Maternal infections in pregnancy and the risk of sudden unexpected infant death in the offspring in the U.S., 2011-2015

Abstract

Background Infection is thought to play a part in some infant deaths. Maternal infection in pregnancy has focused on chlamydia with some reports suggesting an association with sudden unexpected infant death (SUID). Objectives We hypothesized that maternal infections in pregnancy are associated with subsequent SUID in their offspring. Setting All births in the United States, 2011-2015 Data source Centers for Disease Control and Prevention (CDC) Birth Cohort Linked Birth-Infant Death Data Files. Study design Cohort study, although the data were analysed as a case control study. Cases were infants that died from SUID. Controls were randomly sampled infants that survived their first year of life; approximately 10 controls per SUID case. Exposures Chlamydia, gonorrhea and hepatitis C. Results There were 19, 849, 690 live births in the U.S. for the period 2011-2015. There were 37, 143 infant deaths of which 17, 398 were classified as SUID cases (a rate of 0.86/1000 live births). The proportion of the control mothers with chlamydia was 1.7%, gonorrhea 0.2% and hepatitis C was 0.3%. Chlamydia was present in 3.8% of mothers whose infants subsequently died of SUID compared with 1.7% of controls (unadjusted OR = 2.35, 95% CI = 2.15, 2.56; adjusted OR = 1.08, 95% CI = 0.98, 1.19). Gonorrhea was present in 0.7% of mothers of SUID cases compared with 0.2% of mothers of controls (OR = 3.09, (2.50, 3.79); aOR = 1.20(0.95, 1.49)) and hepatitis C was present in 1.3% of mothers of SUID cases compared with 0.3% of mothers of controls (OR = 4.69 (3.97, 5.52): aOR = 1.80 (1.50, 2.15)). Conclusions The marked attenuation of SUID risk after adjustment for a wide variety of socioeconomic and demographic factors suggests the small increase in the risk of SUID of the offspring of mothers with infection with hepatitis C in pregnancy is due to residual confounding.