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High parity poses greatest SIDS risk in offspring.(Obstetrics)
WASHINGTON -- High parity has replaced preterm delivery as the greatest risk factor for SIDS, according to a study of national data, presented at the annual meeting of the Pediatric Academic Societies.
"Our highest single risk factor was high parity," said Donna R. Halloran, M.D., of the University of Alabama, Birmingham. Mothers with a parity of five or greater were 3.6 times more likely to have an infant die of SIDS.
The shift follows an epidemiologic shift in SIDS deaths that occurred in the mid-1990s. In 1991, 1.2 cases of SIDS occurred for every 1,000 live births in the United States. By 1996, the number had dropped dramatically, to 0.7 cases for every 1,000 live births. In 2002, there were 0.6 cases for every 1,000 live births.
The decrease in SIDS deaths has been attributed to the National Institute of Child Health and Human Development's "Back to Sleep" educational campaign initiated in 1994. The number of parents putting their infants in a prone sleep position dropped dramatically. In 1992, 70% of infants were sleeping in a prone position, compared with 18% in 1996.
The study population included all singleton live births in the United States from 1996 to 1998. These data came from the National Center for Health Statistics birth cohort (with linked birth and death files). Infants were excluded if their gestation was less than 22 weeks or greater than 44 weeks. Multiple gestations also were excluded, as were infants of nonresident mothers.
The multivariate analysis model included maternal variables--race/ethnicity, education, age, marital status, smoking, alcohol use, diabetes, hypertension, and parity. The model also included infant gender, region of birth, fetal growth, and gestation. Fetal growth was defined as birth weight given the length of gestation: small (lower-10th percentile), appropriate, and large (upper-10th percentile).
A total of 8,199 deaths due to SIDS were identified for a rate of 0.72 deaths per 1,000 live births. High parity may have replaced preterm delivery as the greatest risk factor, but preterm birth still is a strong predictor of SIDS risk. Infants less than 32 weeks gestational age were three times more likely to die of SIDS, compared with those born at the gestational ...
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