Population Survey After SARS-CoV-2 Pandemic: Lower Risk of Sudden Death in Breastfed Infants <6 Months
Abstract
Introduction: The SARS-CoV-2 pandemic may have impacted breastfeeding (BF) practices and mother-infant contact. We studied changes after the lifting of health restrictions.
Objectives: To examine breastfeeding practices, the frequency of risk factors for sudden infant death syndrome (SIDS) associated with bed-sharing, and the prevalence of SARS-CoV-2 positivity in the same reference population compared to a pre-pandemic study.
Materials and Methods: A retrospective cross-sectional study was conducted in 2022 via anonymous telephone survey, using a population-based random sample of infants aged 0 to 6 months from the Marina Baixa Health Area, Alicante. The “previous day” strategy was employed to assess breastfeeding (BF) and bed-sharing practices.
Results: The final sample was 246 participants. Breastfeeding prevalence was 73.2 %, and exclusive breastfeeding 53.2 %. On the previous day, 53.7 % of infants shared their parents’ bed, with a global prevalence of 65.8 %. Both parents showed lower tobacco and alcohol consumption associated with BS and bed-sharing. Mothers reported 37 minutes longer nocturnal sleep. Pregnant women with positive SARS-CoV-2 tests were 2.5 times more likely to breastfeed. The likelihood of bed-sharing decreased after a positive postnatal SARS-CoV-2 test.
Conclusions: We confirmed a lower frequency of risk factors in breastfed infants. In SARS-CoV-2 positive pregnancies breastfeeding rates were increased. Breastfeeding and bed-sharing were associated with longer maternal nocturnal sleep. These findings call for reflection on the reported declining SIDS rates in the Valencian Community, despite high rates of nocturnal bed-sharing.
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2. Blair PS, Ball HL, Mckenna JJ, Feldman-Winter L, Marinelli KA, Bartick MC. Bedsharing and breastfeeding: the academy of breastfeeding medicine protocol# 6, revision 2019. & Academy of Breastfeeding Medicine. 2020;15(1):5-16. https://www.bfmed.org/assets/Protocol%20Number%206%202019%20Revision.pdf
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4. Comité de Lactancia Materna AEP, Grupo de Trabajo para el Estudio de la Muerte Súbita Infantil de la AEP. Colecho, síndrome de muerte súbita del lactante y Lactancia Materna. Recomendaciones actuales de consenso 2014. Asociación Española de Pediatría [citado el 7 de julio de 2025]. Disponible en: https://www.aeped.es/comite-nutricion-y-lactancia-materna/lactancia-materna/documentos/colecho-sindrome-muerte-subita-lactante-y
5. Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics [Internet]. 2022 jun 21;150(1). Disponible en: https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022
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8. T. Gettler L, McKenna J. Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate “Safe Infant Sleep” Rhetoric in the United States. Current Pediatric Reviews. 2010 Feb 1;6(1):71-7. Disponible en: https://www.academia.edu/72617484/Never_Sleep_with_Baby_Or_Keep_Me_Close_But_Keep_Me_Safe_Eliminating_Inappropriate_Safe_Infant_Sleep_Rhetoric_in_the_United_States
9. Ball HL, Howel D, Bryant A, Best E, Russell C, Ward-Platt M. Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta Paediatrica. 2016 mar. 11;105(6):628-34. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.13354?casa_token=BatBKSPuXsAAAAAA%3AnSLrOTTRt-RfZLxYjbNYLV8eiu3uy4Ky0Wh6Wb-d4frPSkI7XhO5CzhYQjmP2QimDl-aN5fumnB7E0SdGg
10. Kinney HC, Myers MM, Belliveau RA, Randall LL, Trachtenberg FL, Fingers ST et al. Subtle autonomic and respiratory dysfunction in sudden infant death syndrome associated with serotonergic brainstem abnormalities: a case report. Journal of Neuropathology and Experimental Neurology [Internet]. 2005 ag. 1;64(8):689-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16106217/
