Concurrent prenatal drinking and smoking increases risk for SIDS: Safe Passage Study report

Amy J Elliott; Hannah C Kinney; Robin L Haynes; Johan D Dempers; Colleen Wright; William P Fifer; Jyoti Angal; Theonia K Boyd; Larry Burd; Elsie Burger; Rebecca D Folkerth; Coen Groenewald; Gary Hankins; Dale Hereld; Howard J Hoffman; Ingrid A Holm; Michael M Myers; Laura L Nelsen; Hein J Odendaal; Julie Petersen; Bradley B Randall; Drucilla J Roberts; Fay Robinson; Pawel Schubert; Mary Ann Sens; Lisa M Sullivan; Tara Tripp; Peter Van Eerden; Shabbir Wadee; Marian Willinger; Daniel Zaharie; Kimberly A Dukes

doi:10.1016/j.eclinm.2019.100247

Concurrent prenatal drinking and smoking increases risk for SIDS: Safe Passage Study report

EClinicalMedicine. 2020 Jan 20:19:100247. doi: 10.1016/j.eclinm.2019.100247. eCollection 2020 Feb.

Authors

Amy J Elliott^{1

2}, Hannah C Kinney³, Robin L Haynes³, Johan D Dempers⁴, Colleen Wright⁵, William P Fifer⁶, Jyoti Angal^{1

2}, Theonia K Boyd³, Larry Burd⁷, Elsie Burger⁸, Rebecca D Folkerth⁹, Coen Groenewald¹⁰, Gary Hankins¹¹, Dale Hereld¹², Howard J Hoffman¹³, Ingrid A Holm¹⁴, Michael M Myers⁶, Laura L Nelsen¹⁵, Hein J Odendaal¹⁰, Julie Petersen^{16

17}, Bradley B Randall¹⁸, Drucilla J Roberts¹⁹, Fay Robinson^{16

20}, Pawel Schubert²¹, Mary Ann Sens²², Lisa M Sullivan²³, Tara Tripp¹⁶, Peter Van Eerden²⁴, Shabbir Wadee⁴, Marian Willinger²⁵, Daniel Zaharie⁵, Kimberly A Dukes^{16

23

26}

Affiliations

¹ Center for Pediatric & Community Research, Avera Health, 6001 S. Sharon Ave., Suite 2, Sioux Falls, SD 57108, United States.
² Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57104, United States.
³ Department of Pathology, Boston Children's Hospital, Harvard School of Medicine, Boston, MA 02115, United States.
⁴ Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Health Services, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
⁵ Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town 7505, South Africa.
⁶ Department of Psychiatry and Pediatrics, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
⁷ North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States.
⁸ Department of Forensic Medicine, NSW Health Pathology, Glebe 2037, Australia.
⁹ Department of Forensic Medicine, New York University School of Medicine, New York, NY 10016, United States.
¹⁰ Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town 7505, South Africa.
¹¹ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, United States.
¹² National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Rockville, MD 20852, United States.
¹³ Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Division of Scientific Programs, Room 8325, MSC 9670 Executive Boulevard, 6001 Executive Boulevard, Bethesda, MD 20892, United States.
¹⁴ Division of Genetics & Genomics & the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States.
¹⁵ Department of Pathology, Maine General Medical Center, Augusta, ME 04330, United States.
¹⁶ DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, United States.
¹⁷ Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA 02118, United States.
¹⁸ Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, SD 57105, United States.
¹⁹ Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States.
²⁰ PPD, 929N. Front Street, Wilmington, NC 28401, United States.
²¹ Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
²² Department of Pathology, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND 58202, United States.
²³ Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA 02118, United States.
²⁴ Department of Obstetrics and Gynecology, School of Medicine, University of North Dakota, Fargo, ND 58203, United States.
²⁵ Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Room 2305, Bethesda, MD 20892, United States.
²⁶ Biostatistics and Epidemiology Data Analysis Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, United States.

Abstract

Background: Sudden infant death syndrome (SIDS) is the leading cause of postneonatal mortality. Although the rate has plateaued, any unexpected death of an infant is a family tragedy thus finding causes and contributors to risk remains a major public health concern. The primary objective of this investigation was to determine patterns of drinking and smoking during pregnancy that increase risk of SIDS.

Methods: The Safe Passage Study was a prospective, multi-center, observational study with 10,088 women, 11,892 pregnancies, and 12,029 fetuses, followed to 1-year post delivery. Subjects were from two sites in Cape Town, South Africa and five United States sites, including two American Indian Reservations. Group-based trajectory modeling was utilized to categorize patterns of drinking and smoking exposure during pregnancy.

Findings: One-year outcome was ascertained in 94·2% infants, with 28 SIDS (2·43/1000) and 38 known causes of death (3·30/1000). The increase in relative risk for SIDS, adjusted for key demographic and clinical characteristics, was 11·79 (98·3% CI: 2·59-53·7, p < 0·001) in infants whose mothers reported both prenatal drinking and smoking beyond the first trimester, 3.95 (98·3% CI: 0·44-35·83, p = 0·14), for drinking only beyond the first trimester and 4·86 (95% CI: 0·97-24·27, p = 0·02) for smoking only beyond the first trimester as compared to those unexposed or reported quitting early in pregnancy.

Interpretation: Infants prenatally exposed to both alcohol and cigarettes continuing beyond the first trimester have a substantially higher risk for SIDS compared to those unexposed, exposed to alcohol or cigarettes alone, or when mother reported quitting early in pregnancy. Given that prenatal drinking and smoking are modifiable risk factors, these results address a major global public health problem.

Funding: National Institute on Alcohol Abuse and Alcoholism, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Deafness and Other Communication Disorders.

Keywords: Alcohol; Nicotine; Prenatal exposure; SIDS; Sudden infant death syndrome.

Abstract

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