Understanding SIDS and Substance Use in Pregnancy: Separating Risk from Blame

Public discussions of infant death and substance use often lack clinical nuance, which can unintentionally increase stigma and blame toward grieving mothers. This article aims to clarify what we know about Sudden Infant Death Syndrome (SIDS), substance use in pregnancy, and the designation “Infant of a Substance-Using Mother (ISAM),” while emphasizing compassion, evidence, and the limits of our current understanding.

Here are some facts about SIDS:

The occurrence of SIDS has been documented for 3000 years. SIDS is a leading cause of death in infants under one year old. It is most likely to occur in infants between two and four months old. It is most likely to occur in males, and Native Americans and African Americans are at higher risk. It occurs more frequently in the winter months, especially January.

Researchers are now seeing evidence that SIDS might be caused by the infant brain’s inability to control arousal or detect high levels of carbon monoxide in the blood. The more knowledge researchers can gather, the closer researchers are to finding ways to hopefully prevent this tragedy from occurring.

But the exact cause of SIDS is not yet known. A diagnosis of SIDS is made by gathering information from the autopsy, from an investigation of the death scene, plus an investigation of the infant and family and family history. From this investigation, if there is no information indicating another cause of death, a SIDS diagnosis is made.

Although it is not known what SIDS is, we know SIDS is not caused by choking, vomiting, a minor illness or by vaccinations. SIDS is not contagious.

Risk factors are behaviors and environmental influences that may be associated with a particular condition, but risk factors do not necessarily cause the condition.

It is important to realize that risk reduction does not prevent SIDS, and conversely, the existence of risky conditions does not mean that SIDS will actually occur.

Some of the risk factors associated with SIDS are:

• maternal cigarette smoking during pregnancy

• maternal substance abuse during pregnancy

• exposure to secondhand smoke after birth

• babies who sleep on their stomachs

• babies who had a brother or sister who died of SIDS

• maternal history of sexually transmitted diseases

• teen mothers

• premature babies

• poor prenatal care

• poverty

• overheating

• soft bedding

• unsafe co-sleeping arrangements which include:

  • sleeping on sofas or chairs with the baby

  • parent alcohol or substance abuse and sleeping with a baby

Conclusion

Sudden Infant Death Syndrome is a devastating and poorly understood loss that affects families across all backgrounds. While certain behaviors and environmental factors are associated with increased risk, risk factors do not equal cause, and they do not determine outcome.

When substance use, mental health struggles, and infant loss intersect, it is especially important to avoid blame-based narratives. Grieving mothers and families deserve accurate information, compassionate care, and access to appropriate medical and mental health support.

Supporting families after loss means educating the public clearly, separating risk from responsibility, and recognizing that maternal mental health is a critical part of infant and family well-being.

If you or someone you love is struggling with grief, depression, anxiety, or substance use during the perinatal period, help is available. Reaching out is not a failure — it is an act of care.