Maternal and infant characteristics associated with accidental suffocation and strangulation in bed in US infants

To identify maternal and infant characteristics associated with accidental suffocation and strangulation in bed (ASSB) in US infants. Using 2000-2002 US linked infant birth and death certificate cohort files, we compared ASSB deaths to survivors. Adjusted odds ratios (aOR) from logistic regression were used to analyze associations between selected maternal and infant characteristics and ASSB mortality. During 2000-2002, 1,064 infants died from ASSB, resulting in an ASSB mortality rate of 9.2 per 100,000 live births. Most ASSB deaths (71%) occurred before an infant reached 4 months old. Maternal factors associated with an increased risk of ASSB were younger age (using maternal age of 25-29 years as reference aOR 2.6 for mothers <20 years old and 1.6 for mothers 20-24 years old), lower educational attainment (aOR 4.3 for <12 years and 3.3 for 12 years compared to ≥16 years), multiparity (aOR 1.7, 2.2, and 3.5 for parity 2, 3, and 4 or higher, respectively) and smoking during pregnancy (aOR 2.8). Compared to non-Hispanic whites, non-Hispanic blacks (aOR 1.8) and American Indians (aOR 1.8) were more likely to have an ASSB death. Being male and born preterm were also associated with a higher ASSB mortality risk. Younger, less educated, mulitparous, non-Hispanic black or American Indian women and their families who smoke during their pregnancy and deliver male or preterm infants, may need more intense safe sleeping education during the infant's first year of life, especially during the first 4 months of age.