Exclusive: A major new report seen by the IoS has revealed that smoking
holds the key to a mystery that has baffled doctors and brought
heartache to thousands. By Roger Dobson and Senay Boztas
Nine out of 10 mothers whose babies suffered cot death smoked during
pregnancy, according to a scientific study to be published this week.
The study, thought to be one of the most authoritative to date on Sudden
Infant Death Syndrome (SIDS), says women who smoke during pregnancy are
four times more likely than non-smokers to see their child fall victim
to cot death.
The comprehensive report will make a strong case for the Government to
increase the scope of anti-smoking legislation. It even suggests a
possible move to try to ban pregnant women from getting tobacco altogether.
The study, produced by Bristol University's Institute of Child Life and
Health, is based on analysis of the evidence of 21 international studies
on smoking and cot death. The report, co-authored by Peter Fleming,
professor of infant health and developmental physiology, and Dr Peter
Blair, senior research fellow, will be published this week in the
medical journal Early Human Development.
The report urges the Government "to emphasise the adverse effects of
tobacco smoke exposure to infants and among pregnant women". It also
warns that this year's ban on smoking in public places must not result
in an increased exposure of infants or pregnant woman at home – smoking
in their presence should be seen as being "anti-social, potentially
dangerous, and unacceptable".
The study points out that many mothers and mothers-to-be have not heeded
warnings about smoking and may need to have their access to tobacco
restricted. "Given the power that tobacco addiction holds over its
victims, there is grave concern as to whether it will be a successfully
modifiable risk factor without fundamental changes in tobacco
availability to vulnerable individuals," it states.
Scientists are working to the theory that exposure to smoke during the
pregnancy or just after birth has an effect on brain chemicals in the
foetus or in infants, increasing the risk of SIDS.
The Government is considering whether it should change its advice on
smoking. It recommends that pregnant women should not drink alcohol at
all, but simply recommends that mothers and fathers "cut smoking in
pregnancy".
These findings will add weight to calls from doctors earlier this year
for a ban on parents smoking indoors where children are present.
Professor Robert West, of University College London, the Government's
most senior smoking adviser, said: "We can apply powerful social
pressure on parents not to smoke in the house."
Speaking about the new report, Dr Blair said: "If smoking is a cause of
SIDS, and the evidence suggests it is, we think that if all parents
stopped smoking tomorrow more than 60 per cent of SIDS deaths would be
prevented."
According to the Foundation for the Study of Infant Deaths (FSID), at
least 300 babies in the UK each year die suddenly and unexpectedly,
mostly between the ages of one month and four months. SIDS is the
biggest killer of babies over a month old, claiming more deaths than
traffic accidents, leukaemia and meningitis put together.
The issue has prompted a number of high-profile criminal convictions
against mothers such as Angela Cannings and Sally Clark. Mrs Cannings
suffered the deaths of three babies who died in their cribs. Mrs Clark
had two infants who were taken by SIDS. Both women were jailed but later
had their convictions overturned and were released in 2003. Mrs
Cannings, whose family smoked, was too upset by personal matters to
comment yesterday on the findings of this latest study. Mrs Clark, a
non-smoker, died last March.
Although scientists are still trying to understand precisely why babies
die so young, medical research is providing effective steps that parents
can take to reduce the risk of it happening.
Anti-smoking messages have provided some benefits: in the past 15 years,
researchers found that the proportion of smokers among all pregnant
mothers in the UK has fallen from 30 to 20 per cent.
Nevertheless, according to another study, in 1984 57 per cent of babies
who died from SIDS had mothers who smoked during pregnancy. This had
increased to 86 per cent by 2003. It is thought that the huge rise in
the proportion of SIDS mothers who smoke is at least to some degree a
result of the Back to Sleep campaign which was launched in 1991, and
which appears to have had a dramatic effect in reducing cot death.
The key message of this campaign was that parents should put their baby
on its back to sleep. Since then, the number of SIDS deaths has fallen
by three-quarters. The proportion of SIDS babies found lying face down
has fallen from 89 per cent to 24 per cent.
The campaign has also changed the social profile of parents whose
infants have died from SIDS. Before the Back to Sleep campaign, fewer
than half were from lower socio-economic classes, considered to be
"deprived". Now, this proportion has risen to 74 per cent.
