Smoking in pregnancy is a key factor for sudden infant death among Maori

Aim: To examine the sudden unexpected death in infancy (SUDI) disparity between maori and non-Maori in New Zealand. Methods: A nationwide prospective case-control study ran from March 2012 to February 2015. Exposure to established SUDI risk factors was analysed to investigate the disparity experienced by maori. Infant ethnicity was based on mother's ethnicity. maori ethnicity was prioritised. Non-Maori includes Pacific, Asian, NZ European and Other. Results: There were 137 cases and 649 controls. The maori SUDI rate was 1.41/1000 live births compared to 0.53/1000 for non-Maori. Parents/caregivers of 132 cases (96%) and 258 controls (40%) were interviewed. Smoking in pregnancy was associated with an equally increased SUDI risk for maori (adjusted OR = 8.11, 95% CI = 2.64, 24.93) and non-Maori (aOR = 5.09, 95% CI = 1.79, 14.47), as was bed-sharing (aOR = 3.66, 95% CI = 1.49, 9.00 vs aOR = 11.20, 95% CI = 3.46, 36.29). Bed-sharing prevalence was similar; however, more maori controls smoked during pregnancy (46.7%) than non-Maori (22.8%). The main contributor relating to increased SUDI risk for Maori/non-Maori infants is the combination of smoking in pregnancy and bed sharing. Conclusion: The association between known SUDI risk factors, including bed sharing and/or smoking in pregnancy and SUDI risk, is the same regardless of ethnicity. maori infants are exposed more frequently to both behaviours because of the higher maori smoking rate.