateral going-to-sleep position
- Very low quality evidence from 2 phase 2 case-control studies (N=928) - 1 non-nested prospective population-based study and 1 retrospective nested study in an online cohort of known size - examined whether there was an association between right-lateral going-to-sleep position on last month and stillbirth compared to left lateral going-to-sleep position on last month. However, none of the studies found any such association: aOR 1.1 (95%CI 0.43 to 2.6); aOR 1.14 (95%CI 0.70 to 1.85).
- Very low quality evidence from 1 phase 2 case control study – a retrospective nested study in an online cohort of known size (N=633) - examined whether there was an association between sitting/propped going-to-sleep position on last month and stillbirth compared to left lateral going-to-sleep position on last month. However, no association was found in this study: aOR 1.20 (95%CI 0.39 to 3.68).
- Very low quality evidence from 2 case-control studies in (N=928) - 1 phase 1 non-nested prospective population-based study and 1 phase 2 retrospective nested study in an online cohort of known size - examined whether there was an association between supine going-to-sleep position on last month and stillbirth compared to left lateral going-to-sleep position on last month. One study found that supine going-to-sleep position was associated with an increase in stillbirth compared to left lateral going-to-sleep position: aOR 6.26 (95%CI 1.2 to 34.00) whereas no association was found in another study: aOR 0.37 (95%CI 0.04 to 3.12).
- Very low quality evidence from 1 phase 2 retrospective nested case control study in an online cohort of known size (N=633) examined whether there was an association between variable-lateral going-to-sleep position on last month and stillbirth compared to left lateral going-to-sleep position on last month. However, no association was found in this study: aOR 0.87 (95%CI 0.48 to 1.55).
Association between going-to-sleep position on last night or last week of pregnancy and pre-term stillbirth (28 to 36 weeks gestation) in comparison to left lateral going-to-sleep position on last night or last week
Going-to-sleep position on last night
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between restless going-to-sleep position on last night and preterm stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 3.50 (95%CI 0.61 to 19.97).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between right-lateral going-to-sleep position on last night and preterm stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 0.96 (95%CI 0.48 to 1.94).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between sitting/propped going-to-sleep position on last night and preterm stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 4.37 (95%CI 0.11 to 178.86).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between supine going-to-sleep position on last night and preterm stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 2.25 (95%CI 0.65 to 7.84).
Going-to-sleep position on last week
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between prone going-to-sleep position on last week and preterm stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 10.71 (95%CI 0.43 to 268.28).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between right-lateral going-to-sleep position on last week and preterm stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 0.73 (95%CI 0.34 to 1.54).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between sitting/propped going-to-sleep position on last week and preterm stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 4.01 (95%CI 0.08 to 210.43).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between supine going-to-sleep position on last week and preterm stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 2.25 (95%CI 0.65 to 7.84).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between variable-lateral going-to-sleep position on last week and preterm stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 0.63 (95%CI 0.18 to 2.19).
Association between going-to-sleep position on last night or last week of pregnancy and term stillbirth (≥37 weeks gestation) in comparison to left going-to-sleep position on last night or last week
Going-to-sleep position on last night
- Very low quality evidence from 1 prospective phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between restless going-to-sleep position on last night and term stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 2.0 (95%CI 0.64, 6.21).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between right-lateral going-to-sleep position on last night and term stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 0.98 (95%CI 0.48 to 1.99).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between sitting/propped going-to-sleep position on last night and term stillbirth compared to left lateral going-to-sleep position on last night. However, no association was found in this study: aOR 1.02 (95%CI 0.17 to 5.97).
- Low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between supine going-to-sleep position on last night and term stillbirth compared to left lateral going-to-sleep position on last night. The study found that supine going-to-sleep position was associated with an increase in stillbirth compared to left lateral going-to-sleep position: aOR 10.26 (95%CI 3.01 to 35.04).
Going-to-sleep position on last week
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between right-lateral going-to-sleep position on last week and term stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 0.95 (95%CI 0.48 to 1.89).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between sitting/propped going-to-sleep position on last week and term stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 2.64 (95%CI 0.47 to 14.81).
