Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring

doi:10.1016/S0022-3476(05)81554-9

The Journal of Pediatrics

Volume 123, Issue 1, July 1993, Pages 120-126

https://doi.org/10.1016/S0022-3476(05)81554-9 Get rights and content

To assess the possible relationship between maternal drug use during pregnancy and subsequent sudden infant death syndrome (SIDS), we identified 1760 cases of SIDS from a population of more than 1.2 million infants (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 known associated high-risk variables, the risk ratio for SIDS in each individual 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 than in the non-drug-exposed group. Higher rates of SIDS were found in infants exposed to oplates 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 increasing 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 the 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 variation and distribution of ages at time of SIDS death did not differ between the drug-exposed group and the nonexposed group, suggesting that drug-associated SIDS may provide clues as to the cause or causes of SIDS.

References (22)

KahnEJ et al.
The course of the heroin withdrawal syndrome treated with phenobarbital or chlorpromazine
J Pediatr
(1969)
RajegowdaBK et al.
Sudden unexpected death in infants of narcotic-dependent mothers
Early Hum Dev
(1978)
FinneganLP
In utero opiate exposure and sudden infant death syndrome
Clin Perinatol
(1979)
ChavezCJ et al.
Sudden infant death syndrome among infants of drug-dependent mothers
J Pediatr
(1979)
DurandDJ et al.
Association between perinatal cocaine exposure and sudden infant death syndrome
J Pediatr
(1990)
BauchnerH et al.
Risk of sudden infant death syndrome among infants with in utero exposure to cocaine
J Pediatr
(1988)
OlsenGD et al.
Ventilatory response to carbon dioxide of infants following chronic prenatal methadone exposure
J Pediatr
(1980)
SchwartzPJ
Cardiac sympathetic innervation and the sudden infant death syndrome
Am J Med
(1976)
DickerM et al.
Trends in diagnosed drug problems among newborns: United States, 1979–1987
Drug Alcohol Depend
(1991)
ChaneyNE et al.
Cocaine convulsions in a breast-feeding baby
J Pediatr
(1988)

PiersonPS et al.

Sudden deaths in infants born to methadone-maintained addicts

JAMA

(1972)

Cited by (137)

Placental DNA methylation profiles in opioid-exposed pregnancies and associations with the neonatal opioid withdrawal syndrome
2021, Genomics
Opioid abuse during pregnancy can result in Neonatal Opioid Withdrawal Syndrome (NOWS). We investigated genome-wide methylation analyses of 96 placental tissue samples, including 32 prenatally opioid-exposed infants with NOWS who needed therapy (+Opioids/+NOWS), 32 prenatally opioid-exposed infants with NOWS who did not require treatment (+Opioids/-NOWS), and 32 prenatally unexposed controls (-Opioids/-NOWS, control). Statistics, bioinformatics, Artificial Intelligence (AI), including Deep Learning (DL), and Ingenuity Pathway Analyses (IPA) were performed. We identified 17 dysregulated pathways thought to be important in the pathophysiology of NOWS and reported accurate AI prediction of NOWS diagnoses. The DL had an AUC (95% CI) =0.98 (0.95–1.0) with a sensitivity and specificity of 100% for distinguishing NOWS from the +Opioids/-NOWS group and AUCs (95% CI) =1.00 (1.0–1.0) with a sensitivity and specificity of 100% for distinguishing NOWS versus control and + Opioids/-NOWS group versus controls. This study provides strong evidence of methylation dysregulation of placental tissue in NOWS development.
After NAS
2019, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Whether there are inherent risks within opioid-exposed children to increase their risk of mortality are unclear and needs further study. Death from Sudden Infant Death Syndrome (SIDS) may be up to 10-times higher in infants of substance-using mothers [27] as well as fathers [28] than in the general population. The exact cause of this is unclear and may be due to a combination of physiological differences as well as environmental factors (e.g. safe sleeping techniques, parenting behavior, etc).
Mothers have used opioids for thousands of years but neonatal abstinence syndrome (NAS) or rather, survivors of NAS, is a modern phenomenon. Unrecognized and/or untreated opioid withdrawal was almost always fatal but with greater awareness and standardization of treatment, NAS is now an uncommon direct cause of infant death. However, opioids are now increasingly accessible and potent and the outcomes of children after the neonatal period are of great concern, especially when coupled with multiple other social and health risks. Complex individual, environmental and genetic factors need to be considered when assessing outcomes or future research for babies with NAS. Any intervention or research efforts must address these multifactorial complexities. This review will discuss pertinent post neonatal outcomes, including mortality, physical and mental health and social functioning of children with a history of NAS.
Neonatal abstinence syndrome
2019, Seminars in Perinatology
Neonates exposed prenatally to opioids will often develop a collection of withdrawal signs known as neonatal abstinence syndrome (NAS). The incidence of NAS has substantially increased in recent years placing an increasing burden on the healthcare system. Traditional approaches to assessment and management have relied on symptom-based scoring tools and utilization of slowly decreasing doses of medication, though newer models of care focused on non-pharmacologic interventions and rooming-in have demonstrated promise in reducing length of hospital stay and medication usage. Data on long-term outcomes for both traditional and newer approaches to care of infants with NAS is limited and an important area of future research. This review will examine the history, incidence and pathophysiology of NAS. We will also review diagnostic screening approaches, scoring tools, differing management approaches and conclude with recommendations for continued work to improve the care of infants with NAS.
Maternal Codeine and Its Effect on the Fetus and Neonate: A Focus on Pharmacogenomics, Neuropathology, and Withdrawal
2016, Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions
Codeine is widely prescribed during pregnancy and the postpartum period for pain control. Studies have shown an association between maternal codeine during early pregnancy and major congenital anomalies, especially cardiac and neural tube defects. Breastfeeding is considered safe while taking codeine; however, rare and serious side effects such as respiratory depression and death have been reported in exclusively breastfed infants. This risk of opioid toxicity depends on the dose of codeine, amount of breast milk intake, maternal genotype for CYP2D6, and ethnicity. Neonates can also present with signs of codeine withdrawal syndrome, especially if the mother was on prolonged codeine intake during pregnancy. Therefore, counseling should be done regarding the potential benefits and side effects of codeine to all women taking codeine during pregnancy and the postpartum period. Codeine can be given at the lowest effective dose and preferably for short duration (<4 days) in breastfed mothers to reduce neonatal side effects.
Fetal and Infant Effects of Maternal Opioid Use during Pregnancy: A Literature Review including Clinical, Toxicological, Pharmacogenomic, and Epigenetic Aspects for Forensic Evaluation
2024, Children
A retrospective review of methylamphetamine detected in child deaths reported to the Victorian Coroner, Australia
2024, Forensic Science, Medicine, and Pathology

View all citing articles on Scopus

^*: Presented in part at the American Pediatric Society-Society for Pediatric Research, New Orleans, La., April 28 to May 2, 1991.

View full text

Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring*

J Pediatr

Early Hum Dev

Clin Perinatol

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Am J Med

Drug Alcohol Depend

J Pediatr

Sudden deaths in infants born to methadone-maintained addicts

JAMA