Alcohol use and sudden infant death syndrome

Parental alcohol and drug abuse and offspring mortality by age 10: a population-based register study

BACKGROUND

Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce.

METHODS

Using population-based register data on all births in Sweden in 1973-2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother's and father's SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood.

RESULTS

Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1-9. Risk of SIDS was 130-280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40-174% higher mortality due to accidents in infancy and in ages 1-9. The associations between parental SA and offspring mortality were similar for male and female offspring.

CONCLUSIONS

Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.

High-intensity drinking by parental status: Differences by age and sex

AIMS

To examine differences in high-intensity drinking (HID) by parental status, parent age, and parent sex, including two- and three-way interaction effects of these parent demographic categories.

METHODS

The present study included individuals ages 18-50 from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012-13), a sample of non-institutionalized adults in the US (N = 22,278). We calculated weighted estimates of past-year HID (≥10/≥8 standard drinks for men/women on a single occasion) for each parental status group (parents of young children <5, parents of children 5-17, not parents of children <18) overall and stratified by sex and stratified by age. We then examined the overall association of parental status and HID and tested for interactions of parental status × sex, parental status × age, and parental status × age × sex, while controlling for other relevant sociodemographic characteristics.

RESULTS

Prevalence of HID varied considerably by parental status, with 14.84% of parents with kids under age 5, 12.72% of parents with kids 5 to 17, and 23.15% of non-parents reporting HID. The strength of the associations of parenthood and HID were strongest for females and for older parents.

CONCLUSIONS

While parents engage in HID less than those who are not parents, a portion of parents of young and adolescent children do report heavy drinking. Younger parents and male parents, in particular, are at high risk for HID. Given the risks to children and parents, interventions focused on preventing HID among parents, especially fathers, could have significant public health impacts.

Identifying infants at risk for sudden infant death syndrome

PURPOSE OF REVIEW

This review examines recent research relevant to the underlying pathophysiology and risk factors for sudden infant death syndrome.

RECENT FINDINGS

Current research focuses on the linkage between known risk factors and vulnerability, genetic contributions, and the role of dysfunctional brainstem neurotransmission in the pathogenesis of this syndrome. While social inequalities, prematurity, maternal smoking, infant sleeping practices and sleep environment, arousal failures and environmental pollutants remain important risk factors, new evidence is emerging that certain genetic polymorphisms may contribute to vulnerability. New neuropathological studies have provided strong support for abnormal brainstem serotonergic function. Since serotonin influences a wide range of physiological systems including breathing, the cardiovascular system, temperature, and sleep-wake cycles, this finding strongly supports the hypothesis that sudden infant death syndrome is the result of dysregulation of the autonomic nervous system and provides biological plausibility for certain risk reduction strategies.

SUMMARY

Despite a putative diagnostic shift, sudden infant death syndrome remains the most common cause of death from 1 month to 1 year of age. Recent studies confirmed established risk factors and have suggested new genetic vulnerabilities. Finally, new evidence supports a key role for abnormalities in brainstem serotonin systems in the pathophysiology of this syndrome.