Results from the MiNESS Trial: Does Supine vs Left-Sided Sleeping Position Impact Risk of Stillbirth?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the study design used for this study 2. Recall the major findings related to sleep position and stillbirth risk
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
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Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Stillbirth rates are 1.7-8.8 per 1,000 births > 28 weeks in high-income countries with significant variation related to economic factors and population characteristics such as ethnicity and race
Variation suggests that there may be modifiable risk factors unlike age that can be altered
The Auckland Stillbirth Study and other studies demonstrated an association between a supine going-to-sleep position and late stillbirth risk
Data limited due to study size, recall bias and adjustment for confounders
Heasell et al. (BJOG, 2017) sought to determine the association between maternal sleep practices and risk of stillbirth
Prospective case-control study (2014-2016)
Midlands and North of England Stillbirth Study (MiNESS) was conducted in 41 maternity units in the UK
Cases: Women who had a stillbirth after ≥ 28 weeks’ gestation and no known congenital anomalies
Interviews were conducted as close to the time of stillbirth as possible with an aim of being completed 1–6 weeks after the birth
Controls: Women with ongoing pregnancy (2:1 ratio to cases)
Women who had a stillbirth or child with an anomaly were excluded from the analysis
Randomly given a gestational age for the interview so that there would be a similar gestational age distribution compared to the late stillbirths in that particular hospital
Going-to-sleep position was classified as left side, supine, right side, tummy, variable side, propped up, or unknown
Odds of late stillbirth associated with self-reported maternal going-to-sleep position on the night prior to stillbirth for cases and the night before the interview for controls
Sleeping position in the last 4 weeks before the stillbirth and prior to pregnancy
Duration of sleep, frequency of getting up to go to the toilet during the last night, and daytime napping in the last four weeks
291 women with a previous stillbirth and 733 with a live-born baby were interviewed
Supine going-to-sleep position the night before stillbirth had a 2.3-fold increased risk of late stillbirth (adjusted Odds Ratio [aOR] 2.31, 95% CI 1.04–5.11) compared to having gone to sleep on the left side
There was no significant difference in sleep position in the preceding four weeks or prior to pregnancy between cases and controls
Women who slept < 5.5 hours or ≥ 9.5 hours were more likely to have a stillbirth
Women who were got up to use the toilet once or less the night before stillbirth were more likely to have a stillbirth (aOR 2.81, 95% CI 1.85–4.26)
Women who took a daytime nap every day was also more likely to have a still birth (aOR 2.22, 95% CI 1.26–3.94)
Findings were independent of gestational age, the presence of an SGA fetus, obesity, education level, parity, and maternal smoking status
Supine going-to-sleep position is associated with 2.3x increased risk of stillbirth after 28 weeks’ gestation
The results in this study suggest that 3.7% of stillbirths > 28 weeks may be related to the supine sleep position
Programs have already begun in New Zealand to encourage women not to sleep on their back
A fall in late stillbirth in New Zealand in the last five years may be due to documented changes in maternal going-to-sleep position
The authors conclude that it would take over 1 million women to demonstrate differences in an interventional trial and based on these results and consistency with previous studies, “it is timely to evaluate whether going-to-sleep position can be modified, and how this can best be achieved”.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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