Prenatal substance use may increase sudden unexpected infant death risks through unsafe sleep practices: Study

A recent study used data from the Sudden Death in the Young Registry and highlighted the startling link between maternal substance use during pregnancy and increased risks of sudden unexpected infant death (SUID), particularly through unsafe sleep environments and social vulnerabilities. After analyzing cases from 2015 to 2020, the study published in the Pediatrics journal identified critical differences in sleep-related SUID among infants who were prenatally exposed to substances when compared to the ones not exposed.

Of the 2,010 infant sleep-related deaths studied, 283 (14%) involved infants exposed to substances prenatally. The data revealed that more than half of all deaths occurred in hazardous sleep environments, such as adult beds (52%) or when surface sharing with adults (53%). These risks were disproportionately higher among infants with prenatal substance exposure by suggesting the need for targeted prevention measures.

One of the most concerning findings was the impairment of supervisors at the time of infant death. Among prenatally exposed cases, 34% of supervisors were impaired (e.g., under the influence of drugs or alcohol) when compared to 16% of non-exposed cases. This points to the necessity of support systems to ensure safe infant care during periods when parents or caregivers might be unable to provide attentive supervision.

Beyond the immediate sleep environment, the study also identified stark social vulnerabilities contributing to these outcomes. Families impacted by prenatal substance use were significantly more likely to undergo barriers such as limited access to health care, involvement with child welfare systems, intimate partner violence, and inadequate insurance coverage. These factors collectively exacerbate the risks of unsafe sleep practices and SUID. 

The study emphasize that addressing these disparities requires a two-pronged approach, one being the targeted safe sleep education and the other by tackling the underlying social determinants of health. Safe sleep messaging should focus on discouraging adult bed-sharing and surface sharing, along with promoting the use of cribs or bassinets for infants. Support systems must be engaged to assist families during periods of impairment.

Also, the structural support is crucial where the families must have improved access to health care, safe sleep materials (like cribs), and interventions to reduce social vulnerabilities like addressing intimate partner violence and ensuring stable insurance coverage. Overall, this study brings out the importance of tailoring prevention efforts to meet the unique needs of substance-affected families.

Reference:

Deutsch, S. A., Loiselle, C. E., Hossain, J., & De Jong, A. (2024). Sleep-Related Sudden Unexpected Infant Death Among Infants Prenatally Substance Exposed. In Pediatrics. American Academy of Pediatrics (AAP). https://doi.org/10.1542/peds.2024-067372