384 - Prevalence of and Factors Associated with Intention to Place Infants Supine for Sleep among Pregnant Persons

Publication Number: 384.6251

Eve R.. Colson, WashU Medicine, Saint Louis, MO, United States; Ann Kellams, University of Virginia, Charlottesville, VA, United States; Stephen Kerr, BU, Boston, MA, United States; Fern R. Hauck, UVA, Charlottesville, VA, United States; Margaret Parker, UMass Memorial Children's Medical Center, Worchester, MA, United States; Marc T.. Kiviniemi, University of Kentucky, Lexington, KY, United States; Fiona Rice, Boston University School of Medicine, boston, MA, United States; Rachel Y. Moon, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Sudden Unexpected Infant Death (SUID) remains the leading cause of post-neonatal infant death in the US. Placing infants supine to sleep reduces SUID risk. Rates of supine sleep have plateaued, and disparities persist. No studies have explored prenatal intention to place infants supine for sleep nor factors associated with supine sleep intentions.

Objective: To determine the current prevalence of and factors associated with prenatal persons’ intention to place infants supine for sleep.

Design/Methods: As part of a RCT to promote safe sleep and breastfeeding, we surveyed English- and Spanish-speaking pregnant persons recruited through WIC and federally qualified health centers in 17 states and the District of Columbia from Jan 2022-Oct 2024. Surveys were delivered at 32-34-weeks’ gestation, prior to randomization. To examine prevalence, we calculated frequency of response to the question: What position do you plan to place your baby to sleep? (check all that apply; back, stomach, side). Exclusively supine was intended back sleep only. A logistic regression model examined social and family characteristics associated with intent to place the infant exclusively supine for sleep.

Results: Of 1296 pregnant people surveyed, 897 (69.2%) reported that they intended to place their infants exclusively supine, 180 (13.9%) side and supine, and 204 (15.7%) planned to place their infants prone at least some of the time. Those more likely to choose exclusively supine self-described as non-Hispanic White compared with Hispanic of any race (OR 0.51; 95% CI 0.33,0.79) or non-Hispanic Black (OR 0.34; 95% CI 0.25, 0.48). Education (higher), country of birth (US), and parity (not first child) were associated with planning to exclusively use supine.

Conclusion(s): More than 30 years after the launch of the Back to Sleep Campaign, only 70% of the pregnant participants planned to place their infants exclusively supine for sleep. It remains critical to understand the social barriers to full adoption of supine placement for sleep and how to implement effective, evidence-based interventions equitably to address this lingering issue.