11. Landa-Rivera JL, Pérez-Pérez J, González-Núñez M del P, Gil-Miralles RA, Jover-Escolano Y, Fernández-Pan Astacio V. Population-Based Survey Showing That Breastfed Babies Have a Lower Frequency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeeding Medicine. 2021 dic. 16;17(2). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8867097/
12. Ball HL. Bed-sharing practices of initially breastfed infants in the first 6 months of life. Infant and Child Development. 2007 ag.;16(4):387-401. Disponible en: https://doi.org/10.1002/icd.519
13. Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development [Internet]. 2008 jul.;84(7):441-9. DIsponible en: https://www.sciencedirect.com/science/article/abs/pii/S0378378207002423
14. Morelen D, Menke R, Rosenblum KL, Beeghly M, Muzik M. Understanding Bidirectional Mother-Infant Affective Displays across Contexts: Effects of Maternal Maltreatment History and Postpartum Depression and PTSD Symptoms. Psychopathology. 2016;49(4):305-14. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27576477/
15. Gettler LT, McKenna JJ, McDade TW, Agustin SS, Kuzawa CW. Does Cosleeping Contribute to Lower Testosterone Levels in Fathers? Evidence from the Philippines. O’Connor KA, editor. PLoS ONE [Internet]. 2012 sep. 5;7(9):e41559. Disponible en: https://dx.doi.org/10.1371%2Fjournal.pone.0041559
16. McKenna J, Gettler LT Co-sleeping. Breastfeeding and Sudden Infant Death Syndrome. En: Sleeping Behaviour in Encyclopedia on early Childhood Development [citado el 10 de enero de 2025]. Disponible en: https://www.child-encyclopedia.com/pdf/expert/sleeping-behaviour/according-experts/co-sleeping-breastfeeding-and-sudden-infant-death-syndrome
17. Mitchell EA, Thompson JM, Zuccollo J, MacFarlane M, Taylor B, Elder D et al. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study. N Z Med J. 2017;130(1456):52-64. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28571049/
18. Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. van Wouwe J, editor. PLoS ONE [Internet]. 2014 sep. 19;9(9):e107799. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107799
19. Doan T, Gay CL, Kennedy HP, Newman J, Lee KA. Nighttime Breastfeeding Behavior Is Associated with More Nocturnal Sleep among First-Time Mothers at One Month Postpartum. Journal of Clinical Sleep Medicine [Internet]. 2014 mar. 15;10(3). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927438/
20. Ruan H, Zhang Y, Tang Q, Zhao X, Zhao X, Xiang Y et al. Sleep duration of lactating mothers and its relationship with feeding pattern, milk macronutrients and related serum factors: A combined longitudinal cohort and cross-sectional study. Frontiers in Nutrition. 2022 ag. 30;9. Disponible en: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.973291/full
21. Tully KP, Ball HL. Postnatal unit bassinet types when rooming-in after cesarean birth: implications for breastfeeding and infant safety. Journal of Human Lactation: Official Journal of International Lactation Consultant Association [Internet]. 2012 Nov 1;28(4):495-505. DIsponible en: https://pubmed.ncbi.nlm.nih.gov/22914755/
22. Monzó Blasco A, Izquierdo Macián I, Cardona Valencia B, Marín Reina P, Más Asencio M, Zorio Grima E. Estudio y prevención de la muerte súbita infantil: Experiencia en la Comunidad Valenciana. CorSalud [Internet]. 2017sep. [citado el 7 julio 2025]; 9(3):137-42. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2078-71702017000300003&lng=es
23. Blair PS, Ball HL, Pease A, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Arch Dis Child [Internet]. 2023;108(4):e6. Disponible en: http://dx.doi.org/10.1136/archdischild-2021-323469
