Sleep in the Supine Position During Pregnancy is Associated with Fetal Cerebral Redistribution

The supine sleep position in late pregnancy is a major risk factor for stillbirth, with a population attributable risk of 5.8% and one in four pregnant women reportedly sleeping in a supine position. Although the mechanisms linking the supine sleep position and late stillbirth remain unclear, there is evidence that it exacerbates pre-existing maternal sleep disordered breathing, which is another known risk factor for adverse perinatal outcomes. Given that maternal sleep position is a potentially modifiable risk factor, the aim of this study was to characterize and correlate uteroplacental and fetal hemodynamics, including cardiac function, in a cohort of women with apparently uncomplicated pregnancies with their nocturnal sleep position. This was a prospective observational cohort study at an Australian tertiary obstetric hospital. Women were asked to complete a series of questions related to their sleep position in late pregnancy after 35 weeks of completed gestation. They also underwent an ultrasound assessment where Doppler indices of various fetoplacental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. Pregnancy outcome data was extracted from the electronic hospital database for analysis. A total of 274 women were included in the final analysis. Of these, 78.1% (214/274) reported no supine sleep, and 21.9% (60/274) reported going to sleep in a supine position. The middle cerebral artery, anterior cerebral artery, and vertebral artery pulsatility indices were all significantly lower in the supine sleep cohort, as was the cerebroplacental ratio. There were no significant differences in the mode or indication for delivery or in serious neonatal outcomes, including 5-min Apgar score < 7, acidosis, and neonatal intensive care unit admission between cohorts. Women in the supine cohort were more likely to have an infant with a BW > 90th centile (p = 0.04). This data demonstrates fetal brain sparing in association with the maternal supine sleep position in a low-risk population. This data contributes to the growing body of literature attempting to elucidate the etiological pathways responsible for the association of late stillbirth with the maternal supine sleep position.

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Modification of Maternal Sleep Position to Optimise Fetal Well-being in Late Pregnancy: A Survey in a Multicultural New Zealand Region

Journal of Midwifery & Women s Health ◽

10.1111/jmwh.12689 ◽

2017 ◽

Vol 62 (5) ◽

pp. 632-632

Author(s):

Robin S. Cronin ◽

Carol Chelimo ◽

Edwin A. Mitchell ◽

Kara Okesene-Gafa ◽

John Thompson ◽

...

Keyword(s):

New Zealand ◽

Late Pregnancy ◽

Well Being ◽

Sleep Position ◽

Maternal Sleep

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Modifying Maternal Sleep Position in Late Pregnancy Through Positional Therapy: A Feasibility Study

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.7280 ◽

2018 ◽

Vol 14 (08) ◽

pp. 1387-1397 ◽

Cited By ~ 7

Author(s):

Jane Warland ◽

Jillian Dorrian ◽

Allan J. Kember ◽

Craig Phillips ◽

Ali Borazjani ◽

...

Keyword(s):

Feasibility Study ◽

Late Pregnancy ◽

Sleep Position ◽

Positional Therapy ◽

Maternal Sleep

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Factors influencing infant sleep position: decisions do not differ by SES in African-American families

Archives of Disease in Childhood ◽

10.1136/archdischild-2011-301360 ◽

2012 ◽

Vol 97 (10) ◽

pp. 900-905 ◽

Cited By ~ 11

Author(s):

David Robida ◽

Rachel Y Moon

Keyword(s):

African American ◽

Supine Position ◽

African American Families ◽

Sleep Position ◽

African American Parents ◽

Infant Sleep ◽

Infant Sleep Position ◽

Factors Influencing ◽

Supine Sleep ◽

American Families

ObjectiveTo investigate factors influencing African-American parents’ knowledge, attitudes and practice regarding infant sleep position and determine if these differ by socioeconomic status (SES).MethodsA cross-sectional sample of 412 parents with infants ≤6 months of age participated in a validated survey of knowledge, attitudes and practice.ResultsThere was no significant difference in attitudes or practice, and knowledge was similar regarding infant sleep position between African-American parents of higher and lower SES. The healthcare provider recommendation of exclusive supine sleep position use was associated with increased knowledge, overall decreased use of the side position (5.0% vs 16.8%, p<0.01) and increased occasional use of the supine position in the lower SES group (81.6% vs 68.6%, p=0.03). It was not associated with increased positive parental attitudes about the supine sleep position in either group. Neither a senior caregiver living in the home nor observation of hospital personnel placing infants in a non-supine position was associated with differences in sleep position practices in either group.ConclusionsSleep position practices in African-American families do not differ by SES. Improved attitudes toward positioning and increased use of supine positioning may result if healthcare providers address common concerns and misconceptions about sleep position.

