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Smoking, intra-uterine growth retardation and sudden infant death syndrome
1Institute of Child Health, Liverpool, UK.
Insights
Maternal smoking is a significant risk factor for sudden infant death syndrome (SIDS), potentially explaining much of the SIDS risk linked to hidden growth retardation in infants.
Area of Science:
- Pediatrics
- Neonatal Health
- Public Health
Background:
- Sudden infant death syndrome (SIDS) is linked to maternal smoking and low birthweight.
- Subtle organ-level growth retardation in SIDS infants is often undetected clinically.
- Identifying hidden growth retardation and its association with maternal smoking is crucial.
Purpose of the Study:
- To investigate the association between maternal smoking and hidden growth retardation in SIDS infants.
- To quantify the contribution of maternal smoking to SIDS risk related to growth retardation.
Main Methods:
- A case-control study compared 104 SIDS victims with 206 controls.
- Infant birthweight, head circumference, and maternal smoking habits were recorded.
- Ratios for birthweight, head circumference, and overall growth retardation were calculated.
Main Results:
- No significant differences in growth ratios were found between SIDS and control groups overall.
- Infants of mothers who smoked exhibited significant growth retardation.
- SIDS was significantly associated with gestational age and maternal smoking, but not independently with birthweight ratios.
Conclusions:
- Maternal smoking is a primary contributor to SIDS risk associated with growth retardation.
- Hidden growth retardation in SIDS infants is largely explained by maternal cigarette use.
Background:
Sudden infant death syndrome (SIDS) is associated with factors such as maternal smoking and low birthweight, which may be linked causally. Recent pathological studies have shown evidence for growth retardation at organ level in SIDS infants whose weights at birth were above the tenth centile, and were not therefore recognized as growth retarded clinically. It might be of value to identify such hidden growth retardation at birth, and to have an estimate of how much of it may be associated with maternal cigarette smoking.
Methods:
104 SIDS victims who died between 1987 and 1992 and who were brought to a single children's hospital, were compared to 206 controls, matched for place and date of birth. Birthweight, occipitofrontal head circumference, maternal age, and smoking habit, and height and weight at booking were recorded. Birthweight ratio (BWR), head circumference ratio (OFCR), and a growth retardation ratio (GRR = OFCR/BWR) were computed for each infant.
Results:
No significant differences were seen between SIDS and control groups for BWR. OFCR or GRR. Separating smoking mothers from non-smokers in both groups showed significant growth retardation in smokers' children. SIDS infants of non-smokers as a group were not growth retarded, but had a lower gestational age at birth. Logistic regression analysis showed SIDS to be significantly related to gestation (OR 0.86/week) and smoking (OR 4.8), but not independently to BWR, maternal age or maternal body mass index (MBMI).
Conclusion:
Most of the risk of SIDS associated with growth retardation may be accounted for by maternal smoking.
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