24. Ball HL, Tomori C, McKenna JJ. Toward an Integrated Anthropology of Infant Sleep. American Anthropologist. 2019 jul. 8;121(3). Disponible en: https://anthrosource.onlinelibrary.wiley.com/doi/10.1111/aman.13284
25. McKenna JJ, Mosko S. Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS. Acta Paediatrica. 1993 ag.;82(s390):31-6. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.1993.tb12871.x
2. Blair PS, Ball HL, Mckenna JJ, Feldman-Winter L, Marinelli KA, Bartick MC. Bedsharing and breastfeeding: the academy of breastfeeding medicine protocol# 6, revision 2019. & Academy of Breastfeeding Medicine. 2020;15(1):5-16. https://www.bfmed.org/assets/Protocol%20Number%206%202019%20Revision.pdf
3. Ball HL, Ward-Platt MP, Heslop E. Randomised trial of mother-infant sleep proximity on the post-natal ward: implications for breastfeeding initiation and infant safety. Arch Dis Child. 2006;91:1005-10 [citado el 7 de julio de 2025]. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC2083001/
4. Comité de Lactancia Materna AEP, Grupo de Trabajo para el Estudio de la Muerte Súbita Infantil de la AEP. Colecho, síndrome de muerte súbita del lactante y Lactancia Materna. Recomendaciones actuales de consenso 2014. Asociación Española de Pediatría [citado el 7 de julio de 2025]. Disponible en: https://www.aeped.es/comite-nutricion-y-lactancia-materna/lactancia-materna/documentos/colecho-sindrome-muerte-subita-lactante-y
5. Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics [Internet]. 2022 jun 21;150(1). Disponible en: https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022
6. UNICEF. Co-sleeping and SIDS. A guide for health professionals. 2019 [citado el 25 de enero 2025]. Disponible en: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/07/Co-sleeping-and-SIDS-A-Guide-for-Health-Professionals.pdf
7. NICE. Postnatal care NICE guideline [Internet]. National Institute for Health and Care Excellence. 2021 abr. [citado el 7 de julio 2025]. Disponible en: https://www.nice.org.uk/guidance/ng194/resources/postnatal-care-pdf-66142082148037
8. T. Gettler L, McKenna J. Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate “Safe Infant Sleep” Rhetoric in the United States. Current Pediatric Reviews. 2010 Feb 1;6(1):71-7. Disponible en: https://www.academia.edu/72617484/Never_Sleep_with_Baby_Or_Keep_Me_Close_But_Keep_Me_Safe_Eliminating_Inappropriate_Safe_Infant_Sleep_Rhetoric_in_the_United_States
9. Ball HL, Howel D, Bryant A, Best E, Russell C, Ward-Platt M. Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta Paediatrica. 2016 mar. 11;105(6):628-34. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.13354?casa_token=BatBKSPuXsAAAAAA%3AnSLrOTTRt-RfZLxYjbNYLV8eiu3uy4Ky0Wh6Wb-d4frPSkI7XhO5CzhYQjmP2QimDl-aN5fumnB7E0SdGg
10. Kinney HC, Myers MM, Belliveau RA, Randall LL, Trachtenberg FL, Fingers ST et al. Subtle autonomic and respiratory dysfunction in sudden infant death syndrome associated with serotonergic brainstem abnormalities: a case report. Journal of Neuropathology and Experimental Neurology [Internet]. 2005 ag. 1;64(8):689-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16106217/
11. Landa-Rivera JL, Pérez-Pérez J, González-Núñez M del P, Gil-Miralles RA, Jover-Escolano Y, Fernández-Pan Astacio V. Population-Based Survey Showing That Breastfed Babies Have a Lower Frequency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeeding Medicine. 2021 dic. 16;17(2). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8867097/
12. Ball HL. Bed-sharing practices of initially breastfed infants in the first 6 months of life. Infant and Child Development. 2007 ag.;16(4):387-401. Disponible en: https://doi.org/10.1002/icd.519
13. Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development [Internet]. 2008 jul.;84(7):441-9. DIsponible en: https://www.sciencedirect.com/science/article/abs/pii/S0378378207002423
