© 1996 Oxford University Press
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Smoking during Pregnancy and Poor Antenatal Care: Two Major Preventable Risk Factors for Sudden Infant Death Syndrome
* Department of Epidemiology and Social Medicine 30623 Hannover, Germany.
**Institute for Legal Medicine 30623 Hannover, Germany.
Department of Paediatric Pulmonology, Hannover Medical School 30623 Hannover, Germany.
Lower Saxony Perinatal Working Group
Schlaud M (Department of Epidemiology and Social Medicine, Hannover Medical School, OE 5410, 30623 Hannover, Germany), Kleeman W J, Poets C F and Sens B. Smoking during pergnancy and poor antenatal care; two major preventable risk factors for sudden infant death synfroms. Itemational Journal of Epidemiology 1996; 25: 959–965.
BACKGROUND: In this case-control study on sudden infant death syndrome (SIDS), the magnitude of the risk factors ‘mataernal smoking during pergnancy’ and ‘poor anteratal care’ was assessed and the attributable proportions of SIDS incidence estimated.
METHODS: Perinatal data from 190 SIDS cases, who died between 1986 and 1990 at age >7 days and had a diagnosis of SIDS confirmed by autopsy, were compared to 5920 controls. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed by unconditional logistlc regression. The attributable risk per cent among the exposed AR%) and the population attributable risk per cent (PAR%) were calculated.
RESULTS: Maternal smoking during pregnancy was associated with a more than twofold risk of SIDS (OR = 2.4; 95% CI; 1.7–3.4) and showed significant does-response. Low numbers of antenatal care visits were also associated with an increased risk of SIDS; OR = 1.6 (95% CI: 1.1–2.3) for 4–8 consultations and 2.9 (95% CI: 1.4–5.8) for 0–3 consultations; reference: >8 consultations Maternal smoking during pregnancy yielded an AR% of 58% (95% CI:42–70) and a PAR% OF 28% (95% CI:16–40). The AR% for 
8 antenatal care visits versus >8 consultations was 41% (95% CI: 16–59); the PAR% 10% (95% CI; 3–17).
CONCLUSIONS: Assuming causality, our data suggest that a reduction of the prevalence of elther risk factor by population-based interventions may yield a worthwhile public health impact in terms of a substantially lower SIDS incidence.
Keywords sudden infant death, risk, smoking, antenatal care, public health
Revised 1 February 1996
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