Effect of maternal position on fetal behavioural state and heart rate variability in healthy late gestation pregnancy

Stone, Peter R.; Burgess, Wendy; McIntyre, Jordan P. R.; Gunn, Alistair J.; Lear, Christopher A.; Bennet, Laura; Mitchell, Edwin A.; Thompson, John M. D.; the Maternal Sleep In Pregnancy Research Group, The University of Auckland

doi:10.1113/jp273201

Cited by 65Heart Rate Variability and Autonomic ControlMaternal and Perinatal Health InterventionsPregnancy and preeclampsia studies

Effect of maternal position on fetal behavioural state and heart rate variability in healthy late gestation pregnancy

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Stone, Peter R., Burgess, Wendy, McIntyre, Jordan P. R., Gunn, Alistair J., Lear, Christopher A., Bennet, Laura, Mitchell, Edwin A., Thompson, John M. D. +1 more·2017·The Journal of Physiology

DOI 10.1113/jp273201PMC PMC5309385

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Abstract

Key points: Fetal behavioural state in healthy late gestation pregnancy is affected by maternal position. Fetal state 1F is more likely to occur in maternal supine or right lateral positions. Fetal state 4F is less likely to occur when the woman lies supine or semi‐recumbent. Fetal state change is more likely when the woman is supine or semi‐recumbent. Fetal heart rate variability is affected by maternal position with variability reduced in supine and semi‐recumbent positions. Fetal behavioural states (FBS) are measures of fetal wellbeing. In acute hypoxaemia, the human fetus adapts to a lower oxygen consuming state with changes in the cardiotocograph and reduced fetal activity. Recent studies of late gestation stillbirth described the importance of sleep position in the risk of intrauterine death. We designed this study to assess the effects of different maternal positions on FBS in healthy late gestation pregnancies under controlled conditions. Twenty‐nine healthy women had continuous fetal ECG recordings under standardized conditions in four randomly allocated positions, left lateral, right lateral, supine and semi‐recumbent. Two blinded observers, assigned fetal states in 5 min blocks. Measures of fetal heart rate variability were calculated from ECG beat to beat data. Compared to state 2F, state 4F was less likely to occur when women were semi‐recumbent [odds ratio (OR) = 0.11, 95% confidence interval (95% CI) 0.02, 0.55], and supine (OR = 0.27, 95% CI 0.07, 1.10). State 1F was more likely on the right (OR = 2.36, 95% CI 1.11, 5.04) or supine (OR = 4.99, 95% CI 2.41, 10.43) compared to the left. State change was more likely when the mother was semi‐recumbent (OR = 2.17, 95% CI 1.19, 3.95) or supine (OR = 2.67, 95% CI 1.46, 4.85). There was a significant association of maternal position to mean fetal heart rate. The measures of heart rate variability (SDNN and RMSSD) were reduced in both semi‐recumbent and supine positions. In healthy late gestation pregnancy, maternal position affects FBS and heart rate variability. These effects are likely fetal adaptations to positions which may produce a mild hypoxic stress.

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Altering maternal positioning during labor as a means of fetal resuscitation is common.
“Altering maternal positioning during labor as a means of fetal resuscitation is common (38–40).”
From Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings (2021) · cites this paper as [38]

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An investigation of fetal behavioural states during maternal sleep in healthy late gestation pregnancy: an observational study
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Authors: Stone, P. R., Burgess, W., McIntyre, J. P. R., Gunn, A. J., Lear, C. A., Bennet, L., Mitchell, E. A., Thompson, J. M. D., & the Maternal Sleep In Pregnancy Research Group, T. U. O. A.
Affiliations: University of Auckland (NZ)
Corresponding author: Stone, Peter R.
ORCID: Stone, Peter R.
Burgess, Wendy
McIntyre, Jordan P. R.
Gunn, Alistair J.
Lear, Christopher A.
Bennet, Laura
Mitchell, Edwin A.
Thompson, John M. D.
Venue: The Journal of Physiology
Publisher: Wiley
Published: 2016-12-11
Volume: 595
Issue: 4
Pages: 1213-1221
ISSN: 0022-3751 (ISSN-L)
1469-7793
DOI: 10.1113/jp273201
PMC: PMC5309385
OpenAlex: W2553620978
Cited by: 65
References: 49
Citations by year: 2026: 4 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 11 · 2021: 7 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 7 · 2012: 1
FWCI: 5.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: The Journal of Physiology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
ResearchSpace (University of Auckland) (submittedVersion)
Funders: Cure Kids
University of Auckland
Auckland Medical Research Foundation
Health Research Council of New Zealand
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords: maternal position, fetal heart rate variability, fetal well-being, supine position, semi-recumbent position, fetal sleep, fetal hypoxaemia, stillbirth risk
MeSH terms: Adult, Female, Fetal Heart, Fetal Movement, Heart Rate, Humans, Posture, Pregnancy, Pregnancy Trimester, Third, Random Allocation

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Effect of maternal position on fetal behavioural state and heart rate variability in healthy late gestation pregnancy

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