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Sudden infant death and maternal cigarette smoking: Results from the Lower Saxony Perinatal Working Group

  • Preventive Pediatrics and Epidem
  • Original Paper
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Abstract

Maternal smoking has long been identified as a risk factor for sudden infant death (SID). However, only few studies analysed the biological plausibility of the relationship between maternal smoking and SID. In Lower Saxony (North Germany), detailed information concerning the perinatal period is routinely obtained for almost all infants born in this region. The perinatal data sets from 190 SID cases who had died between 1986 and 1990 and in whom a full autopsy had been performed were identified and compared to data sets from 5920 random controls, frequency matched to cases on year of birth. After adjusting for potential confounders (socio-economic status, birth weight, maternal age and nationality), smoking during pregnancy was still associated with a significantly increased risk of SID (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.7–4.5). There was a clear dose-effect relationship between the number of cigarettes smoked and the risk of SID: adjusted ORs were 2.6 (1.5–4.4) for 1–10 cigarettes/day, 2.8 (1.8–6.0) for 11–20 cigarettes/day, and 6.9 (1.9–25.5) for >20 cigarettes/day. There also appeared to be an interaction between smoking during pregnancy and maternal anaemia: the risk of SID almost doubled if mothers not only smoked, but were also anaemic (haemoglobin <100 g/l). These results support the concept that smoking during pregnancy has direct biological effects on the fetus which are associated with an increased risk of SID later in life. The exact mechanism(s) whereby smoking increases the risk of SID, however, remains to be determined. The detrimental effects of smoking on SID should be strongly addressed in any national or local campaign aiming to reduce the incidence of SID in a community.

Conclusion

Maternal smoking during pregnancy is an important modifiable risk factor for SID.

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Abbreviations

SID :

sudden infant death

References

  1. Bergman AB (1976) Relationship of passive cigarette smoking to sudden infant death syndrome. Pediatrics 58:665–668

    Google Scholar 

  2. Buck GM, Cookfair DL, Michalek AM, Nasca PC, Standfast SJ, Sever LE (1989) Assessment of in utero hypoxia and risk of sudden infant death syndrome. Pediatr Perinat Epidemiol 3:157–173

    Google Scholar 

  3. Bulterys MG, Greenland S, Kraus JF (1990) Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy. Pediatrics 86:535–540

    Google Scholar 

  4. Haglund B, Cnattingius S (1990) Cigarette smoking as a risk factor for sudden infant death syndrome: a population-based study. Am J Publ Health 80:29–32

    Google Scholar 

  5. Jorch G, Schmidt-Troschke S, Bajanowski T, et al. (1994) Epidemiologische Risikofaktoren des plötzlichen Kindstodes. Monatsschr Kinderheilkd 142:45–51

    Google Scholar 

  6. Li DK, Daling JR (1991) Maternal smoking, low birth weight, and ethnicity in relation to sudden infant death syndrome. Am J Epidemiol 134:958–964

    Google Scholar 

  7. Malloy MH, Hoffman HJ, Peterson DR (1992) Sudden infant death syndrome and maternal smoking. Am J Publ Health 82:1380–1382

    Google Scholar 

  8. Malloy MH, Kleinman JC, Land GH, Schramm WF (1988) The association of maternal smoking with age and cause of infant death. Am J Epidemiol 128:46–55

    Google Scholar 

  9. Martinez FD (1991) Sudden infant death syndrome and small airway occlusion: facts and a hypothesis. Pediatrics 87:190–198

    Google Scholar 

  10. Meberg A, Haga P, Sande H, Foss OP (1979) Smoking during pregnancy-hematological observations in the newborn. Acta Paediatr Scand 68:731–734

    Google Scholar 

  11. Mitchell EA, Ford RPK, Stewart AW, et al (1993) Smoking and the sudden infant death syndrome. Pediatrics 91:893–896

    Google Scholar 

  12. Murphy JF, Newcombe RG, Sibert JR (1982) The epidemiology of sudden infant death syndrome. J Epidemiol Community Health 36:17–21

    Google Scholar 

  13. Naeye RL (1988) Sudden infant death syndrome, is the confusion ending? Modern Pathol 1:169–174

    Google Scholar 

  14. Naeye RL, Ladis B, Drage JS (1976) Sudden infant death syndrome. A prospective study. Am J Dis Child 130:1207–1210

    Google Scholar 

  15. Poets CF, Samuels MP, Wardrop CAJ, Picton-Jones E, Southall DP (1992) Reduced haemoglobin levels in infants presenting with apparent life-threatening events—a retrospective investigation. Acta Paediatr 81:319–321

    Google Scholar 

  16. Rintahaka PJ, Hirvonen J (1986) The epidemiology of sudden infant death syndrome in Finland in 1969–1980. Forensic Sci Int 30:219–233

    Google Scholar 

  17. Schoendorf KC, Kiely JL (1992) Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 90:905–908

    Google Scholar 

  18. Steele R, Langworth JT (1966) The relationship of antenatal and postnatal factors to sudden unexpected death in infancy. Can Med Assoc J 4:1165–1171

    Google Scholar 

  19. Wright AL, Holberg C, Martinez FD, Taussig LM, Group Health Medical Associates (1991) Relationship of parental smoking to wheezing and non-wheezing lower respiratory tract illnesses in infancy. J Pediatr 118:207–214

    Google Scholar 

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Poets, C.F., Schlaud, M., Kleemann, W.J. et al. Sudden infant death and maternal cigarette smoking: Results from the Lower Saxony Perinatal Working Group. Eur J Pediatr 154, 326–329 (1995). https://doi.org/10.1007/BF01957372

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  • DOI: https://doi.org/10.1007/BF01957372

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