The effect of supine positioning on maternal hemodynamics during late pregnancy

Humphries, Aimee; Mirjalili, S. Ali; Tarr, Gregory P.; Thompson, John M. D.; Stone, Peter

doi:10.1080/14767058.2018.1478958

Cited by 92 publications

(119 citation statements)

References 33 publications

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“…Indeed, the time spent in specific sleep states and the distribution of the sleep states across the night is known to affect blood pressure. 42 A strength of the current study is that it is the first to include an international group of women and the only one to include women from the United States; indeed, the majority of women received their care in the United States. This has particular relevance since maternal hypotension has been reported to be associated with fetal growth restriction, premature birth, and stillbirth.…”

Section: Discussionmentioning

confidence: 99%

Maternal sleep practices and stillbirth: Findings from an international case‐control study

O’Brien

Warland

Stacey

et al. 2019

Birth

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Background: Late stillbirth, which occurs ≥28 weeks' gestation, affects 1.3-8.8 per 1000 births in high-income countries. Of concern, most occur in women without established risk factors. Identification of potentially modifiable risk factors that relate to maternal behaviors remains a priority in stillbirth prevention research. This study aimed to investigate, in an international cohort, whether maternal sleep practices are related to late stillbirth. Methods: An Internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days before completing the survey (n = 153) and women with an ongoing third-trimester pregnancy or who had delivered a live born child within 30 days (n = 480). Bivariate and multivariate logistic regressions were used to determine unadjusted and adjusted odds ratios (OR and aOR, respectively) with 95% confidence intervals (95% CIs) for stillbirth. Results: Sleeping >9 hours per night in the previous month was associated with stillbirth (aOR 1.75 [95% CI 1.10-2.79]), as was waking on the right side (2.27 [1.31-3.92]). Nonrestless sleep in the last month was also found to be associated with stillbirth (1.73 [1.03-2.99]), with good sleep quality in the last month approaching significance (1.64 [0.98-2.75]). On the last night of pregnancy, not waking more than one time was associated with stillbirth (2.03 [1.24-3.34]). No relationship was found with going to sleep position during pregnancy, although very few women reported settling in the supine position (2.4%). Conclusions: Long periods of undisturbed sleep are associated with late stillbirth. Physiological studies of how the neuroendocrine and autonomic system pathways are regulated during sleep in the context of late pregnancy are warranted. K E Y W O R D S maternal sleep, sleep duration, stillbirth | 345 O'BRIEN Et al.

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Section: Discussionmentioning

confidence: 99%

Maternal sleep practices and stillbirth: Findings from an international case‐control study

O’Brien

Warland

Stacey

et al. 2019

Birth

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“…In addition, we suggest that the subject lies in the left lateral position (10 • -20 • tilt), mainly to avoid caval vein compression, as even minor changes in the maternal circulation may have a detectable impact on the placental T2* value. A recent study by Humphries et al 10 found that a maternal supine position in late pregnancy reduced the flow in the inferior caval vein by 85% compared with the left lateral position. While the venous return in the azygos vein was increased, probably to compensate, cardiac output was reduced by 16%.…”

Section: How To Obtain T2*-weighted Placental Imagesmentioning

confidence: 96%

T2*‐weighted placental MRI: basic research tool or emerging clinical test for placental dysfunction?

Sørensen

Hutter

Seed

et al. 2020

Ultrasound in Obstet & Gyne

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“…External factors may complicate this adaptation process. For instance, during late pregnancy, uterine weight increases and this can lead to partial/complete occlusion of the inferior vena cava and lateral displacement of the sub‐renal aorta in the supine position, affecting maternal hemodynamics and fetal oxygenation . Supine position may also result in decreased vagal activity and increased cardiac sympathetic activity when compression of the vena cava, abdominal aorta, and the iliac arteries reduces venous return and cardiac output .…”

Section: Introductionmentioning

confidence: 99%

Effects of maternal sleep position on fetal and maternal heart rate patterns using overnight home fetal ECG recordings

Lucchini

Wapner

Nhan-Chang

et al. 2020

Intl J Gynecology & Obste

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Objective To assess the effects of maternal position on maternal and fetal heart rate and heart rate variability (HRV) in healthy late gestation pregnancies using non‐invasive techniques during overnight studies. Methods In an observational study of women between 34 and 36 weeks of pregnancy conducted from September 1, 2013, to March 31, 2014, at Columbia University Medical Center, New York, US, maternal and fetal ECG recordings and position monitoring were undertaken through the night in the woman's own home. These data were used for time domain analyses of fetal and maternal heart rate and HRV. Results Forty‐two women were recruited to the study which showed that maternal position affected maternal heart rate (MHR), with left side sleeping associated with lower heart rate (left vs right P=0.017, left vs supine P=0.027) and higher overall HRV (left vs right P=0.032). MHR showed significant overnight changes (P=0.032). No significant positional or overnight effects were observed in fetal heart rate patterns. Conclusion This study uniquely incorporated analyses on maternal and fetal physiology and extended the knowledge of effects of maternal overnight sleep position on MHR in the natural sleep environment.

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The effect of supine positioning on maternal hemodynamics during late pregnancy

Abstract: Women in late pregnancy experience an increase in collateral venous blood flow when lying supine, likely as a response to marked compression of the IVC in this position. However, cardiac output and aortic blood flow were found to decrease while in the supine position.

Cited by 92 publications

References 33 publications

Maternal sleep practices and stillbirth: Findings from an international case‐control study

Maternal sleep practices and stillbirth: Findings from an international case‐control study

T2*‐weighted placental MRI: basic research tool or emerging clinical test for placental dysfunction?

Effects of maternal sleep position on fetal and maternal heart rate patterns using overnight home fetal ECG recordings

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