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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.