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Study: Higher risk of stillbirth for Ghanaian women who sleep on backs

March 28, 2013
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Pregnant women in Ghana who slept on their back were at an increased risk of stillbirth compared to women who did not sleep on their back, according to new research led by a University of Michigan researcher.

The study found that supine sleep – or sleeping on your back – increased the risk of low birth weight by a factor of five, and that it was the low birth weight that explained the high risk for stillbirth in these women. The findings were published this month in the International Journal of Gynecology and Obstetrics.

The senior author, Louise O’Brien, said that although the study was conducted in a maternity hospital in Ghana, which has high perinatal mortality, a recent case-control study from New Zealand also found a link between maternal supine sleep and stillbirth.

A mother with her  baby in Ghana.

A mother rests with her newborn baby in Ghana. (Photo courtesy of Jocelynn Owusu)

Stillbirth is a traumatic event that occurs in about two to five babies out of every 1,000 born in high-income countries. In low-income countries, such as those in Africa, about 20 to 50 babies out of every 1,000 are stillborn.

“But if maternal sleep position does play a role in stillbirth, encouraging pregnant women everywhere not to sleep on their back is a simple approach that may improve pregnancy outcomes,” said O’Brien, an associate professor in U-M’s Sleep Disorders Center.

Sub-Saharan Africa has the highest rate of stillbirth in the world, and little progress has been made in reducing those deaths.

“In Ghana, inexpensive interventions are urgently needed to improve pregnancy outcomes. This is a behavior that can be modified. Encouraging women to avoid sleeping on their backs would be a low-cost method to reduce stillbirths in Ghana and other low-income countries,” O’Brien said.

The study’s first author, Jocelynn Owusu, of the Department of Health Behavior and Education in U-M’s School of Public Health, interviewed women soon after delivery at Korle Bu Teaching Hospital in Accra Ghana.

O’Brien said the possibility that supine sleep has a part in low birth weight and subsequently stillbirth is plausible because of uterine compression on the inferior vena cava, the large vein that carries blood from the lower half of the body into the heart. This results in reduced venous filling and cardiac output.

“The data in this study suggests that more than one-quarter of stillbirths might be avoided by altering maternal sleep position,” O’Brien said. “This supports the need to develop simple intervention trials.”

A longer version of this story is available at UofMHealth.org.

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