{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:08:39Z","timestamp":1789002519129,"version":"build-2803163510"},"reference-count":64,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,10,1]]},"abstract":"<jats:p>Objective.\u2003Prone sleeping is a strong risk factor for sudden infant death syndrome (SIDS). We investigated whether the combined effect of prone sleeping position and prenatal risk factors further increased the SIDS risk.<\/jats:p><jats:p>Methods.\u2003In the Nordic Epidemiological SIDS Study, parents of SIDS victims in Denmark, Norway, and Sweden completed a questionnaire on potential risk factors for SIDS. Forensic pathologists verified the SIDS diagnosis. Four controls of the same gender, age, and place of birth were selected. This matched case\u2013control study, which included 244 SIDS cases and 869 controls from 1992 to 1995, was analyzed by conditional logistic regression.<\/jats:p><jats:p>Results.\u2003Odds ratios (ORs) for prone and side sleeping compared with supine sleeping for the last sleep were 13.9 (95% confidence interval 8.2\u201324) and 3.5 (2.1\u20135.7). Infants 13 to 24 weeks old had particularly high risk in prone and side sleeping, at 28.5 (7.9\u2013107) and 5.9 (1.6\u201322). OR for prone sleeping was higher in girls, at 30.4 (11\u201388), than in boys, 10.3 (5.5\u201319). We found strong combined effects of sleeping position and prenatal risk factors (more than multiplicative). The OR for prone and side sleeping was increased for infants with birth weight &amp;lt;2500 g, at 83 (25\u2013276) and 36.6 (13\u2013107); for preterm infants, at 48.8 (19\u2013128) and 40.5 (14\u2013115); and for intrauterine growth retarded, at 38.8 (14\u2013108) and 9.6 (4.3\u201322), compared with supine position in infants without these prenatal factors. The combined effect of nonsupine positions and intrauterine growth retarded was highest among 13- to 24-week-old infants. Effects of combined presence of nonsupine sleeping positions and each of the factors of smoking in pregnancy, young maternal age, higher parity, low level of maternal education, and single motherhood were more than additive. Attributable fractions in the population for prone and side sleeping were 18.5% and 26.0%.<\/jats:p><jats:p>Conclusions.\u2003Both prone and side sleeping increased the risk of SIDS. The risk was increased further in low birth weight infants, preterm infants, and infants at the age of 13 to 24 weeks, suggesting that SIDS may be triggered by nonsupine sleeping in infants with prenatal risk factors during a vulnerable period of postnatal development.<\/jats:p>","DOI":"10.1542\/peds.100.4.613","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:40:17Z","timestamp":1092440417000},"page":"613-621","source":"Crossref","is-referenced-by-count":177,"title":["Combined Effects of Sleeping Position and Prenatal Risk Factors in Sudden Infant Death Syndrome: The Nordic Epidemiological SIDS Study"],"prefix":"10.1542","volume":"100","author":[{"given":"Nina","family":"\u00d8yen","sequence":"first","affiliation":[{"name":"From the Division of Preventive Medicine, Department of Public Health and Primary Health Care,"},{"name":"Medical Birth Registry of Norway,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trond","family":"Markestad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolv Skj\u00e6rven","family":"PhD","sequence":"additional","affiliation":[{"name":"Medical Birth Registry of Norway,"},{"name":"Section for Medical Informatics and Statistics, University of Bergen, Bergen, Norway; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorentz M","family":"Irgens","sequence":"additional","affiliation":[{"name":"From the Division of Preventive Medicine, Department of Public Health and Primary Health Care,"},{"name":"Medical Birth Registry of Norway,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Helweg-Larsen","sequence":"additional","affiliation":[{"name":"The Danish Institute for Clinical Epidemiology, Copenhagen, Denmark, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernt","family":"Alm","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Go\u0308teborg, Go\u0308teborg, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Norvenius","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Go\u0308teborg, Go\u0308teborg, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go\u0308ran","family":"Wennergren","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Go\u0308teborg, Go\u0308teborg, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1997,10,1]]},"reference":[{"key":"2021120904390332200_B1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/j.1651-2227.1989.tb11061.x","article-title":"Secular