Abstract
We utilized data from the National Maternal and Infant Health Survey (NMHIS) to analyze the risk of SIDS and other infant deaths among women who smoke during pregnancy adjusting for potentially modifiable risk factors such as secondhand smoke exposure and breastfeeding. The following variables were assessed with respect to risk for SIDS and other infant deaths: smoking exposure, level of education, infant and maternal age, infant and maternal birthweight, maternal BMI, gender, secondhand smoke exposure, breast feeding, prenatal vitamins, WIC, multiple gestation, sleep apnea monitor prescription, sleep apnea incidents and maternal alcohol use. Univariate analysis and multivariate logistic regression were performed to identify variables significantly associated with the odds of mortality from SIDS. Analysis utilized weighted estimates using SUDAAN 9.0.0 to adjust for design effects. A p-value <0.01 was considered statistically significant. Women who smoked during pregnancy were 1.83 times more likely to give birth to an infant that died from SIDS versus some other cause of death, OR (95%) = 1.83(1.33, 2.51). Other Race infants and Black infants were more likely to suffer SIDS mortality than White infants, but the result was not significant in the final model. Other modifiable risk factors, such as secondhand smoke exposure and breast feeding, were not significant predictors of SIDS mortality. Independent of sociodemographic variables and other potential risk factors for SIDS death, maternal smoking was associated with an increased risk of SIDS death versus other death. This study highlights the importance of screening all pregnant women for tobacco use and emphasizes the importance of smoking cessation to decrease the risk of infant death from SIDS.
Highlights
Sudden Infant Death Syndrome (SIDS) is the leading cause of postneonatal death among all racial and ethnic groups, representing nearly one-third of such deaths
In addition to the significant variables reported in the unweighted analysis, maternal prepregnancy BMI was significantly lower in the SIDS mortality group (22.93) compared to the other
Use of a sleep apnea monitor, an infant that stopped breathing, infant age at death, maternal age, and infant birthweight were significant predictors of SIDS mortality. (Table 4) Women who smoked during pregnancy were 1.83 times more likely to give birth to an infant that died from SIDS versus some other cause of death, OR = 1.83 (1.33, 2.51)
Summary
Sudden Infant Death Syndrome (SIDS) is the leading cause of postneonatal death among all racial and ethnic groups, representing nearly one-third of such deaths. Two components of cigarette smoke potentially responsible for a role in SIDS pathophysiology are carbon monoxide (CO) and nicotine. These toxins, which cross the placental barrier, have been demonstrated to alter the physiologic development of organs and tissues most susceptible to hypoxia damage, including the brain and heart in animal models [1,2,3,4]. It has been hypothesized that CO exposure from maternal smoking may have an effect on postnatal electrophysiological remodeling which could predispose the infant heart to fatal arrythmias [3]. The potential effect of CO exposure on AP duration is a plausible explanation for an arrhythmia resulting in sudden death
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