Study Identifies SIDS Risk Factors
Among American Indian Infants
A study of Northern Plains Indians
found that infants were less likely to die of Sudden Infant
Death Syndrome (SIDS) if their mothers received visits from
public health nurses before and after giving birth.
The Aberdeen Area Infant Mortality
Study, appearing in the December 4 Journal of the American
Medical Association, also found that binge drinking (five
or more drinks at a time) during the mother's first trimester
of pregnancy made it eight times more likely that her infant
would die of SIDS. Any maternal alcohol use during the periconceptional
period (three months before pregnancy or during the first
trimester) was associated with a six-fold increased risk of
SIDS. The study also found that infants were more likely to
die of SIDS if they wore two or more layers of clothing while
they slept.
"This study has identified important
risk and protective factors for SIDS among this group of American
Indians," said Solomon Iyasu, MBBS, MPH, an epidemiologist
with the reproductive health program at the CDC, and lead
author of the study. "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."
The Aberdeen study was funded by three
agencies of the Department of Health and Human Services: the
Indian Health Service (IHS), the National Institute of Child
Health and Human Development (NICHD) of the National Institutes
of Health, and the Centers for Disease Control and Prevention
(CDC). The study was carried out by a consortium of researchers
at the Aberdeen Area of the Indian Health Service, the NICHD,
the CDC, Boston Children's Hospital, Harvard Medical School,
and the Massachusetts SIDS Center.
The study analyzed 33 SIDS infant
deaths between 1992 and 1996 and 66 control infants, who were
matched for postnatal age and community of residence.
Infants in homes where a public health
nurse had visited before or after birth were 80 percent less
likely to die from SIDS than babies in homes that never had
such visits - but the study's authors were unable to draw
a conclusion about what aspects of the nurse's visit helped.
The IHS currently recommends that public health nurses make
one prenatal home visit and visits at one and six weeks postpartum.
"The proportion of women who
drank in the study declined markedly after the first trimester-indicating
that the majority of women stopped drinking once they learned
they were pregnant," said Dr. Marian Willinger, Ph.D,
Special Assistant for SIDS at NICHD and a study author. "However,
there is a risk for SIDS associated with maternal drinking
in the period when women may not know they are pregnant."
Wearing two or more layers of clothing
(not including a diaper) increased a baby's risk for SIDS
more than six-fold, the researchers found. This is consistent
with other studies showing that excess thermal insulation
for a specific room temperature was associated with increased
SIDS risk.
"Parents should dress their babies
lightly for sleep and maintain a comfortable room temperature.
Overdressing them can result in potentially dangerous overheating",
said Leslie Randall, RN, MPH, an epidemiologist with CDC,
member of the Nez Perce Tribe, and co-Principal Investigator
for the Aberdeen Area Infant Mortality Study while at IHS.
The rate of SIDS among American Indians
is the highest of any population group and was slightly more
than double that of whites in 1999 - 1.5 SIDS deaths per 1,000
live births compared with 0.7 per 1,000. The rate of SIDS
in the Aberdeen Area of the Indian Health Service, which serves
reservations in North and South Dakota, Nebraska and Iowa,
is the highest of all of the 12 IHS regions. During 1996 to1998,
the most recent data on infants available from the AAIHS,
the rate of SIDS was 3.5 deaths for every 1,000 live births.
The Aberdeen Area Tribal Chairman's
Health Board assisted in the study's design and implementation.
Parents willingly participated in the study and were interviewed
by American Indian nurses to help identify factors that contribute
to the high rates of SIDS in their communities. Nine tribes
and one urban American Indian community participated in the
study.
The HHS-supported Back to Sleep Campaign
recommends that all infants be placed on their backs for sleep
to reduce the risk of SIDS. Visit http://www.nichd.nih.gov/sids/
for more information.
A copy of the Aberdeen
Area Infant Mortality Study is available from a related
press release on the IHS website at: http://www.ihs.gov/PublicInfo/PublicAffairs/PressReleases/Press_Release_2002/
Release_21_Aberdeen_SIDS_Study_2002.asp
To print a .pdf copy of this release, click
here.
For additional information about
the CDC, visit their website at: www.cdc.gov;
about the IHS, visit their website at: www.ihs.gov;
and about NICHD, visit their website at: www.nichd.nih.gov
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