Sudden Infant Death Services of

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					Sudden Infant Death Services of the
   2700 S. Quincy St. Suite 220
       Arlington VA 22206
     Betty Connal, RN, MS
      March of Dimes Summit
         Washington D.C.
           June 22 2007
      Pregnancy and Smoking
• Every day in Washington D.C., 153 babies are
• 22 of them are born prematurely
• 2 of them die before their first birthday
• 16.2 % of women smoke cigarettes
• Smoking is an important determinant of health
  status and a major contributor to prematurity,
  low birth weight and SIDS
    Interventions that work to reduce
      prematurity and infant deaths
• Early, comprehensive, accessible prenatal care
• Educate all pregnant women about preterm labor signs and
• Screen and treat all UTIs and STIs
• Identify cigarette smokers and intervene (5As)
•   Assess for alcohol use and intervene
•   Identify illicit substance users and intervene
•   Assess for domestic violence and intervene
•   Eliminate folic acid deficiency
•   Reduce major stress levels early and throughout pregnancy
        Smoking and Pregnancy
• Smoking during pregnancy is responsible for:
   – 20% of all LBW
   – 8% of preterm births
   – 5% of all perinatal deaths
• Pregnant smokers compared to nonsmokers are:
   – 2.0-5.0 times as likely to experience PPROM
   – 1.2-2.0 times as likely to deliver preterm
   – 1.5-10 times as likely to deliver a SGA infant
   – 1.5-3.5 times as likely to deliver a LBW infant
       Smoking and Pregnancy
• Smoking increases risk of stillbirth (RR=1.4-1.6)
   – Risk increases with increased amount smoked
• Smoking during and after pregnancy triples risk
  for SIDS
• Babies whose mothers smoke have a 4 times
  greater risk of SIDS
• Babies in smoking environments have twice the
  risk of SIDS
Smoking and Pregnancy
      Smoking and Pregnancy
Black smokers had substantially higher
  cotinine concentrations at all levels of
  cigarette smoking than White smokers.

                            Caraballo, JAMA 280:135, 1998
      Smoking and Pregnancy
• Smoking is the most modifiable risk factor for
  poor birth outcomes
• Successful treatment of tobacco dependence can
  – 20% reduction in low–birth-weight babies
  – 17% decrease in preterm births
  – Average increase in birth weight of 28 g
    Smoking Risks in Pregnancy
• Ectopic pregnancy
• Intrauterine growth
• Placenta previa
• Abruptio placentae
• Spontaneous abortion
• Preterm delivery
• SIDS (up to 4 times greater
  occurrence in smoking
Smoking and Child Health
Cost of   Complicated*   Births
 Intervention Makes a Difference
• Smoking cessation
  intervention by clinicians
  improves quit rates
• Brief counseling (5 to 15
  minutes total) is all that
  is needed to help many
  pregnant smokers quit
• A woman is more likely
  to quit smoking during
  pregnancy than at any
  other time in her life
                    The 5 A’s
•   1. Ask about tobacco use
•   2. Advise to quit
•   3. Assess willingness to make a quit attempt
•   4. Assist in quit attempt
•   5. Arrange follow-up
Quitline 1-800-QUITNOW
  deaths have
  deaths from
  have gone
   • The American
 Academy of Pediatrics
does NOT recommend
• The safest place for
 baby to sleep is in his
  own crib in the same
  room with his or her
 mother, but NOT the
       same bed.
• If you must bedshare:
• Your bed must be absolutely safe for your
  baby. The best choice is to place the mattress
  on the floor, making sure there are no crevices
  that your baby can become wedged in. Make
  certain your mattress is flat, firm, and smooth.
  Do not allow your baby to sleep on a soft
  surface such as a waterbed, sofa, pillow-top
  mattress, or any other flexible surface.
• If your bed is raised off the floor, use mesh
  guardrails to prevent Baby from rolling off the
  bed, and be especially careful that there is no
  space between the mattress and headboard or
  footboard. (Some guardrails designed for older
  children are not safe for babies because they
  have spaces that could entrap babies.)
• If your bed is placed against a wall or other furniture, check
  every night to be sure there is no space between the
  mattress and wall or furniture where baby could become stuck.
• Infants should be placed between their mother and the wall
  or guardrail. Fathers, siblings, and grandparents don't have the
  same instinctual awareness of a baby’s location as mothers do.
  Mothers, your little one should be able to awaken you with a
  minimum of movement or noise. If you find that you are such a
  deep sleeper that you only wake when your baby lets out a loud
  cry, you should move Baby out of your bed, perhaps into a
  cradle, playyard or crib near your bedside.
• Do not ever sleep with
  your baby if you have been
  drinking alcohol, have used
  any drugs or medications, are
  an especially sound sleeper or
  if you are suffering from
  sleep deprivation and find it
  difficult to awaken. Do not
  bedshare if anybody in
  your house smokes.
• Do not sleep with your baby if you are a large
  person, as a parent’s excess weight has been
  determined to pose a risk to Baby in a co-sleeping
  situation. If Baby rolls towards you, if there is a large
  dip in the mattress, or if you suspect any other
  dangerous situations, play it safe and move Baby to a
  bedside crib or cradle.
• Do not allow pets to sleep in bed with your baby.
• Other children in the bed make the bed dangerous
  for Baby.
• Remove all pillows and blankets
  from the bed. Dress Baby and
  yourselves appropriately for
  sleep. Keep in mind that body
  heat will add warmth during the
  night. Make sure your baby
  doesn’t become overheated.
  Consider using a blanket sleeper
  like this one
• Make sure that your young baby
  is sleeping on his or her back –
  the safest position for sleep.
• Never leave your baby alone in
  an adult bed.
Bedsharing and Twins

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