- Low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between supine going-to-sleep position on last week and term stillbirth compared to left lateral going-to-sleep position on last week. The study found that supine going-to-sleep position was associated with an increase in stillbirth compared to left lateral going-to-sleep position: aOR 12.73 (95%CI 2.92 to 55.46).
- Very low quality evidence from 1 phase 2 non-nested prospective population-based case-control study (N=733) examined whether there was an association between variable-lateral going-to-sleep position on last week and term stillbirth compared to left lateral going-to-sleep position on last week. However, no association was found in this study: aOR 1.11 (95%CI 0.49 to 3.01).
The committee’s discussion of the evidence
Interpreting the evidence
The quality of the evidence
The quality of each primary study was appraised using the QUIPS checklist. The main reasons for downgrading the quality of studies were recall bias due to the time delay between recruitment and interview, and selection bias due to limited participation from all the eligible women. The overall quality of evidence for each outcome was assessed using a modified GRADE framework for prognostic reviews and ranged from very low to low. Although a phase 3 prospective cohort study is the best study design to establish the causal relationship between a prognostic factor and an outcome, the frequency of stillbirth is low and such a study is therefore not practically feasible to conduct. Therefore, no restrictions were initially placed on the appropriate types of study considered for this review with phase 1 and 2 studies initially rated as providing a moderate and high quality of evidence, respectively. The main reasons for downgrading the overall evidence for all sleep positions was risk of bias associated with each of the contributing studies (recall bias, selection bias), inconsistency (variation in effect estimates across studies), indirectness (sample not clearly representative of target population), imprecision (effect estimate has wide 95% confidence intervals) and publication bias (due to the small number of early phase studies reporting outcomes).
The IPD meta-analysis quality was appraised using the ROBIS checklist and both IPD meta-analyses were at low risk of bias. The individual outcomes within the IPD meta-analyses ranged in quality rating from high (for example supine sleeping position and its association with stillbirth) to very low. The IPD meta-analyses outcomes were typically downgraded due to imprecision in their estimates and publication bias (due to the small number of early phase primary studies reporting outcomes).
Benefits and harms
Overall, the evidence suggests that there may be an increased risk of stillbirth after 28+0 weeks and babies being born small for gestational age (SGA) associated with going to sleep on one’s back (in other words in the supine position) compared to going to sleep on one’s left-hand side – in both the primary studies and the IPD meta-analysis. The best estimate, from the IPD meta-analysis was that sleeping in a supine position approximately doubled the odds of stillbirth and trebled the odds of babies being born SGA.
While the quality of the evidence from the primary studies ranged depending on the timing and precise outcomes considered, the quality of the evidence from the IPD, particularly for the evidence around supine sleeping position, was relatively high. The evidence still may not be considered to be definitive evidence of causality between going to sleep position and stillbirth or SGA as the IPD meta-analysis does not overcome issues with the study design of the primary studies. However the committee agreed it was of sufficient quality to advise women to try to avoid going to sleep on their back after 28 weeks and inform women of the likely link with stillbirth, alongside a caveat that the evidence is uncertain. The committee chose to specifically highlight stillbirth as this is a more concerning outcome than babies being born SGA and they agreed that including SGA in the recommendations made the advice less clear.
The evidence also suggests that the risk of going to sleep in any other position is the same as that of going to sleep on one’s left side (that is, there is not an increased likelihood of stillbirth associated with any other going-to-sleep position). The committee agreed that, as there has been some concern that there is such an association, it was important to highlight that the evidence does not support the view that there is an increased likelihood of stillbirth associated with going to sleep on one’s right side irrespective of the time of reporting compared to going to sleep on one’s left side. However the evidence for other sleep positions was generally an absence of definitive association (with serious imprecision) as opposed to definitive evidence of no association, therefore the committee did not include this information in the recommendations.
