The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome.
OBJECTIVE
To examine the relationship between sudden infant death syndrome (SIDS) and smoking during pregnancy; postnatal tobacco smoke exposure from the mother, father, live-in-adults, and day care providers; and postnatal smoke exposure from breast-feeding.


METHODS
Case-control study.


METHODS
Five counties in Southern California.


METHODS
A total of 200 white, African-American, Hispanic, and Asian parents of infants who died of SIDS between 1989 and 1992 were compared with 200 control parents who delivered healthy infants. Case infants were matched to control infants on the basis of birth hospital, birth date, gender, and race. All information was obtained from a detailed telephone interview and validated with medical records.


METHODS
Risk of SIDS associated with passive smoking by the mother, father, live-in adults, and day care providers; smoking in the same room as the infant; total number of cigarettes smoked by all adults; and maternal smoking during the time period of breast-feeding.


RESULTS
Conditional logistic regression resulted in overall adjusted odds ratios (ORs) for SIDS associated with passive smoke from the mother of 2.28, the father of 3.46, other live-in adults of 2.18, and all sources of 3.50 (95% confidence interval, 1.81 to 6.75), while simultaneously adjusting for birth weight, sleep position, prenatal care, medical conditions at birth, breast-feeding, and maternal smoking during pregnancy. A dose-response effect was noted for SIDS associated with increasing numbers of cigarettes, as well as total number of smokers. Breast-feeding was protective for SIDS among nonsmokers (OR = 0.37) but not smokers (OR = 1.38), when adjusting for potential confounders.


CONCLUSIONS
Passive smoking in the same room as the infant increases the risk for SIDS. Physicians should educate new and prospective parents about the risk of tobacco smoke exposure during pregnancy and the first year of the infant's life.
Klonoff-Cohen
H S
HS
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093-0607.
Edelstein
S L
SL
Lefkowitz
E S
ES
Srinivasan
I P
IP
Kaegi
D
D
Chang
J C
JC
Wiley
K J
KJ
D001942:Breast Feeding; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008895:Milk, Human / Q000378:metabolism; D010947:Plants, Toxic; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D012907:Smoking / Q000378:metabolism; D013398:Sudden Infant Death / Q000453:epidemiology*; D014026:Nicotiana / Q000378:metabolism; D014028:Tobacco Smoke Pollution
D014028:Tobacco Smoke Pollution