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SIDS is associated with prenatal drug use: a meta-analysis and systematic review of 4 238 685 infants
  1. Louise Makarious1,
  2. Arthur Teng2,
  3. Ju Lee Oei1,3,4
  1. 1 School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
  2. 2 Sleep Medicine Department, Sydney Children’s Hospital, Randwick, New South Wales, Australia
  3. 3 Department of Newborn Care, The Royal Hospital for Women Newborn Intensive Care Unit, Randwick, New South Wales, Australia
  4. 4 NHMRC Clinical Trial Centre, University of Sydney, Sydney, NSW, Australia
  1. Correspondence to Dr Ju Lee Oei, Department of Newborn Care, The Royal Hospital for Women Newborn Intensive Care Unit, Randwick, New South Wales, Australia; j.oei{at}


Objective To conduct a meta-analysis to determine the association between prenatal drug exposure and risk of sudden infant death syndrome (SIDS).

Design Studies were searched using PubMed, Medline and Embase and restricted to English, with no publication date limit. Selected studies included published cohort, population or case studies comparing the incidence of SIDS among drug-exposed with drug-free controls. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Data were pooled using a random-effects model to evaluate risk ratios (RR).

Setting High-income countries.

Patients Children with a history of prenatal drug exposure.

Interventions None.

Main outcome measures RR of SIDS between drug-exposed and control infants.

Results Sixteen studies (36 730 infants with any prenatal drug exposure, 21 661 exposed to opioids, 21 571 exposed to cocaine, 5031 exposed to methadone compared with 4 201 955 with no exposure). Any prenatal drug exposure was associated with an increased crude risk of SIDS (RR 7.84, 95% CI 5.21 to 11.81). Prenatal opioid exposure had the highest associative crude risk of SIDS (RR 9.76, 95% CI 5.28 to 18.05), followed by methadone (RR 9.52, 95% CI 4.60 to 19.70) and cocaine (RR 4.40, 95% CI 2.52 to 7.67). Increased crude risk persisted after adjusting for socioeconomic factors (RR 4.24, 95% CI 1.39 to 12.88). The incidence of SIDS for this cohort decreased between 1972 and 2020 but remained significantly higher than controls.

Conclusion Exposure to any drug of dependency during pregnancy is associated with an increased risk of SIDS after controlling for socioeconomic factors. Further study to evaluate mechanisms and contribution of other confounders (eg, smoking) is warranted.

  • mortality
  • child health

Data availability statement

Data are available upon request.

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Data availability statement

Data are available upon request.

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  • Contributors LM carried out data collection, data analysis, drafted the initial manuscript and reviewed and revised the manuscript. JLO conceptualised and designed the study, critically reviewed and revised the manuscript. AT reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. Ju Lee OEI is responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.