The committee discussed that the studies looked at the association between going to sleep position and outcomes because due to the nature of the observational studies relying on women’s recall, it would not be possible to study the association between the woman’s sleeping position and outcomes. However, the going to sleep position should be considered a proxy for sleeping position. Sleeping position is perhaps best controlled by controlling the going to sleep position. In addition, pillows or other props could be used to aid that the position stays when sleeping. This review did not assess the effectiveness of any interventions to modify sleeping position but in the committee agreed, based on their knowledge and experience, to recommend advising women to consider using for example pillows so that they can maintain their position when sleeping.
The committee noted that there may be a psychological impact of informing pregnant women of the potential link between sleeping on one’s back and stillbirth or SGA and did not want to cause undue anxiety. The committee also noted the relatively low incidence of stillbirth (1 in every 244 births in the UK according to 2018 Office for National Statistics [ONS] data).
However on balance they agreed that the evidence was strong enough that women should be advised about the risk.
Cost effectiveness and resource use
No economic studies were identified which were applicable to this review question.
Professional time advising women on healthy behaviours is already current practice. Therefore, the recommendations to advise women on sleeping position, and the possible link between sleep position and adverse outcomes is unlikely to require any increase in clinician time. In turn, advising women against sleeping on their backs after 28 weeks of pregnancy may reduce adverse outcomes such as stillbirth and small for gestational age reducing future healthcare costs.
References
Anderson 2019
Anderson, N.H., Gordon, A., Li, M., CroninRS, Thompson, J.M.D., Raynes-Greenow, C.H., Heazell, A.E.P., Stacey, T., Culling, V.M., Wilson, J., Askie, L.M., Mitchell, E.A., McCowan, L.M.E.. 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 Network Open2019; 2(10):e1912614 [PMC free article: PMC6777255] [PubMed: 31577362]Cronin 2019
CroninRS, Li, M., Thompson, J.M.D., Gordon, A., Raynes-Greenow, C.H., Heazell, A.E.P., Stacey, T., Culling, V.M., Bowring, V.Anderson, N.H., O’Brien, L.M., Mitchell, E.A., Askie, L.M., McCowan, L.M.E.. An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. EClinical Medicine2019; 10:49–57. [PMC free article: PMC6543252] [PubMed: 31193832]Gordon 2015
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, Obstetrics and Gynecology, 125, 347–355, 2015. [PubMed: 25568999]Heazell 2018
Heazell, A. E. P., Li, M., Budd, J., Thompson, J. M. D., Stacey, T., Cronin, R. S., Martin, B., Roberts, D., Mitchell, E. A., McCowan, L. M. E.Association between maternal sleep practices and late stillbirth - findings from a stillbirth case-control study, BJOG: An International Journal of Obstetrics and Gynaecology, 125, 254–262, 2018. [PMC free article: PMC5765411] [PubMed: 29152887]McCowan 2017
McCowan, L. M. E., Thompson, J. M. D., Cronin, R. S., Li, M., Stacey, T., Stone, P. R., Lawton, B. A., Ekeroma, A. J., Mitchell, E. A.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, 12 (6): e0179396, 2017. [PMC free article: PMC5469491] [PubMed: 28609468]O’Brien 2019
O’Brien, L. M., Warland, J, Stacey, T, Heazell, A. E. P., Mitchell, E. A.Maternal sleep practices and stillbirth: Findings from an international case-control study, Issues in Perinatal care, 1–11, 2019.Stacey 2011
Stacey, T., Thompson, J. M. D., Mitchell, E. A., Ekeroma, A. J., Zuccollo, J. M., McCowan, L. M. E.Association between maternal sleep practices and risk of late stillbirth: A case-control study, BMJ, 342: d3403, 2011. [PMC free article: PMC3114953] [PubMed: 21673002]
Appendices
Appendix A. Review protocols
Appendix B. Literature search strategies
Appendix C. Clinical evidence study selection
Appendix D. Clinical evidence tables
Appendix E. Forest plots
Forest plots for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
No meta-analyses were performed and therefore no forest plots are presented.
Appendix F. GRADE tables
Appendix G. Economic evidence study selection
Economic evidence study selection for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
A single economic search was undertaken for all topics included in the scope of this guideline. No economic studies were identified which were applicable to this review question. See supplementary material 2 for details.
