Maternal Smoking During Pregnancy and Sudden Infant Death Using the National Maternal and Infant Health Survey: A Case-Case Study

Kathleen F Brookfield, James D Wilkinson, Barbara Luke, Kristopher Arheart, Eleni Sfakianaki

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DOI: 10.4236/ijcm.2011.23055                

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.

Keywords

Sudden Infant Death, Smoking, Pregnancy, Passive Smoking, Breastfeeding

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Machaalani R, Waters KA, Tinworth KD. Effects of postnatal nicotine exposure on apoptotic markers in the developing piglet brain. Neuroscience 2005; 132: 325- 333.
[2]	Slotkin TA. Cholinergic systems in brain development and disruption by neurotoxicants: nicotine, environmental tobacco smoke, organophosphates. Toxicol Appl Pharmacol 2004; 198: 132-151.
[3]	Sartiani L, Cerbai E, Lonardo G et al. Prenatal exposure to carbon monoxide affects postnatal cellular electrophysiological maturation of the rat heart. Circulation 2004; 109: 419-423.
[4]	Neff RA, Simmens SJ, Evans C, Mendelowitz D. Prenatal nicotine exposure alters central cardiorespiratory responses to hypoxia in rats: implications for Sudden Infant Death Syndrome. J Neuroscience 2004; 24: 9261-9268.
[5]	Browne CA, Colditz PB, Dunster KR. Infant autonomic function is altered by maternal smoking during pregnancy. Early Hum Dev 2000; 59: 209-218.
[6]	Fifer WP, Ten Fingers S, Youngman M, Gomez-Gribben E, Myers MM. Effects of alcohol and smoking during pregnancy on infant autonomic control. Developmental Psychobiology 2009; 51: 234-42.
[7]	Duncan JR, Garland M, Myers MM et al. Prenatal nicotine-exposure alters fetal autonomic activity and medullary neurotransmitter receptors: implications for SIDS. J Appl Physiol 2009. Epub ahead of print.
[8]	Hafstr?m O, Milerad J, Sandberg KL, Sundell HW. Cardiorespiratory effects of nicotine exposure during development. Resp Phys Neurobiology 2005; 149: 325-341.
[9]	Lindblad A, Marsal K, Andersson KE. Effect of nicotine on human fetal blood flow. Obstet Gynecol 1988; 72: 371-382.
[10]	Thiriez G, Bouhaddi M, Mourot L et al. Heart rate variability in preterm infants and maternal smoking during pregnancy. Clin Auton Res 2009; 19: 149-56.
[11]	Pierce RA, Nguyen NM. Prenatal nicotine exposure and abnormal lung function. Am J Respir Cell Mol Biol 2002; 26: 10-13.
[12]	Byard RW, Krous HF. Sudden Infant Death Syndrome: Problems, Progress and Possibilities. London, United Kingdom: Arnold; 2001.
[13]	Spencer N, Logan S. Sudden unexpected death in infancy and socioeconomic status: a systemic review. J Epidemiol Community Health 2004; 58: 366-373.
[14]	Tong VT, Jones JR, Dietz PM, D’Angelo D, Bombard JM. Trends in smoking before, during and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000-2005. MMWR May 29, 2009; 58(SS04); 1-29.
[15]	Kafouri S, Leonard G, Perron M, Richer L, Se?guin JR, Veillette S, Pausova Z, Paus T. Maternal cigarette smoking during pregnancy and cognitive performance in adolescence. Int J Epidemiol 2009; 38: 158-72.
[16]	Willinger M, Ko C, Hoffman HJ, Kessler RC, Corwin MJ. Factors associated with caregivers’ choice of infant sleep position, 1994-1998: the national infant sleep position study. JAMA 2000; 283: 2135-2142.
[17]	Muhuri P, MacDorman MF, Ezzati-Rice TM. Racial differences in leading causes of infant death in the United States. Paediatric and Perinatal Epidemiology 2004; 18: 51-60.
[18]	Mathews TJ. Smoking during pregnancy in the 1990s. Natl Vital Stat Rep 2001; 49(7): 1-14.
[19]	Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992; 90: 905-8.
[20]	Taylor JA, Sanderson M. A reexamination of the risk factors for the sudden infant death syndrome. J Pediatrics 1995; 126: 887-891.
[21]	Chen A and Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004; 113: 435-439.
[22]	National Center for Health Statistics. Health, United States, 1991. Hyattsville, Maryland: Public Health Service. 1992.
[23]	Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification. Washington: Public Health Service. 1980.
[24]	National Center for Health Statistics. Health, United States, 1998 With Socioeconomic and Health Chartbook. Hyattsville, MD: US Department of Health and Human Services; 1998.
[25]	Mitka M. Policy targets lowering SIDS incidence. JAMA 2005; 294: 2420.
[26]	Li D-K, Willinger M, Petitti DB, Odouli R, Liu L, Hoffman HJ. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. BMJ, doi: 10.1136/bmj.38671.640475.55 (published 9 December 2005).
[27]	Richardson HL, Walker AM, Horne RS. Maternal smoking impairs arousal patterns in sleeping infants. Sleep 2009; 32: 515-21.
[28]	28.) Malloy MH and Hoffman HJ. Home apnea monitoring and sudden infant death syndrome. Preventive Med 1996; 25: 645-649.