Maternal substance use during pregnancy and increased risk of sudden infant death syndrome among African Americans

Sudden infant death syndrome (SIDS) is the leading cause of death among infants one month to one year of age. African American infants are twice as likely to die from SIDS as White infants. We sought to determine if maternal prenatal drug use contributes to the excess risk of SIDS among African Americans and if this is independent of smoking. Data from the Chicago Infant Mortality Study were analyzed for 260 infants who died from SIDS and 260 matched living controls. 75% of the cases and controls were Black. Maternal smoking was more common among SIDS infants than control infants (49% vs. 19%, P<.001), and more common among Black SIDS infants than among Whites (54% vs. 32%, P = .003). Maternal drug use was also more common among Black SIDS infants (40% vs. 3%, P<.001). Cocaine was the most commonly reported drug (32% versus 3%, P<.001). Smoking was associated with increased risk of SIDS (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.7-7.4) among Blacks. Similar results were found in multivariable analysis. Cocaine use in pregnancy among Blacks, adjusted for smoking, sleep environment, and other potential confounders, was associated with increased risk (OR 3.5, 1.3-9.3). The higher prevalence of smoking and cocaine use among mothers of African American infants who died from SIDS may account in part for the racial disparity in SIDS. Clinicians and programs need to identify at-risk patients and offer interventions that will benefit their health as well reduce the risk of SIDS among their newborn infants.