Appendix H. Economic evidence tables
Economic evidence tables for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
No economic evidence was identified which was applicable to this review question.
Appendix I. Health economic evidence profiles
Economic evidence profiles for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
No evidence was identified which was applicable to this review question.
Appendix J. Health economic analysis
Economic analysis for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded studies for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
Clinical studies
Table 13Excluded studies
Study | Reason for exclusion |
---|---|
Bei, B., Neemia, D., Shen, L., Fulgoni, C., Blumfield, M. L., Drummond, S. P., Newman, L. K., Manber, R., A brief, automated cognitive behavioral program prevents sleep disturbance and insomnia in late pregnancy: A randomized controlled trial, Sleep, 41 (Supplement 1), A151, 2018 | Conference abstract |
Cronin, R. S., Chelimo, C., Mitchell, E. A., Okesene-Gafa, K., Thompson, J. M. D., Taylor, R. S., Hutchison, B. L., McCowan, L. M. E., Survey of maternal sleep practices in late pregnancy in a multi-ethnic sample in South Auckland, New Zealand, BMC pregnancy and childbirth, 17 (1) (no pagination), 2017 [PMC free article: PMC5474014] [PubMed: 28623890] | No relevant outcomes reported |
Cronin, R. S., Li, M., Thompson, J. M. D., Gordon, A., Raynes-Greenow, C., Heazell, A. E. P., Stacey, T., Culling, V., Bowring, V., Askie, L., Mitchell, E. A., McCowan, L. M. E., An individual participant data meta-analysis of going-to-sleep position, interactions with fetal vulnerability and the risk of late stillbirth, Journal of Paediatrics and Child Health, 54 (Supplement 1), 3, 2018 [PMC free article: PMC6543252] [PubMed: 31193832] | Conference abstract |
Gaudet, L., Simon, A., Pratt, M., Heslehurst, N., Hayes, L., Flynn, A., Velez, M. P., Smith, G., Skidmore, B., Hutton, B., Rybak, N., Walker, M., Predictors of adverse pregnancy outcomes in obese pregnant women a systematic review, International Journal of Gynecology and Obstetrics, 143 (Supplement 3), 600–601, 2018 | Conference abstract |
Heazell, A. E. P., Cronin, R. S., Li, M., Thompson, J. M. D., Gordon, A., Raynes-Greenow, C., Stacey, T., Culling, V., Bowring, V., Askie, L., Mitchell, E. A., McCowan, L. M. E., Going to sleep position and risk of late stillbirth: A systematic review and metaanalysis, Journal of Paediatrics and Child Health, 54 (Supplement 1), 24–25, 2018 | Conference abstract |
Heazell, A. E. P., Li, M., Thompson, J. M. D., Budd, J., Cronin, R., Mitchell, E., Stacey, T., Roberts, D., Martin, B., McCowan, L. M. E., Going to sleep supine and reduced sleep duration are risk factors for late stillbirth: Findings from the MiNESS Case-Control Study, BMC Pregnancy and Childbirth. Conference: International Stillbirth Alliance Conference, 17, 2017 | Conference abstract |
Hsu, Christine, Sleep Positions Can Predict Women’s Risk of Stillbirth, Inside Childbirth Education, 9–9, 2013 | Newsletter |
Kempler, L., Sharpe, L., Bartlett, D., Sleep education during pregnancy for new mothers, BMC Pregnancy & Childbirth, 12, 155, 2012 [PMC free article: PMC3546917] [PubMed: 23244163] | Protocol |
Kichler, A., Alzubaidi, M., Emery, J., Gabbard, S., Use of a positional therapy device significantly improves nocturnal gastroesophageal reflux disease symptoms in pregnant women, American Journal of Gastroenterology, 1), S703–S704, 2015 | Conference abstract |
Koken, G. N., Kanat-Pektas, M., Kose, S. K., Arioz, D. T., Yilmazer, M., Maternal blood pressure and dominant sleeping position may affect placental localization, Journal of Maternal-Fetal and Neonatal Medicine, 27, 1564–1567, 2014 [PubMed: 24283300] | No relevant outcomes |
