Elliott Amy J, Kinney Hannah C, Haynes Robin L, Dempers Johan D, Wright Colleen, Fifer William P, Angal Jyoti, Boyd Theonia K, Burd Larry, Burger Elsie, Folkerth Rebecca D, Groenewald Coen, Hankins Gary, Hereld Dale, Hoffman Howard J, Holm Ingrid A, Myers Michael M, Nelsen Laura L, Odendaal Hein J, Petersen Julie, Randall Bradley B, Roberts Drucilla J, Robinson Fay, Schubert Pawel, Sens Mary Ann, Sullivan Lisa M, Tripp Tara, Van Eerden Peter, Wadee Shabbir, Willinger Marian, Zaharie Daniel, Dukes Kimberly A
Center for Pediatric & Community Research, Avera Health, 6001 S. Sharon Ave., Suite 2, Sioux Falls, SD 57108, United States.
Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57104, United States.
EClinicalMedicine. 2020 Jan 20;19:100247. doi: 10.1016/j.eclinm.2019.100247. eCollection 2020 Feb.
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.
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.
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, < 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, = 0·14), for drinking only beyond the first trimester and 4·86 (95% CI: 0·97-24·27, = 0·02) for smoking only beyond the first trimester as compared to those unexposed or reported quitting early in pregnancy.
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.
National Institute on Alcohol Abuse and Alcoholism, National Institute of Child Health and Human Development, and the National Institute on Deafness and Other Communication Disorders.
婴儿猝死综合征（SIDS）是新生儿期后死亡的主要原因。尽管该比率已趋于平稳，但婴儿的任何意外死亡都是家庭悲剧，因此寻找风险的原因和促成因素仍然是一个主要的公共卫生问题。本调查的主要目的是确定孕期饮酒和吸烟模式增加SIDS风险的情况。
安全通道研究是一项前瞻性、多中心、观察性研究，涉及10088名女性、11892次妊娠和12029名胎儿，随访至产后1年。研究对象来自南非开普敦的两个地点和美国的五个地点，包括两个美洲印第安人保留地。基于群体的轨迹模型用于对孕期饮酒和吸烟暴露模式进行分类。
94.2%的婴儿确定了1年的结局，其中28例为SIDS（2.43/1000），38例为已知死亡原因（3.30/1000）。在调整关键人口统计学和临床特征后，母亲报告在孕早期后既饮酒又吸烟的婴儿发生SIDS的相对风险增加11.79（98.3%CI：2.59-53.7，<0.001），仅在孕早期后饮酒的婴儿为3.95（98.3%CI：0.44-35.83，P=0.14），仅在孕早期后吸烟的婴儿为4.86（95%CI：0.97-24.27，P=0.02），与未暴露或报告在孕早期戒烟的婴儿相比。
与未暴露、仅暴露于酒精或香烟或母亲报告在孕早期戒烟的婴儿相比，孕早期后继续同时暴露于酒精和香烟的婴儿发生SIDS的风险显著更高。鉴于孕期饮酒和吸烟是可改变的风险因素，这些结果解决了一个重大的全球公共卫生问题。
国家酒精滥用与酒精中毒研究所、国家儿童健康与人类发展研究所、国家耳聋与其他交流障碍研究所。