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Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

BMJ Open ◽

10.1136/bmjopen-2020-047681 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047681

Author(s):

Robin S Cronin ◽

John M D Thompson ◽

Rennae S Taylor ◽

Jessica Wilson ◽

Karen F Falloon ◽

...

Keyword(s):

Public Health ◽

New Zealand ◽

Pregnant Women ◽

Supine Position ◽

Health Professionals ◽

Primary Outcome ◽

Late Pregnancy ◽

Sleep Position ◽

Public Health Campaign ◽

Health Campaign

IntroductionA ‘Sleep-On-Side When Baby’s Inside’ public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk factor for stillbirth from 28 weeks’ gestation. We evaluated the success of the campaign on awareness and modification of late pregnancy going-to-sleep position through nationwide surveys.Methods and analysisTwo web-based cross-sectional surveys were conducted over 12 weeks in 2019–2020 in a sample of (1) pregnant women ≥28 weeks, primary outcome of going-to-sleep position; and (2) health professionals providing pregnancy care, primary outcome of knowledge of going-to-sleep position and late stillbirth risk. Univariable logistic regression was performed to identify factors associated with supine going-to-sleep position.DiscussionThe survey of pregnant women comprised 1633 eligible participants. Going-to-sleep position last night was supine (30, 1.8%), non-supine (1597, 97.2%) and no recall (16, 1.0%). Supine position had decreased from 3.9% in our previous New Zealand-wide study (2012–2015). Most women (1412, 86.5%) had received sleep-on-side advice with no major resultant worry (1276, 90.4%). Two-thirds (918, 65.0%) had changed their going-to-sleep position based on advice, with most (611 of 918, 66.5%) reporting little difficulty. Supine position was associated with Māori (OR 5.05, 95% CI 2.10 to 12.1) and Asian-non-Indian (OR 4.20, 95% CI 1.27 to 13.90) ethnicity; single (OR 10.98, 95% CI 4.25 to 28.42) and cohabitating relationship status (OR 2.69, 95% CI 1.09 to 6.61); hospital-based maternity provider (OR 2.55, 95% CI 1.07 to 6.10); education overseas (OR 3.92, 95% CI 1.09 to 14.09) and primary-secondary level (OR 2.80, 95% CI 1.32 to 6.08); and not receiving sleep-on-side advice (OR 6.70, 95% CI 3.23 to 13.92). The majority of health professionals (709 eligible participants) reported awareness of supine going-to-sleep position and late stillbirth risk (543, 76.6%).ConclusionMost pregnant women had received and implemented sleep-on-side advice without major difficulty or concern. Some groups of women may need a tailored approach to acquisition of going-to-sleep position information.

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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 ◽

10.1371/journal.pone.0179396 ◽

2017 ◽

Vol 12 (6) ◽

pp. e0179396 ◽

Cited By ~ 42

Author(s):

Lesley M. E. McCowan ◽

John M. D. Thompson ◽

Robin S. Cronin ◽

Minglan Li ◽

Tomasina Stacey ◽

...

Keyword(s):

Risk Factor ◽

New Zealand ◽

Supine Position ◽

Case Control Study ◽

Late Pregnancy ◽

Case Control ◽

Modifiable Risk Factor ◽

Control Study

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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 ◽

10.1136/bmjopen-2017-020323 ◽

2018 ◽

Vol 8 (4) ◽

pp. e020323 ◽

Cited By ~ 2

Author(s):

Minglan Li ◽

John M D Thompson ◽

Robin S Cronin ◽

Adrienne Gordon ◽

Camille Raynes-Greenow ◽

...