Lakshmi, Sujatha Thankappanet al. , Risk factors for still birth: a hospital based case control study, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6, 970–974, 2017 | Incorrect comparison (non-left vs left) |
Lee,K.A., Gay,C.L., Sleep in late pregnancy predicts length of labor and type of delivery, American Journal of Obstetrics and Gynecology, 191, 2041–2046, 2004 [PubMed: 15592289] | No relevant outcomes |
Li, M., McCowan, L. M. E., Thompson, J. M. D., Cronin, R. S., Anderson, N., Stacey, T., Stone, P., Lawton, B. A., Ekeroma, A. J., Mitchell, E. A., Supine going-to-sleep position is a major risk factor for term stillbirth: Findings from the New Zealand multicentre stillbirth case-control study, BMC Pregnancy and Childbirth. Conference: International Stillbirth Alliance Conference, 17, 2017 | Conference abstract |
Li, M., Mitchell, E. A., Cronin, R. S., Thompson, J. M. D., Gordon, A., Raynes-Greenow, C., Heazell, A. E. P., Stacey, T., Culling, V., Bowring, V., Askie, L., McCowan, L. M. E., Environmental tobacco smoke exposure is associated with increased late stillbirth: Findings from the collaborative individual participant data (IPD) sleep and stillbirth (CRIBSS) meta-analysis, Journal of Paediatrics and Child Health, 54 (Supplement 1), 31, 2018 | Conference abstract |
Li, M., Thompson, J. M. D., Cronin, R. S., Gordon, A., Raynes-Greenow, C., Heazell, A. E. P., Stacey, T., Culling, V., Bowring, V., Mitchell, E. A., McCowan, L. M. E., Askie, L., The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol, BMJ open, 8, e020323, 2018 [PMC free article: PMC5898330] [PubMed: 29643161] | Protocol |
Li, R., Zhang, J., Zhou, R., Liu, J., Dai, Z., Liu, D., Wang, Y., Zhang, H., Li, Y., Zeng, G., Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth, Journal of maternal-fetal & neonatal medicine, 30, 733–738, 2017 [PubMed: 27125889] | Sleep position not examined in study |
Lillis, T. A., Hamilton, N. A., Pressman, S. D., Khou, C. S., The Association of Daytime Maternal Napping and Exercise With Nighttime Sleep in First-Time Mothers Between 3 and 6 Months Postpartum, Behavioral sleep medicine, 16, 527–541, 2018 [PubMed: 28632088] | Sleep position not examined in study |
McCowan, L., Contribution of maternal going-to-sleep position and fetal movements to late stillbirth, Australian and New Zealand Journal of Obstetrics and Gynaecology, 57 (Supplement 1), 19–20, 2017 | Conference abstract |
McCowan, Lesley M. E., Cronin, Robin S., Gordon, Adrienne, O’Brien, Louise, Heazell, Alexander E. P., Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes, Obstetrics & Gynecology, 135, 218–218, 2020 [PubMed: 31856106] | Commentary |
McIntyre, J. P. R., Ingham, C. M., Hutchinson, B. L., Thompson, J. M. D., McCowan, L. M., Stone, P. R., Veale, A. G., Cronin, R., Stewart, A. W., Ellyett, K. M., Mitchell, E. A., A description of sleep behaviour in healthy late pregnancy, and the accuracy of self-reports, BMC Pregnancy and Childbirth, 16 (1) (no pagination), 2016 [PMC free article: PMC4870756] [PubMed: 27194093] | Non-comparative study |
McIntyre, J. P. R., Stone, P. R., Mitchell, E. M., Veale, A. G., How healthy women sleep in late pregnancy; A video and portable polysomnography study, Sleep and Biological Rhythms, 11, 44, 2013 | Conference abstract |
Morokuma, S., Shimokawa, M., Kato, K., Sanefuji, M., Shibata, E., Tsuji, M., Senju, A., Kawamoto, T., Kusuhara, K., Maternal sleep and small for gestational age infants in the Japan Environment and Children’s Study: a cohort study, BMC research notes, 10, 394, 2017 [PMC free article: PMC5553583] [PubMed: 28800769] | Sleep position not examined in study |
