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Combining smoking and drinking when pregnant causes an increased risk of SIDS

New research shows that infants exposed to a combination of alcohol and smoking during pregnancy have an increased risk of SIDS.

Sudden infant death syndrome (SIDS) is defined as the sudden and unexplained death of a baby less than one year old where no cause is found. Boys are seen to be at slightly greater risk than girls and over a third of SIDS cases could be avoided if all women abstained from smoking in pregnancy.

Both smoking and heavy drinking in pregnancy have individually been linked to an increased risk of SIDS, however, the combination of smoking and drinking together has not previously been investigated. The Safe Passage Study, published in Eclinicalmedicine, investigated outcomes of over 11,000 pregnancies. Pregnant women from two South African sites and five US sites (including two American Indian Reservations) were targeted due to the high rates of SIDS and alcohol use in pregnancy in these areas. The researchers followed each subject until one year post-birth, categorising patterns of drinking and smoking during pregnancy.

The researchers found that mothers who combined smoking and drinking beyond the first trimester of pregnancy have a twelve-fold increased risk of SIDS compared to those who either abstain altogether or cease after the first trimester. The increased risk of SIDS was five fold in babies whose mothers continued to smoke beyond the first trimester and four fold in babies whose mothers continued to drink beyond the first trimester. These results suggest that dual exposure to alcohol and smoking poses a significantly increased risk of SIDS.

The new information provided in The Safe Passage Study regarding dual exposure to alcohol and smoking in pregnancy helps to grow an understanding of how prenatal toxins are related to SIDS. There is no advice that absolutely guarantees the prevention of SIDS, however, safe sleep and safe baby care advice can be followed to help reduce the risk. Current recommendations are to:

  • Put babies on their back for every sleep.
  • Put babies to sleep in a clear and flat safe space.
  • Keep baby free from smoke exposure day and night.

Following The Safe Passage Study, further research into the interaction of alcohol and smoking in pregnancy is needed to develop a greater understanding of the risks. The study also highlights the need for stronger public health information around smoking and drinking in pregnancy.


Written by Helen Massy, BSc


References: (2020). Data and Statistics for SIDS and SUID | CDC. [online] Available at: [Accessed 21 Jan. 2020].

Elliott, A., Kinney, H., Haynes, R., Dempers, J., Wright, C., Fifer, W., Angal, J., Boyd, T., Burd, L., Burger, E., Folkerth, R., Groenewald, C., Hankins, G., Hereld, D., Hoffman, H., Holm, I., Myers, M., Nelsen, L., Odendaal, H., Petersen, J., Randall, B., Roberts, D., Robinson, F., Schubert, P., Sens, M., Sullivan, L., Tripp, T., Van Eerden, P., Wadee, S., Willinger, M., Zaharie, D. and Dukes, K. (2020). Concurrent prenatal drinking and smoking increases risk for SIDS: Safe Passage Study report. EClinicalMedicine, p.100247.

EurekAlert!. (2020). Combined prenatal smoking and drinking greatly increases SIDS risk. [online] Available at: [Accessed 21 Jan. 2020]. (2020). Statistics on SIDS. [online] Available at: [Accessed 21 Jan. 2020]. (2020). [online] Available at: [Accessed 22 Jan. 2020].

Image by Rainer Maiores from Pixabay



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