trends of sudden infant death syndrome and other causes of post perinatal mortality in Norwegian birth cohorts 1967\u20131984.","volume":"78","author":"Irgens","year":"1989","journal-title":"Acta Paediatr Scand"},{"key":"2021120904390332200_B2","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1542\/peds.89.5.855","article-title":"Sudden infant death syndrome (SIDS) in Denmark: evaluation of the increasing incidence of registered SIDS in the period 1972 to 1983 and results of a prospective study in 1987 through 1988.","volume":"89","author":"Helweg-Larsen","year":"1992","journal-title":"Pediatrics"},{"key":"2021120904390332200_B3"},{"key":"2021120904390332200_B4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/j.1365-3016.1994.tb00460.x","article-title":"Secular trends of sudden infant death syndrome in Norway, 1967\u20131988. Application of a method of case identification to Norwegian registry data.","volume":"8","author":"\u00d8yen","year":"1994","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2021120904390332200_B5","first-page":"7193","article-title":"Overheating and sudden infant death. Temperature regulation in relation to the prone position, the possible pathogenesis of sudden infant death [in Danish].","volume":"156","author":"Helweg-Larsen","year":"1994","journal-title":"Ugeskr Laeger"},{"key":"2021120904390332200_B6","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1136\/adc.65.4.462","article-title":"Choice of sleeping position for infants: possible association with cot death.","volume":"65","author":"Engelberts","year":"1990","journal-title":"Arch Dis Child"},{"key":"2021120904390332200_B7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/bmj.301.6743.85","article-title":"Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study.","volume":"301","author":"Fleming","year":"1990","journal-title":"Br Med J."},{"key":"2021120904390332200_B8","first-page":"71","article-title":"Results from the first year of the New Zealand cot death study.","volume":"104","author":"Mitchell","year":"1991","journal-title":"N Z Med J"},{"key":"2021120904390332200_B9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/j.1651-2227.1993.tb12898.x","article-title":"Information about sudden infant death syndrome for the general public.","volume":"82(suppl 389)","author":"Markestad","year":"1993","journal-title":"Acta Paediatr."},{"key":"2021120904390332200_B10"},{"key":"2021120904390332200_B11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1136\/adc.72.6.478","article-title":"Sleeping position and sudden infant death syndrome in Norway 1967\u201391.","volume":"72","author":"Irgens","year":"1995","journal-title":"Arch Dis Child"},{"key":"2021120904390332200_B12","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0379-0738(86)90012-5","article-title":"Sudden infant death syndrome. Morphology update for forensic pathologists 1985.","volume":"30","author":"Valdes-Dapena","year":"1986","journal-title":"Forensic Sci Int"},{"key":"2021120904390332200_B13","first-page":"73","article-title":"Role of apnoea in the sudden infant death syndrome: a personal view.","volume":"81","author":"Southall","year":"1988","journal-title":"Pediatrics."},{"key":"2021120904390332200_B14"},{"key":"2021120904390332200_B15","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1093\/oxfordjournals.aje.a115221","article-title":"Intrauterine growth retardation and risk of sudden infant death syndrome (SIDS).","volume":"129","author":"Buck","year":"1989","journal-title":"Am J Epidemiol."},{"key":"2021120904390332200_B16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/00005072-199101000-00003","article-title":"Delayed central nervous system myelination in the sudden infant death syndrome.","volume":"50","author":"Kinney","year":"1991","journal-title":"J Neuropathol Exp Neurol."},{"key":"2021120904390332200_B17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3109\/15513819309048221","article-title":"Renal developmental arrest in sudden infant death syndrome.","volume":"13","author":"Hinchliffe","year":"1993","journal-title":"Pediatr Pathol."},{"key":"2021120904390332200_B18","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/oxfordjournals.aje.a117549","article-title":"Fetal growth retardation in sudden infant death syndrome (SIDS) infants and their siblings.","volume":"142","author":"\u00d8yen","year":"1995","journal-title":"Am J Epidemiol"},{"key":"2021120904390332200_B19","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1093\/oxfordjournals.epirev.a036057","article-title":"Sudden infant death syndrome epidemiology: a review and update.","volume":"12","author":"Little","year":"1990","journal-title":"Epidemiol Rev."