Factors associated with racial disparities in maternal-infant bed-sharing: Findings from Wisconsin

Background. Although the American Academy of Pediatrics has recommended a separate but proximate sleep surface for infants since 2005, maternal-infant bed-sharing remains a common practice, especially among African-Americans. Bed-sharing has been associated with a higher risk of Sudden Infant Death Syndrome, which affects African-Americans at a disproportionately higher rate. This study examined factors associated with bed-sharing (main outcome) among African-American and White mothers.

Methods. Analysis of the 2007-2010 Wisconsin Pregnancy Risk Assessment and Monitoring System (PRAMS) using separate logistic regression models for African-Americans and Whites.

Results. The sample consisted of 806 African-Americans and 1,680 Whites (N = 2,486). A significantly larger proportion of African-Americans (70.6%) reported bed-sharing than Whites (53.4%). For both races, partner-related stress was significantly associated with bed-sharing; no significant differences were found between the two racial groups. For African-Americans, partner stress (OR: 1.79: 1.22-2.63) and maternal education of 13-15 years (OR: 1.99: 1.16-3.42) or ≥ 16 years (OR: 2.67: 1.14-6.27) was associated with increased odds of bed-sharing. For Whites, partner stress (OR: 1.34: 1.02-1.76), breastfeeding (OR: 2.48: 1.93-3.11), income of $35,000-$49,999 (OR: 1.64: 1.18-2.29), being unmarried (OR: 1.54: 1.08-2.2), needing money for food (OR: 1.58: 1.09-2.3), and non-supine sleep position (OR: 1.75: 1.17-2.61) were associated with bed-sharing.

Conclusion. Differences were found in bed-sharing factors were found between racial groups, which suggests a need for culturally-relevant, tailored safe infant sleep interventions. Providers should ask families about their infant's sleeping environment and address safety issues within that environment. More research is needed on the context and reasons for bed-sharing.