Risk Factors for Sudden Infant Death
Syndrome Among Northern Plains Indians
Solomon
Iyasu, MBBS, MPH; Leslie L. Randall, RN, MPH; Thomas K. Welty, MD; Jason
Hsia, PhD; Hannah C. Kinney, MD; Frederick Mandell, MD; Mary McClain, RN,
MS; Brad Randall, MD; Don Habbe, MD; Harry Wilson, MD; Marian Willinger, PhD
Context Sudden infant death syndrome (SIDS) is a leading cause
of postneonatal mortality among American Indians, a group whose infant death
rate is consistently above the US national average.
Objective To determine prenatal and postnatal risk factors for
SIDS among American Indians.
Design, Setting, and Participants Population-based case-control
study of 33 SIDS infants and 66 matched living controls among American
Indians in South Dakota, North Dakota, Nebraska, and Iowa enrolled from
December 1992 to November 1996 and investigated using standardized parental
interview, medical record abstraction, autopsy protocol, and infant death
review.
Main Outcome Measures Association of SIDS with maternal
socioeconomic and behavioral factors, health care utilization, and infant
care practices.
Results The proportions of case and control infants who were
usually placed prone to sleep (15.2% and 13.6%, respectively), who shared a
bed with parents (59.4% and 55.4%), or whose mothers smoked during pregnancy
(69.7% and 54.6%) were similar. However, mothers of 72.7% of case infants
and 45.5% of control infants engaged in binge drinking during pregnancy.
Conditional logistic regression revealed significant associations between
SIDS and 2 or more layers of clothing on the infant (adjusted odds ratio [aOR],
6.2; 95% confidence interval [CI], 1.4-26.5), any visits by a public health
nurse (aOR, 0.2; 95% CI, 0.1-0.8), periconceptional maternal alcohol use (aOR,
6.2; 95% CI, 1.6-23.3), and maternal first-trimester binge drinking (aOR,
8.2; 95% CI, 1.9-35.3).
Conclusions Public health nurse visits, maternal alcohol use
during the periconceptional period and first trimester, and layers of
clothing are important risk factors for SIDS among Northern Plains Indians.
Strengthening public health nurse visiting programs and programs to reduce
alcohol consumption among women of childbearing age could potentially reduce
the high rate of SIDS.
JAMA. 2002;288:2717-2723
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Author/Article Information
Author Affiliations: Division of Reproductive Health, National Center
for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, Atlanta, Ga (Drs Iyasu and Hsia and Ms Randall);
Aberdeen Area Indian Health Service, Rapid City, SD (Dr Welty); Children's
Hospital Boston, Harvard Medical School, Boston, Mass (Dr Kinney); Harvard
Medical School, Boston, Mass (Dr Mandell); Massachusetts SIDS Center, Boston
Medical Center, Boston (Ms McClain); LCM Pathologists, PC, Sioux Falls, SD
(Dr Randall); Clinical Laboratory of the Black Hills, Rapid City, SD (Dr
Habbe); Department of Pathology, Providence Memorial Hospital, El Paso, Tex
(Dr Wilson); and National Institute of Child Health and Human Development,
National Institutes of Health, Bethesda, Md (Dr Willinger). Dr Iyasu is now
with the Division of Pediatrics, Office of Counter Terrorism and Pediatric
Drug Development, Center for Drug Evaluation and Research, Food and Drug
Administration, Rockville, Md.
Corresponding Author and Reprints: Solomon Iyasu, MBBS, MPH, Division
of Pediatrics, Office of Counter Terrorism and Pediatric Drug Development,
Center for Drug Evaluation and Research, Food and Drug Administration,
5A-33, HFD-960, 5600 Fishers Ln, Rockville, MD 20857 (e-mail:
IyasuS@cder.fda.gov).
Author Contributions: Study concept and design: Iyasu, L.
Randall, Welty, Kinney, B. Randall, Wilson, Willinger.
Acquisition of data: L. Randall, Welty, Kinney, B. Randall,
Wilson, Habbe.
Analysis and interpretation of data: Iyasu, Welty, Hsia, Kinney,
Mandell, McClain, Willinger.
Drafting of the manuscript: Iyasu, Welty, Wilson, Willinger.
Critical revision of the manuscript for important intellectual
content: Iyasu, L. Randall, Welty, Hsia, Kinney, Mandell, McClain, B.
Randall, Habbe, Willinger.
Statistical expertise: Iyasu, Hsia.
Obtained funding: Iyasu, Welty, Kinney, Willinger.
Administrative, technical, or material support: Iyasu, L. Randall,
Welty, Kinney, Habbe.
Study supervision: Iyasu, Welty, Willinger.
Funding/Support: This study was funded by the National Institute
of Child Health and Human Development, the Centers for Disease Control and
Prevention, and the Indian Health Service through interagency agreements.
The study would not have been possible without the collaboration and support
provided by the Aberdeen Area Tribal Chairmen's Health Board and the 10
participating tribal communities.
Acknowledgment: We would like to thank the Steering Committee for
the study and the Perinatal Infant Mortality Review Committee for their
guidance and contributions to the study and the staff at the Centers for
Disease Control and Prevention and the office of Epidemiology, Aberdeen Area
Indian Health Service, and the many families who participated in the study.
