Maternal adherence to safe infant sleep recommendations in the USA: trends and disparities from PRAMS 2016-2022.

Abstract

<h4>Purpose</h4>Sleep-related infant deaths in the USA have plateaued despite long-standing evidence-based recommendations for safe sleep. Understanding maternal patterns of adherence and associated disparities is critical to improving infant safety. Using nationally representative Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 surveillance data (2016-2022), we estimated adherence to four safe sleep recommendations, examined temporal trends and assessed sociodemographic and behavioural correlates of non-adherence.<h4>Methods</h4>We analysed 125 931 weighted maternal responses (weighted count: 6 372 445) on infant sleep position, location, surface and bedding. Temporal trends were assessed using log-linear regression and expressed as the average annual percentage change (APC). Disparities were examined using multiple logistic regression, reporting adjusted ORs (AORs) and 95% CIs.<h4>Results</h4>Adherence was highest for supine sleep position (79.8%; 95% CI 79.4 to 80.2) and lowest for safe bedding (32.8%; 95% CI 32.4 to 33.2). Significant improvements were observed in adherence to safe bedding (APC=11.5%) and safe sleep surfaces (APC=2.8%). Compared with non-Hispanic white mothers, non-Hispanic black mothers had substantially higher odds of unsafe practices, including non-supine position (AOR 3.4; 95% CI 3.2 to 3.7), infant bed-sharing (AOR 2.4; 95% CI 2.3 to 2.6), unsafe sleep surfaces (AOR 1.5; 95% CI 1.4 to 1.6) and loose bedding (AOR 3.6; 95% CI 3.3 to 3.9). Elevated risks were also seen among Hispanic mothers, Medicaid or uninsured, unmarried, smokers and those not receiving healthcare worker advice.<h4>Conclusion</h4>Maternal adherence to safe sleep recommendations remains low, with persistent sociodemographic disparities. These findings highlight the need for stronger integration of safe sleep counselling within antenatal and postpartum care.