Risk factors for sudden infant death syndrome among northern plains Indians.
BACKGROUND
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.


METHODS
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.


METHODS
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.
Iyasu
Solomon
S
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga, USA. IyasuS@cder.fda.gov
Randall
Leslie L
LL
Welty
Thomas K
TK
Hsia
Jason
J
Kinney
Hannah C
HC
Mandell
Frederick
F
McClain
Mary
M
Randall
Brad
B
Habbe
Don
D
Wilson
Harry
H
Willinger
Marian
M
D000428:Alcohol Drinking; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007223:Infant; D007224:Infant Care; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D013398:Sudden Infant Death / Q000453:epidemiology / Q000208:ethnology*; D014481:United States / Q000453:epidemiology