},{"key":"2021120904390332200_B20","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1056\/NEJM199308053290601","article-title":"Factors potentiating the risk of sudden infant death syndrome associated with the prone position.","volume":"329","author":"Ponsonby","year":"1993","journal-title":"N Engl J Med"},{"key":"2021120904390332200_B21","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1136\/adc.67.2.171","article-title":"Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death.","volume":"67","author":"Gilbert","year":"1992","journal-title":"Arch Dis Child"},{"key":"2021120904390332200_B22","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1159\/000244052","article-title":"A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple risk model.","volume":"65","author":"Filiano","year":"1994","journal-title":"Biol Neonate"},{"key":"2021120904390332200_B23"},{"key":"2021120904390332200_B24"},{"key":"2021120904390332200_B25"},{"key":"2021120904390332200_B26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/oxfordjournals.epirev.a036143","article-title":"Statistical analysis of case-control studies.","volume":"16","author":"Thompson","year":"1994","journal-title":"Epidemiol Rev"},{"key":"2021120904390332200_B27","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/0010-4809(88)90041-9","article-title":"Computational implementation of the conditional logistic regression model in the analysis of epidemiologic matched studied.","volume":"21","author":"Le CT, Lindgren BL","year":"1988","journal-title":"Comput Biomed Res"},{"key":"2021120904390332200_B28"},{"key":"2021120904390332200_B29"},{"key":"2021120904390332200_B30"},{"key":"2021120904390332200_B31","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/oxfordjournals.epirev.a036144","article-title":"Attributable risk estimation in case-control studies.","volume":"16","author":"Coughlin","year":"1994","journal-title":"Epidemiol Rev."},{"key":"2021120904390332200_B32","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0378-3782(83)90001-4","article-title":"Intrauterine growth retardation: beyond birth weight criteria (editorial).","volume":"8","author":"Wilcox","year":"1983","journal-title":"Early Hum Dev"},{"key":"2021120904390332200_B33","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/ije\/15.2.188","article-title":"Birth weight and perinatal mortality. III. Towards a new method of analysis.","volume":"15","author":"Wilcox","year":"1986","journal-title":"Int J Epidemiol."},{"key":"2021120904390332200_B34"},{"key":"2021120904390332200_B35","first-page":"3489","article-title":"Favourite sleeping position among infants in the county of Roskilde. Is there a connection with sudden, unexplained infant death [in Danish]?","volume":"154","author":"Trier","year":"1992","journal-title":"Ugeskr Laeger."},{"key":"2021120904390332200_B36","first-page":"18","article-title":"Epidemiological research. Many fewer cases of crib death [in Danish].","volume":"94","author":"Mo\u0308ller","year":"1994","journal-title":"Sygeplejersken."},{"key":"2021120904390332200_B37"},{"key":"2021120904390332200_B38"},{"key":"2021120904390332200_B39"},{"key":"2021120904390332200_B40"},{"key":"2021120904390332200_B41"},{"key":"2021120904390332200_B42","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/bmj.313.7051.191","article-title":"Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993\u201395 case control study for confidential inquiry into stillbirths and deaths in infancy.","volume":"313","author":"Fleming","year":"1996","journal-title":"Br Med J"},{"key":"2021120904390332200_B43","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/j.1651-2227.1995.tb13653.x","article-title":"Sleeping position and sudden infant death syndrome (SIDS): effect of an intervention programme to avoid prone sleeping.","volume":"84","author":"Markestad","year":"1995","journal-title":"Acta Paediatr"},{"key":"2021120904390332200_B44","first-page":"69","article-title":"Infant sleep position following new AAP guidelines.","volume":"96","author":"American Academy of Pediatrics","year":"1995","journal-title":"Pediatrics."