The researchers now believe that laying babies face down has been
largely removed as the main reason for SIDS. The remaining primary
dangers are exposure to tobacco smoke and other factors possibly linked
to deprivation.
"The risk of unexpected infant death is greatly increased by both
prenatal and postnatal exposure to tobacco smoke," said Dr Blair. "We
should aim to achieve a 'smoke-free zone' around pregnant women and infants.
"Reduction of prenatal exposure to tobacco smoke, by reducing smoking in
pregnancy, and of postnatal exposure to tobacco, by not allowing smoking
in the home, will substantially reduce the risk of SIDS."
There are a number of theories to explain how smoking could affect the
baby. Babies exposed to tobacco could have breathing problems. Lung
development in the growing foetus could be hindered. Another theory is
that levels of brain chemicals are affected by smoke exposure.
"Exposure to tobacco smoke, either prenatally or postnatally, will lead
to a complex range of effects upon normal physiological and anatomical
development in foetal and postnatal life, together with an increased
incidence of acute viral infection that places infants at greatly
increased risk of SIDS," says the Bristol University study.
Deborah Arnott, the director of ASH, the anti-smoking charity, said that
this report should provoke a strong government campaign to highlight the
risks of women smoking while pregnant, and of parents smoking in the home.
"Because of other advice on avoiding cot death, smoking has become an
increasingly important trigger and we are very concerned that there is a
lack of understanding of how important it is," she said.
A YouGov poll commissioned for ASH at the end of August showed only 17
per cent of respondents thought second-hand smoke had a big impact on
cot-death risk, and 26 per cent that it had "some impact". But Ms Arnott
does not believe the public ban will necessarily increase smoking at
home. She added: "About 85 per cent of smoke is invisible and people
think it isn't having an impact if they smoke in a room where the baby
isn't, but it moves around the house. Our advice is, if you have a baby
and cannot give up, don't smoke in the home or car and use
nicotine gum
or patches for cravings. Being realistic, banning smoking in the home
isn't something we can do."
Catherine Parker-Littler, a midwife and founder of midwivesonline.com,
said that her confidential service has received emails from smokers who
lost infants to cot death. "In our 'Ask a Midwife' service, we have
definitely had emails from a small number of parents who smoke about
their experience in terms of a cot death," she said. "Some are about
feelings of guilt."
A spokeswoman from the Department of Health said: "This is an
interesting report which we will study carefully and consider whether we
need to change our advice. At the moment, our advice on how best to
reduce the chances of cot death is based on the best available
scientific evidence. We advise parents to cut out smoking in pregnancy
and not to share a bed with your baby if you are a smoker."
Falsely accused: Bereaved – and then tried for murder
The court cases of Angela Cannings and Sally Clark became bywords for
miscarriages of justice after both were wrongly convicted of murdering
their children.
Ms Cannings, from Salisbury in Wiltshire, was jailed for life in April
2002 after she was found guilty of smothering her two sons, seven-week
old Jason in 1991 and 18-week-old Matthew in 1999.
Ms Cannings, 43, maintained her babies died from Sudden Infant Death
Syndrome (SIDS) and was eventually freed in 2003. Her marriage has since
broken down and she has left the family home. During her appeal,
Professor Robert Carpenter, a medical statistics expert, said the babies
had been at a "substantially increased risk" of cot deaths because they
may have been exposed to cigarette smoke.
"The Cannings family smoked and the children slept prone," he told the
Court of Appeal in 2003.
But the link between smoking and cot death is not a certainty, as the
case of Sally Clark shows.
Mrs Clark, who died in March at the age of 42, was jailed for life in
1999 for murdering her two sons, eight-week old Harry and 11-week-old
Christopher. Her conviction was finally overturned in 2003.
The Clarks were affluent non-smokers, factors that led Professor Sir Roy
Meadow, a consultant paediatrician and expert witness in both trials, to
wrongly conclude that the chances of two cot deaths in such a family was
"one in 73 million".
Mrs Clark was released after a second appeal found her children had died
of natural causes. She never recovered from her ordeal.
Source: Ian Griggs, The Independent
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Smoking is a mental organic disorder.
www.ciggyfree.com/cigblog
*Article: Unlocking the secrets of cot death 
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