![]() Systematic bibliographic searches of MEDLINE (Appendix A), Embase, LILACS, Web of Science, OpenGrey, Google Scholar, and the WHO International Clinical Trials Registry Platform of studies up until 26 January, 2018 (with no specified earliest date), using relevant terms (“stillbirth”, “fetal death”, “perinatal death” and “sleep”) and synonyms were tested prior to search commencement to check that the located articles were consistent with the inclusion criteria. We sought to assess the accumulated evidence in the first pooled IPD meta-analysis of randomised trials, prospective cohort studies, and case–control studies, to evaluate the relationship between maternal going-to-sleep position and late stillbirth, comprising all the available world-wide data on the topic. The search strategy was developed prior to the systematic bibliographic search. The study was registered with the PROSPERO register of systematic reviews (CRD42017047703). Implications of all the available evidence The population attributable risk for supine going-to-sleep position in this study was 5.8% (3.2–9.2). We therefore conclude that supine going-to-sleep position is independently associated with late stillbirth in the general pregnant population, regardless of body size, baby size, smoking, recreational drug use, pre-existing hypertension or diabetes, fetal movements, or term versus preterm gestation. Furthermore, we found no significant interaction between the assessed indicators of fetal vulnerability and supine going-to-sleep position. Right side going-to-sleep position had no increase in odds compared to left, therefore women can choose to go-to-sleep on either side. ![]() Our study has shown that after adjustment for confounders, maternal supine going-to-sleep position compared with left side going-to-sleep position, was independently associated with a 2.6-fold increase in odds of late stillbirth. Our IPD dataset comprises the largest database addressing this question, including data on confounders that have not been previously reported. We conducted the first individual participant data (IPD) meta-analysis on maternal going-to-sleep position and late stillbirth, assembling all the available world-wide data on the topic. However, the association of right side going-to-sleep position with late stillbirth was inconsistent across studies, and no individual study was large enough to investigate interactions between maternal sleep position and indicators of fetal vulnerability, such as small-for-gestational-age babies, maternal obesity, smoking or recreational drug use, pre-existing hypertension or diabetes, fetal movements, and term versus preterm gestation. Further studies have subsequently investigated the association between supine going-to-sleep position and late stillbirth. This study was considered hypothesis-generating and raised questions about the possibility of a chance finding, recall bias, and reverse causation. This finding was biologically plausible and aligned with existing research on the effects of maternal supine position in the third trimester, including vena-caval and aortic compression. The 2011 Auckland Stillbirth Study was the first study to report an association between maternal supine going-to-sleep position and late stillbirth (≥ 28 weeks' gestation).
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