RELATIONSHIP OF MATERNAL SUBSTANCE-ABUSE TO SUBSEQUENT SUDDEN-INFANT-DEATH-SYNDROME IN OFFSPRING

To assess the possible relationship between maternal drug use during p regnancy and subsequent sudden infant death syndrome (SIDS), we identi fied 1760 cases of SIDS from a population of more than 1.2 million inf ants (1.45/1000) born in New York City between 1979 and 1989. The SIDS rate in drug-exposed infants was 5.83 per 1000 infants, compared with 1.39 per 1000 infants who were not drug exposed. With control for kno wn associated high-risk variables, the risk ratio for SIDS in each ind ividual drug group (methadone, 3.6; heroin, 2.3; methadone and heroin, 3.2; cocaine, 1.6; cocaine and methadone or heroin, 1.1) was higher t han in the non-drug-exposed group. Higher rates of SIDS were found in infants exposed to opiates alone than in cocaine-exposed infants, but increasing rates of SIDS in cocaine-exposed infants toward the end of the decade suggested that ''crack'' cocaine may be linked to these inc reasing rates. Declines in the overall rate of SIDS during the decade were observed for both the drug-exposed (11.28 to 4.09 per 1000) and t he nonexposed groups (1.70 to 1.05 per 1000). Differences in rates of SIDS between major racial-ethnic groups in nonexposed infants were not apparent if the mothers used drugs during pregnancy. Seasonal variati on and distribution of ages at time of SIDS death did not differ betwe en the drug-exposed group and the nonexposed group, suggesting that dr ug-associated SIDS may provide clues as to the cause or causes of SIDS .