Friedmann Isabel, Dahdouh Elias M, Kugler Perlyne, Mimran Gracia, Balayla Jacques
a Faculty of Medicine, McGill University , QC , Canada.
b Department of Obstetrics and Gynecology , University of Montreal , QC , Canada.
J Matern Fetal Neonatal Med. 2017 Oct;30(19):2315-2323. doi: 10.1080/14767058.2016.1247265. Epub 2016 Nov 24.
Public Health initiatives, such as the "Safe to Sleep" campaign, have traditionally targeted infants' risk factors for the prevention of Sudden Infant Death Syndrome (SIDS). However, controversy remains regarding maternal and obstetrical risk factors for SIDS. In our study, we sought out to determine both modifiable and non-modifiable obstetrical and maternal risk factors associated with SIDS.
We conducted a population-based cohort study using the CDC's Linked Birth-Infant Death data from the United States for the year 2010. The impact of several obstetrical and maternal risk factors on the risk of overall infant mortality and SIDS was estimated using unconditional regression analysis, adjusting for relevant confounders.
Our cohort consisted of 4,007,105 deliveries and 24,174 infant deaths during the first year of life, of which 1991 (8.2%) were due to SIDS. Prominent risk factors for SIDS included (OR [95% CI]): black race, 1.89 [1.68-2.13]; maternal smoking, 3.56 [3.18-3.99]; maternal chronic hypertension, 1.73 [1.21-2.48]; gestational hypertension, 1.51 [1.23-1.87]; premature birth <37 weeks, 2.16 [1.82-2.55]; IUGR, 2.46 [2.14-2.82]; and being a twin, 1.81 [1.43-2.29], p < 0.0001. Relative to a cohort of infants who died of other causes, risk factors with a predilection for SIDS were maternal smoking, 2.48 [2.16-2.83] and being a twin, 1.52 [1.21-1.91], p < 0.0001. Conclusions for practice: While certain socio-demographic and gestational characteristics are important risk factors, maternal smoking remains the strongest prenatal modifiable risk factor for SIDS. We recommend the continuation of Public Health initiatives that promote safe infant sleeping practices and smoking cessation during and after pregnancy.
诸如“安全睡眠”运动等公共卫生倡议传统上针对婴儿预防婴儿猝死综合征（SIDS）的风险因素。然而，关于SIDS的孕产妇和产科风险因素仍存在争议。在我们的研究中，我们试图确定与SIDS相关的可改变和不可改变的产科及孕产妇风险因素。
我们使用美国疾病控制与预防中心（CDC）2010年的出生与婴儿死亡关联数据进行了一项基于人群的队列研究。使用无条件回归分析估计了几种产科和孕产妇风险因素对总体婴儿死亡率和SIDS风险的影响，并对相关混杂因素进行了调整。
我们的队列包括4,007,105例分娩和24,174例1岁以内婴儿死亡，其中1991例（8.2%）死于SIDS。SIDS的显著风险因素包括（比值比[95%置信区间]）：黑人种族，1.89[1.68 - 2.13]；母亲吸烟，3.56[3.18 - 3.99]；母亲慢性高血压，1.73[1.21 - 2.48]；妊娠期高血压，1.51[1.23 - 1.87]；早产<37周，2.16[1.82 - 2.55]；胎儿宫内生长受限，2.46[2.14 - 2.82]；以及双胞胎，1.81[1.43 - 2.29]，p<0.0001。相对于死于其他原因的婴儿队列，更易患SIDS的风险因素是母亲吸烟，2.48[2.16 - 2.83]和双胞胎，1.52[1.21 - 1.91]，p<0.0001。实践结论：虽然某些社会人口统计学和妊娠特征是重要的风险因素，但母亲吸烟仍然是SIDS最强的产前可改变风险因素。我们建议继续开展公共卫生倡议，推广安全的婴儿睡眠习惯以及孕期和产后戒烟。