Keyword(s):

Risk Factor ◽

Study Protocol ◽

Meta Analysis ◽

Sleep Position ◽

Individual Participant Data ◽

Analysis Study ◽

Maternal Sleep ◽

Individual Participant

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OP13.09: Pulsed-wave Doppler of the middle cerebral artery in fetal brain abnormalities

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.4539 ◽

2007 ◽

Vol 30 (4) ◽

pp. 499-500

Author(s):

L. R. Pistorius ◽

R. Gooskens ◽

P. H. Stoutenbeek

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Fetal Brain ◽

Brain Abnormalities ◽

Pulsed Wave Doppler

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Infant Sleep Position: Pediatricians' Advice to Parents

PEDIATRICS ◽

10.1542/peds.95.1.55 ◽

1995 ◽

Vol 95 (1) ◽

pp. 55-58

Author(s):

Bonnie B. Hudak ◽

Jane O'Donnell ◽

Nadine Mazyrka

Keyword(s):

Primary Care ◽

New York ◽

Primary Care Physicians ◽

Sleep Position ◽

Infant Sleep ◽

Sources Of Information ◽

Professional Literature ◽

Infant Sleep Position ◽

Supine Sleep ◽

Question Survey

Objective. The American Academy of Pediatrics' (AAP) recommendation for side or supine sleep position in healthy babies has generated much controversy. We surveyed primary care physicians to determine the effect of the AAP statement on physician attitude toward infant sleep position and advice to parents. Methods. We sent a 23-question survey to 194 physicians in Western New York. The survey addressed their attitude toward the AAP recommendations and its impact on their advice to parents. Results. Of the 149 physicians treating newborns, 121 (82%) completed the questionnaire; 98% were aware of the AAP statement. The most common sources of information were the AAP (86%) and professional literature (77%). Of the respondents, 79% agreed with the AAP statement. Reasons for reservation were lack of data (64%), potential adverse consequences of supine position (52%), and their own experience (47%). Gender, years in practice, and type of reimbursement did not influence attitude toward the AAP recommendation. The AAP statement increased the frequency with which physicians routinely discussed sleep position from 34 to 70% (P < .02). Physicians recommending the prone position decreased from 57 to 7% (P < .001), while those recommending supine sleep position increased from 10 to 42% (P < .001). Conclusions. Most physicians agreed with the AAP statement and more frequently discussed sleep position following the AAP recommendations. However, they did not routinely recommend supine sleep position. The majority (69%) recommended the side position even though it is unstable. Although the AAP statement has increased discussion of infant sleep position by primary care physicians in WNY, only a minority recommend that infants sleep supine.

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Abstract P341: Juvenile Exposure To Doxorubicin Differentially Alters The Cardiac Response To Angiotensin II And Isoproterenol In Adult Mice

Circulation Research ◽

10.1161/res.129.suppl_1.p341 ◽

2021 ◽

Vol 129 (Suppl_1) ◽

Author(s):

Marianne K Grant ◽

Beshay N Zordoky

Keyword(s):

Heart Failure ◽

Risk Factor ◽

Angiotensin Ii ◽

Cardiac Function ◽

Cancer Survivors ◽

Childhood Cancer ◽

Significant Risk ◽

Significant Risk Factor ◽

Childhood Cancer Survivors ◽

Cardiac Response

Hypertension is the most significant risk factor for heart failure in doxorubicin (DOX)-treated childhood cancer survivors. We previously developed a two-hit mouse model of juvenile DOX-induced latent cardiotoxicity that is exacerbated by adult-onset angiotensin II (ANGII)-induced hypertension. Nevertheless, it is still not known how juvenile exposure to DOX would predispose the heart to other cardiovascular pathologic stimuli that do not cause hypertension. The objective of this work was to compare the effects of ANGII to those of isoproterenol (ISO) in adult C57BL6/N mice pre-exposed to DOX as juveniles. Five-week-old male mice were administered a low dose of DOX (4 mg/kg/week) or saline for 3 weeks and then allowed to recover for 5 weeks. Thereafter, mice were either infused with ANGII (1.4 mg/kg/day) or injected with ISO (10 mg/kg/day) for 14 days. Juvenile exposure to DOX abrogated the hypertrophic response to both ANGII and ISO, while it failed to correct ANGII- and ISO-induced upregulation in the hypertrophic markers ANP and BNP. ANGII, but not ISO, worsened cardiac function in DOX-exposed mice as measured by echocardiography. Cardiac fibrosis was also exacerbated by ANGII, but not ISO, in DOX-exposed mice as evident by Masson’s trichrome staining and upregulation of the inflammatory and fibrotic markers, Cox-2, Col1a1, Col3a1 , and galectin-3 . In conclusion, the current work demonstrates that ANGII causes more severe deterioration in cardiac function and adverse cardiac remodeling in DOX-exposed mice when compared to ISO. The comparison between DOX/ANGII and DOX/ISO models is critical to understanding why hypertension is the most significant risk factor for heart failure in DOX-treated childhood cancer survivors and thereby devising effective therapeutic strategies against this significant clinical problem.

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