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Maternal mental health and substance use disorders in sudden unexpected death in infancy using routinely collected health data in New Zealand, 2000–2016
  1. Edwin A Mitchell1,
  2. Doney Zhang2,
  3. John M D Thompson1,
  4. Chris Liu2,
  5. Alison Leversha3,
  6. Barry J Milne2
  1. 1 Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  2. 2 Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
  3. 3 Community Paediatrics, Auckland District Health Board, Auckland, New Zealand
  1. Correspondence to Dr Edwin A Mitchell, Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand; e.mitchell{at}auckland.ac.nz

Abstract

Background Mortality from sudden unexpected death in infancy (SUDI) has declined dramatically since the ‘Back to Sleep’ campaign. Deaths now are more prevalent in those with socioeconomic disadvantage. The investigation of SUDI frequently identifies parents that have mental health or drug, alcohol and addiction problems.

Aims To estimate the prevalence of maternal mental health and substance use disorders and assess the magnitude of their risk for SUDI.

Methods We conducted a population-based cohort study using data from the Integrated Data Infrastructure (IDI), a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2000 to 2016. The exposures of interest were maternal mental health problems and maternal substance use disorders in the year prior to the birth. The outcome was deaths from SUDI.

Results The total population was 1086 504 live births and of these 1078 811 (99.3%) were able to be linked to other data sets within the IDI. The prevalence of maternal mental health problems in the total population was 5.2% and substance use disorder was 0.7%. There were 42 deaths from SUDI (0.75/1000) that were exposed to maternal mental illness and 864 deaths (0.84/1000) that were not exposed (adjusted relative risk (aRR)=1.23, 95% CI 0.90 to 1.68). There were 21 deaths from SUDI (2.67/1000) that were exposed to maternal substance use disorders and 885 (0.83/1000) that were not exposed (aRR=1.82, 95% CI 1.17 to 2.83).

Conclusions Maternal substance use disorders, but not maternal mental health problems, in the year prior to the child’s birth was associated with an increased risk of SUDI. However, the numbers that are affected are small and the effect size moderate. This group of women should receive additional SUDI prevention services and Safe Sleep advice.

  • Mental health
  • Child Health
  • Epidemiology
  • Infant Welfare
  • Paediatrics

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are held with the Integrated Data Infrastructure and are managed by Statistics New Zealand. These data are publicly available, although access is restricted. Please see https://www.stats.govt.nz/integrated-data/integrated-data-infrastructure/ for more details.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are held with the Integrated Data Infrastructure and are managed by Statistics New Zealand. These data are publicly available, although access is restricted. Please see https://www.stats.govt.nz/integrated-data/integrated-data-infrastructure/ for more details.

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Footnotes

  • Twitter @alisonleversha

  • Contributors EAM conceptualised the study, helped to design the study, obtained ethical approval, advised on the analyses, wrote the first draft and as the guarantor accepts full responsibility for the finished work and the conduct of the study, had access to the data, and controlled the decision to publish. DZ and CL undertook the preliminary statistical analyses. JMDT helped to design the study, advised on the statistical analyses and critically reviewed the manuscript. AL helped to design the study and critically reviewed the manuscript. BJM helped to design the study, led the analysis of the study and critically reviewed the manuscript.

  • Funding The study was funded by Cure Kids (grant number 3583) and the University of Auckland Faculty Research and Development Fund (grant number 3714730).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.