Sleep Position, Fetal Growth Restriction, and Late-Pregnancy Stillbirth The Sydney Stillbirth Study

OBJECTIVE: To identify potentially modifiable risk factors for late-pregnancy stillbirth. METHODS: This was a population-based matched case-control study of pregnant women at 32 weeks of gestation or greater booked into tertiary maternity hospitals in metropolitan Sydney between January 2006 and December 2011. The case group consisted of women with singleton pregnancies with antepartum fetal death in utero. Women in the control group were matched for booking hospital and expected delivery date with women in the case group. Data collection was performed using a semistructured interview and included validated questionnaires for specific risk factors. Adjusted odds ratios (ORs) were calculated for a priori-specified risk factors using conditional logistic regression. RESULTS: There were 103 women in the case group and 192 women in the control group. Mean gestation was 36 weeks. Supine sleeping was reported by 10 of 103 (9.7%) of women who experienced late-pregnancy stillbirth and by 4 of 192 (2.1%) of women in the control group (adjusted OR 6.26, 95% confidence interval [CI] 1.2-34). Women who experienced stillbirth were more likely to: have been followed during pregnancy for suspected fetal growth restriction, 11.7% compared with 1.6% (adjusted OR 5.5, 95% CI 1.36-22.5); not be in paid work, 25.2% compared with 9.4% (adjusted OR 2.9, 95% CI 1.1-7.6); and to have not received further education beyond high school, 41.7% compared with 25.5% (adjusted OR 1.9, 95% CI 1.1-3.5). None of the deaths to women who reported supine sleeping were classified as unexplained. CONCLUSION: This study suggests that supine sleep position may be an additional risk for late-pregnancy stillbirth in an already compromised fetus. The clinical management of suspected fetal growth restriction should be investigated further as a means of reducing late stillbirth.