},{"key":"2021120904390332200_B45","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/ije\/19.4.1107","article-title":"The impact of differential recall on the results of case-control studies.","volume":"19","author":"Drews","year":"1990","journal-title":"Int J Epidemiol"},{"key":"2021120904390332200_B46","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1093\/oxfordjournals.aje.a116723","article-title":"A comparison of prospective and retrospective responses on sudden infant death syndrome by case and control mothers.","volume":"137","author":"Gibbons","year":"1993","journal-title":"Am J Epidemiol"},{"key":"2021120904390332200_B47","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.2105\/AJPH.57.12.2071","article-title":"Prospective versus retrospective approach in the search for environmental causes of malformations.","volume":"57","author":"Klemetti","year":"1967","journal-title":"Am J Public Health"},{"key":"2021120904390332200_B48","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1111\/j.1440-1754.1992.tb02729.x","article-title":"Four modifiable and other major risk factors for cot death: the New Zealand study.","volume":"28(suppl)","author":"Mitchell","year":"1992","journal-title":"J Paediatr Child Health."},{"key":"2021120904390332200_B49","first-page":"97","article-title":"Infant sleep position: a New Zealand survey.","volume":"98","author":"Hassal","year":"1985","journal-title":"N Z Med J"},{"key":"2021120904390332200_B50","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/0140-6736(92)90652-J","article-title":"Cot deaths and sleep position campaigns (letter).","volume":"339","author":"Golding","year":"1992","journal-title":"Lancet"},{"key":"2021120904390332200_B51","first-page":"69","article-title":"Infant sleep position following new AAP guidelines.","volume":"96","author":"Gibson","year":"1995","journal-title":"Pediatrics"},{"key":"2021120904390332200_B52","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1542\/peds.91.6.1112","article-title":"Prone or supine position and sleep characteristics in infants.","volume":"91","author":"Kahn","year":"1993","journal-title":"Pediatrics."},{"key":"2021120904390332200_B53","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1136\/adc.76.4.320","article-title":"Behaviour and physiological responses during prone and supine sleep in early infancy.","volume":"56","author":"Skadberg","year":"1997","journal-title":"Arch Dis Child"},{"key":"2021120904390332200_B54","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0140-6736(89)91211-7","article-title":"Sleeping position and infant bedding may predispose to hyperthermia and the sudden infant death syndrome.","volume":"28","author":"Nelson","year":"1989","journal-title":"Lancet"},{"key":"2021120904390332200_B55","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1136\/adc.72.4.340","article-title":"Lower body temperature in sleeping supine.","volume":"72","author":"North","year":"1995","journal-title":"Arch Dis Child"},{"key":"2021120904390332200_B56"},{"key":"2021120904390332200_B57"},{"key":"2021120904390332200_B58"},{"key":"2021120904390332200_B59","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1203\/00006450-199210000-00010","article-title":"The relationship between environmental temperature, metabolic rate and evaporative water loss in infants from birth to three months.","volume":"32","author":"Azaz","year":"1992","journal-title":"Pediatr Res"},{"key":"2021120904390332200_B60","first-page":"464","article-title":"Prematurity, sudden infant death syndrome, and age of death.","volume":"96","author":"Malloy","year":"1995","journal-title":"Pediatrics"},{"key":"2021120904390332200_B61"},{"key":"2021120904390332200_B62","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/0378-3782(94)90209-7","article-title":"Infant care practices and the investigation of physiological mechanisms.","volume":"38","author":"Johnson","year":"1994","journal-title":"Early Hum Dev"},{"key":"2021120904390332200_B63","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1136\/adc.69.6.660","article-title":"Sleeping positions for infants and cot death in The Netherlands 1985\u201391.","volume":"69","author":"deJonge","year":"1993","journal-title":"Arch Dis Child."},{"key":"2021120904390332200_B64","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1111\/j.1651-2227.1994.tb13186.x","article-title":"Infant survival in Norway and Sweden 1985\u20131988.","volume":"83","author":"Espehaug","year":"1994","journal-title":"Acta Paediatr"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/4\/613\/889271\/pe109700613o.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/4\/613\/889271\/pe109700613o.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T05:04:49Z","timestamp":1705208689000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/100\/4\/613\/52124\/Combined-Effects-of-Sleeping-Position-and-Prenatal"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,10,1]]},"references-count":64,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1997,10,1]]},"published-print":{"date-parts":[[1997,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.100.4.613","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1997,10,1]]}}}