Assessing disparities in infant safe sleep practice by maternal WIC status in Massachusetts

Background/Purpose: Non-supine infant sleep positions increase risk for sudden unexpected infant death (SUID). Disparities in safe sleep practices are associated with maternal income and race/ethnicity. WIC is a nutrition supplement program for low-income (185% Federal poverty line) pregnant and post-partum women and children up to age 5. Currently in Massachusetts (MA) ≈ 40% of pregnant/post-partum women are WIC clients. To inform development of a SUID intervention strategy, the MA Department of Public Health (MDPH) investigated the association between WIC status and infant safe sleep practices among post-partum MA mothers using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS is an annual statewide survey of mothers of infants conducted by the MDPH in conjunction with the CDC that includes questions about infant sleep position and mothers' prenatal WIC status. We used aggregate (2007-2010) data to estimate the relative risk (RR) of infant safe sleep position by WIC enrollment. Results/Outcomes: The weighted aggregate sample included 276,252 women (≈ 69,063 women/year; mean response rate 68%). The crude RR that WIC (vs. non-WIC) mothers most often placed their infants in supine sleeping positions was 0.81 (95% CI: 0.77, 0.84; p= .0001). Significant differences were found for each year, although convergent trends were observed. Conclusion: MA WIC mothers more frequently reported placing their babies in non-supine positions compared with non-WIC mothers. Given the statewide infrastructure and large proportion of MA pregnant/post-partum women enrolled in WIC, these findings indicate the potential effectiveness of WIC-based safe sleep interventions as a SUID reduction strategy.