O’Brien, Louise M., Warland, Jane, Typical sleep positions in pregnant women, Early Human Development, 90, 315–317, 2014 [PMC free article: PMC4005859] [PubMed: 24661447] | Non-comparative study |
Owusu, Jocelynn T., Anderson, Frank J., Coleman, Jerry, Oppong, Samuel, Seffah, Joseph D., Aikins, Alfred, O’Brien, Louise M., Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women, International Journal of Gynecology & Obstetrics, 121, 261–265, 2013 [PMC free article: PMC3662549] [PubMed: 23507553] | Cross-sectional study |
Paine, S. J., Signal, T. L., Sweeney, B., Priston, M., Muller, D., Smith, A. A., Huthwaite, M., Lee, K., Gander, P. H., Ethnic differences in sleep across pregnancy: A cohort study, Sleep and Biological Rhythms, 2), 63, 2013 | Conference abstract |
Robertson, N., Okano, S., Kumar, S., Sleep in the supine position during pregnancy is associated with fetal cerebral redistribution, Journal of Clinical Medicine, 9, 1–12, 2020 [PMC free article: PMC7356729] [PubMed: 32517385] | Insufficient adjustment for confounders, insufficient detail on outcomes |
Saarenpaa-Heikkila, O., Lehto, U., Kylliainen, A., Stenberg, T., Paunio, T., Paavonen, J., CHILD SLEEP-The finnish birth cohort study: The effect of maternal sleep during pregnancy on a newborn wellbeing and a mother’s labor experience, Sleep Medicine, 1), e42, 2013 | Conference abstract |
Silver, Robert M. M. D., Hunter, Shannon M. S., Reddy, Uma M. M. D. M. P. H., Facco, Francesca M. D., Gibbins, Karen J. M. D., Grobman, William A. M. D. M. B. A., Mercer, Brian M. M. D., Haas, David M. M. D. M. S., Simhan, Hyagriv N. M. D., Parry, Samuel M. D., Wapner, Ronald J. M. D., Louis, Judette M. D., Chung, Judith M. M. D., Pien, Grace M. D., Schubert, Frank P. M. D., Saade, George R. M. D., Zee, Phyllis M. D., Redline, Susan M. D., Parker, Corette B.DrPH, Silver, Robert M., Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes, Obstetrics & Gynecology, 134, 667–676, 2019 [PMC free article: PMC6768734] [PubMed: 31503146] | Primary outcome was a composite adverse pregnancy outcome including stillbirth, hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension), and a small-forgestational-age (SGA) newborns |
Silver, Robert M., Reddy, Uma M., Gibbins, Karen J., Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes, Obstetrics & Gynecology, 135, 218–219, 2020 [PubMed: 31856106] | Looked at sleep position in early pregnancy |
Stacey, T., Mitchell, E. A., Sleep position and risk of late stillbirth, BMC Pregnancy and Childbirth. Conference: Stillbirth Summit, 12, 2011 | Conference presentation of included study (Stacey 2011) |
Stacey, T., Thomspon, J., Mitchell, E., McCowan, L., Maternal sleep practices: Possible risk factor for late stillbirth, Archives of Disease in Childhood: Fetal and Neonatal Edition, 1), Fa1, 2011 | Conference abstract |
Warland, J., Dorrian, J., Kember, A. J., Phillips, C., Borazjani, A., Morrison, J. L., O’Brien, L. M., Modifying maternal sleep position in late pregnancy through positional therapy: A feasibility study, Journal of clinical sleep medicine, 14, 1387–1397, 2018 [PMC free article: PMC6086963] [PubMed: 30092890] | No relevant outcomes |
Warland, J., Dorrian, J., Morrison, J. L., O’Brien, L. M., Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis, Sleep Medicine Reviews, 41, 197–219, 2018 [PubMed: 29910107] | Scoping review - references checked, no additional relevant studies (Lakshmi 2017 not included because it reported non-left vs left sleeping position) |
