Tobacco Documents Online

C ( c I Stillbirths Many of the studies which report on stillbirths as well as low birth weight, perinatal mortality, etc. do not standardize the population for age, parity, sex of the infant, social class, race and other more subtle factors. Unfortunately, this fact makes if difficult to judge the role of possible causative factors. From the following study, one can find examples of potential causative agents perhaps working in concert to affect the fetus. Comstock et al. reported that maternal ' smoking did not account for st-illbirths, but that they are more common if the father is poorly educated.l The stillbirth rates were similar for nonsmokers, maternal smokers, and couples where both partners smoked. This study, from the Johns Hopkins University School of Hygiene and Public Health, also reported that the risk of stillbirths was higher for parents who attended church infrequently or if the home lacked sanitary facilities. Underwood, et al. also found no increase in stillbirths .for smoking mothers.2 Knutzen and Davey found that "the interrelationship of maternal height, maternal weight and weight gain is important"3 with respect to stillbirths and perinatal mortality rate. Few studies have been published in recent years which discuss the role of tobacco in stillbirths. Because of the high probability that the cause is multi-factorial, much more research ys needed before any one agent can be proven harmful.

1 R E F E R E N C E S 1. Comstock, G. W., et al. "Parental Smoking and Perinatal Mortality," American Journal of Obstetrics and Gynecology 98(5), 708-718, 1967. 2. Underwood, P. D., et al., "The Relationship of Smoking to the Outcome of Pregnancy,"' American Journal of Obstetrics and Gynecology 91, 270, 1965. 3. Knutzen, V. K. and D. A. Davey. "The Relationship Between Maternal Height and Weight at Booking and Perinatal Mortality," South African Medical Journal 51(19) 672-675, 1977. ~

SUDDEN I.`7FAONT DEATIi SY2JDRO?iE C A review of the literature on sudden infant death syndrome shows that the cause is not known. While a few nonsmokers may believe "passive smoking" causes S.I.D.S, ". .[R]ecent studies have revealed clear differences, existing from birth, between S.I.D.S. victims and survivors of the first six months."1-5 The following factors have been proposed as risk factors for S.I.D.S.: 1. Young mother.6 2. Late birth order.:6 3. Mother's blood group 0, B, or AB.6,7 4. Mother had urinary tract infection~in pregnancy.6 5. Premature birth (lower gestational ag,e).6,9 6. Bottle fed.6 7. Medical attention;received.6 8. Brainstem abnormality.8 9. Parents are smokers.l0 10. Defect in the regulation of alveolar ventilation.11 11. Botulism.12 12. Low socio-economic statuls.7 13. Maternal influenza infections.7 14. Anemic mother.7 15. Protracted second state of labor.7 16. Postnatal clinic appointment unkept.7 17. Drug use by the mother.l4 O 18. Non-Caucasian race.15 W kl 0;~b 19. Male sex.15 ~ 20. Hypothalmic dysfunction. w 16

1 C C More research is badly needed before any conclusions can~be made about the cause of S.I.D.S. Those who would blame smoking parents have "come full circle to the state of the art prior to 1950."l7 Because many S.I.D.S. parents are not smokers, it is necessary to assess other possible causes before judging that parental smoking or any other factor may be or is the only factor involved. ~

C R E F E' R E 11 C E S 1. 2. 3. 4. 5. 6. 7. ~ 8. 9. C Lipsitt, L. P. In Psychology: From Research to Practice (Edited by H. L. Pick and H. W. Stevenson). New York, 1978 Lipsitt, L. P. In Infants Born~at Risk (Ed'ited'by T. M. Field~, A. M. Sostek, S. Goldberg, and H. H. Shuman). New York, 1978. Valdes-Dapena, M.A.D.H.E.W., Publication No. (HSA)l, 78-5255, 1978. Naeye, R. L. and Drage, J. Pediat. Res., 1975:9, 298 (Abstract). Naeye, R. L., et al. Am. J. Dis. Child, 130, 1207, 1976. "Preventing Sudden Infant Death," Science News, Vol. 112, 167, September 10, 1977. Protestos, C. Di., et al. "Obstetric and Perinatal Histories of Children who Died Unexpectedly," Arch. Dis. Child 48(0): 835-841, 1973. Gunby, Phil. "Brainstem Abnormality May Characterize S.I.D.S. Victims," JArIA, Vol. 240, No. 20, 2138, 2144, November 10, 1978. "Unexpected Infant Death," The Lancet, 692, September 23, 1978. 10. Bergman, A. B., et al. "Relationship of Passive Cigarette- Smoking to Sudden Infant Death Syndrome," Pediatrics 58(5): 665-668, 1976. 11. Shannon, Daniel C., et al., "Abnormal Regulation of Ventila- tion in Infants at Risk for Sudden-Infant-Death Syndrome," N.E.J.r4., Vol. 297, No. 14, 747-750, October 6, 1977. 12. Pottgen, Paul, Ph.D., and~L. H. Hillegass. "Botulism and Sudden Infant Death Syndrome," JAM, Vol. 238, No. 15, 1629, October 10, 1977. 13. Protestos, C. D., et al., Supra. -_ O W ~ ~ En W ~ ~,

14. Oleske, J. M., et al., "Experiences with 118 Infants Born to Narcotic-Using Mothers: Does a Lowered Serum,lonized Calcium Level Contribute to the Symptoms of Withdrawal?" Clinical Pediatrics 16(5)~:418-423, 1977. 15. Bergman, A. B., et al., Supra. 16. Goodkin, Franklin. "Hypothalamic Implications of Crib Death," The Lancet, 997, November 4, 1978. 17. Waite, Charles L., Letter to the Honorable Sidney Goldmann, Hearings of the New Jersey Public Health Council, Trenton, New Jersey, October 27, 1977. l