14. Morelen D, Menke R, Rosenblum KL, Beeghly M, Muzik M. Understanding Bidirectional Mother-Infant Affective Displays across Contexts: Effects of Maternal Maltreatment History and Postpartum Depression and PTSD Symptoms. Psychopathology. 2016;49(4):305-14. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27576477/
15. Gettler LT, McKenna JJ, McDade TW, Agustin SS, Kuzawa CW. Does Cosleeping Contribute to Lower Testosterone Levels in Fathers? Evidence from the Philippines. O’Connor KA, editor. PLoS ONE [Internet]. 2012 sep. 5;7(9):e41559. Disponible en: https://dx.doi.org/10.1371%2Fjournal.pone.0041559
16. McKenna J, Gettler LT Co-sleeping. Breastfeeding and Sudden Infant Death Syndrome. En: Sleeping Behaviour in Encyclopedia on early Childhood Development [citado el 10 de enero de 2025]. Disponible en: https://www.child-encyclopedia.com/pdf/expert/sleeping-behaviour/according-experts/co-sleeping-breastfeeding-and-sudden-infant-death-syndrome
17. Mitchell EA, Thompson JM, Zuccollo J, MacFarlane M, Taylor B, Elder D et al. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study. N Z Med J. 2017;130(1456):52-64. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28571049/
18. Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. van Wouwe J, editor. PLoS ONE [Internet]. 2014 sep. 19;9(9):e107799. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107799
19. Doan T, Gay CL, Kennedy HP, Newman J, Lee KA. Nighttime Breastfeeding Behavior Is Associated with More Nocturnal Sleep among First-Time Mothers at One Month Postpartum. Journal of Clinical Sleep Medicine [Internet]. 2014 mar. 15;10(3). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927438/
20. Ruan H, Zhang Y, Tang Q, Zhao X, Zhao X, Xiang Y et al. Sleep duration of lactating mothers and its relationship with feeding pattern, milk macronutrients and related serum factors: A combined longitudinal cohort and cross-sectional study. Frontiers in Nutrition. 2022 ag. 30;9. Disponible en: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.973291/full
21. Tully KP, Ball HL. Postnatal unit bassinet types when rooming-in after cesarean birth: implications for breastfeeding and infant safety. Journal of Human Lactation: Official Journal of International Lactation Consultant Association [Internet]. 2012 Nov 1;28(4):495-505. DIsponible en: https://pubmed.ncbi.nlm.nih.gov/22914755/
22. Monzó Blasco A, Izquierdo Macián I, Cardona Valencia B, Marín Reina P, Más Asencio M, Zorio Grima E. Estudio y prevención de la muerte súbita infantil: Experiencia en la Comunidad Valenciana. CorSalud [Internet]. 2017sep. [citado el 7 julio 2025]; 9(3):137-42. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2078-71702017000300003&lng=es
23. Blair PS, Ball HL, Pease A, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Arch Dis Child [Internet]. 2023;108(4):e6. Disponible en: http://dx.doi.org/10.1136/archdischild-2021-323469
24. Ball HL, Tomori C, McKenna JJ. Toward an Integrated Anthropology of Infant Sleep. American Anthropologist. 2019 jul. 8;121(3). Disponible en: https://anthrosource.onlinelibrary.wiley.com/doi/10.1111/aman.13284
25. McKenna JJ, Mosko S. Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS. Acta Paediatrica. 1993 ag.;82(s390):31-6. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.1993.tb12871.x
Landa Rivera, L., González Núñez, M. P., Squitteri Rosetti, C., Gil Miralles, R., Martín Bayón, I., Fernández Pan-Astacio, V., … Pérez Pérez, J. (2025). Population Survey After SARS-CoV-2 Pandemic: Lower Risk of Sudden Death in Breastfed Infants <6 Months. Revista De Lactancia Materna, 3, e32610. https://doi.org/10.14201/rlm.32610
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