Warland, J., Heazell, A. E. P., Collins, J. H., Huberty, J. L., Kliman, H. J., McGregor, J. A., Mitchell, E. A., O’Brien, L. M., Parast, M., Peesay, M., Stacey, T., Wimmer, L. J., An international internet survey of the experiences of 1,714 mothers with a late stillbirth: The STARS cohort study, BMC Pregnancy and Childbirth, 15 (1) (no pagination), 2015 [PMC free article: PMC4537542] [PubMed: 26276347] | Companion article to O’Brien 2017, no relevant data |
Warland, J., Mitchell, E. A., A triple risk model for unexplained late stillbirth, BMC Pregnancy & ChildbirthBMC Pregnancy Childbirth, 14, 142, 2014 [PMC free article: PMC3991879] [PubMed: 24731396] | Description of risk model for sudden infant death syndrome |
Warland, J., Mitchell, E. A., O’Brien, L. M., Novel strategies to prevent stillbirth, Seminars In Fetal & Neonatal MedicineSemin Fetal Neonatal Med, 22, 146–152, 2017 [PubMed: 28162972] | Non-systematic review of novel strategies to prevent stillbirth |
Woods, J. R., Heazell, A. E. P., Stillbirth: is it preventable?, Obstetrics, Gynaecology and Reproductive Medicine, 28, 148–154, 2018 | Non-systematic review of stillbirth prevention strategies |
Economic studies
One excluded list was created for all economic studies in this guideline. See supplementary material 2 for further information.
Appendix L. Research recommendations
Research recommendations for review question: Is there an association between sleep position on going to sleep and still birth or having a small for gestational age baby?
No research recommendations were made for this review question.
Final
Evidence reviews underpinning recommendations 1.3.24 to 1.3.25
These evidence reviews were developed by the National Guideline Alliance, which is a part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- Sleeping patterns of Swedish women experiencing a stillbirth between 2000-2014 - an observational study.[BMC Pregnancy Childbirth. 2016]Sleeping patterns of Swedish women experiencing a stillbirth between 2000-2014 - an observational study.Rådestad I, Sormunen T, Rudenhed L, Pettersson K. BMC Pregnancy Childbirth. 2016 Jul 28; 16(1):193. Epub 2016 Jul 28.
- Women's sleep position during pregnancy in low- and middle-income countries: a systematic review.[Reprod Health. 2021]Women's sleep position during pregnancy in low- and middle-income countries: a systematic review.Rossiter SK, Aziz S, Wilson AN, Comrie-Thomson L, Stacey T, Homer CSE, Vogel JP. Reprod Health. 2021 Mar 1; 18(1):53. Epub 2021 Mar 1.
- The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol.[BMJ Open. 2018]The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol.Li M, Thompson JMD, Cronin RS, Gordon A, Raynes-Greenow C, Heazell AEP, Stacey T, Culling V, Bowring V, Mitchell EA, et al. BMJ Open. 2018 Apr 10; 8(4):e020323. Epub 2018 Apr 10.
- Review Combinations of maternal serum markers to predict preeclampsia, small for gestational age, and stillbirth: a systematic review.[J Obstet Gynaecol Can. 2012]Review Combinations of maternal serum markers to predict preeclampsia, small for gestational age, and stillbirth: a systematic review.Hui D, Okun N, Murphy K, Kingdom J, Uleryk E, Shah PS. J Obstet Gynaecol Can. 2012 Feb; 34(2):142-153.
- Review Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis.[Sleep Med Rev. 2018]Review Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis.Warland J, Dorrian J, Morrison JL, O'Brien LM. Sleep Med Rev. 2018 Oct; 41:197-219. Epub 2018 Mar 27.
- Maternal sleep position during pregnancyMaternal sleep position during pregnancy
- 9169[uid] AND (alive[prop]) (1)Gene
- SCAF11 SR-related CTD associated factor 11 [Homo sapiens]SCAF11 SR-related CTD associated factor 11 [Homo sapiens]Gene ID:9169Gene
- TSR1 AND (alive[prop]) (3482)Gene
- GPX7 AND (alive[prop]) (810)Gene
Your browsing activity is empty.
Activity recording is turned off.
See more...