FRONTlines

The Newsletter of CIRCL, the Center for Injury Research & Control at the University of Pittsburgh

Volume 10, Issue 1: Spring 2007

The Impact of Pregnancy-Associated Crashes on Birth Outcomes
and Infant Survival

During the peak reproductive years (ages 15-35), the leading cause of death for women in the United States is unintentional injury with motor vehicle injury deaths accounting for 71% of these deaths. (1) Therefore, it is not surprising that injury is also the leading cause of death during pregnancy in the U.S. (2,3) and approximately 3.9% of pregnant women experience an injury that leads to an emergency department visit. (4)

Recent published reports of population-based hospitalized injury or motor vehicle injury during pregnancy have documented the risks of injury during pregnancy as adverse outcomes for offspring of women injured during pregnancy including: substantially increased fetal mortality, neonatal deaths, placental abruption, prematurity, low birth weight, and birth defects. (5-11)

Furthermore, several studies have shown that regardless of the severity of the pregnant woman’s injury, the pregnancy and/or fetus can still experience adverse outcomes and even fetal death. (2,9,12-18) 

However, there is an inadequate understanding of pregnancy-associated injury due to exclusionary case definitions, difficulties capturing pregnancy status, diagnosis coding limitations, and lack of follow-up for pregnancy outcomes that has limited the availability of data for researching this important health issue. 

CIRCL’s “Impact of Pregnancy-Associated Crashes on Birth Outcomes and Infant Survival” study hopes to contribute to the understanding of pregnancy-associated motor vehicle crash injuries through testing several study hypotheses including:

  1. Fetuses of women involved in serious motor-vehicle crashes during pregnancy will be more likely to die before birth than fetuses of women not exposed to a serious crash.
  2. Babies exposed in-utero to serious crash events will have a significantly higher incidence of premature births than babies not exposed to serious crashes.
  3. Babies exposed in-utero to serious crash events will have a higher incidence of being small for gestational age (SGA) and very-low birth weight than babies not exposed to serious crashes.
  4. Unbelted pregnant drivers involved in crashes are more at risk for having adverse birth outcome and lowered one-year infant survival rates in the affected offspring than their belted counterparts, among both preterm and normal term infants.
  5. Among belted pregnant drivers, adverse reproductive outcomes will vary by crash severity and crash geometry.
  6. The incidence of non-chromosomal birth defects will be higher among infants born to mothers injured in a motor-vehicle crash versus all infants.

This study is CDC funded, IRB approved, and a recent agreement between CIRCL, the Pennsylvania Health Department’s Bureau of EMS (BEMS), and The Pennsylvania Department of Vital Statistics has been made for access to the data necessary to carry out the study.  Upon availability of an honest broker, the data from vital statistics and BEMS will be probabilistically linked, de-identified, and sent to CIRCL for analyses.  CIRCL anticipates having four years of linked data by September of 2007. 

In the interim, CIRCL has had a paper accepted and e-published (ahead of print) by the Maternal and Child Health Journal.  The e-publication citation is: Sirin, H; Weiss, HB; Sauber-Schatz, EK; Dunning, K. Seat belt use, counseling and motor-vehicle injury during pregnancy: Results from a multi-state population-based survey. Maternal and Child Health Journal. 2007 March 6. 

Another paper that is in the works at CIRCL is a collaborative effort with the University of Utah’s Intermountain Injury Control Research Center.  This paper is close to completion and is titled “The Epidemiology of Pregnancy-associated Emergency Department Injury Visits and Their Impact on Reproductive Outcomes.” The paper results are proving to be significant and field developing.  The authors hope to submit it for publication soon. 

One of CIRCL’s most current projects is a poster that was submitted to and was one of the 37 posters accepted for the 25th annual Lifesavers conference in Chicago, IL March 25-27, 2007. Lifesavers is the National Conference on Highway Safety Priorities.  The poster is titled “Protecting Moms and the Fetus: A New Priority for Child Passenger Safety” and was co-authored by Hank Weiss and Erin Sauber-Schatz.  Dr. Weiss attended the conference and presented the poster.

References:

  1. NCIPC. WISQUARS.  National Center for Injury Prevention and Control, CDC, 2006.
  2. Grossman NB. Blunt trauma in pregnancy. Am Fam Physician 2004;70(7):1303-10.
  3. Fildes J, Reed L, Jones N, Martin M, Barrett J. Trauma: The leading cause of maternal death. J Trauma 1992;32(5):643-45.
  4. Weiss HB., Sauber-Schatz EK., Cook LJ. The Epidemiology of Pregnancy-associated Emergency Department Injury Visits and Their Impact on Reproductive Outcomes.  University of Pittsburgh, Center for Injury Research and Control, 2007.
  5. Wolf ME, Alexander BH, Rivara FP, Hickok DE, Maier RV, Starzyk PM. A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash. J Trauma 1993;34(1):116-9.
  6. Greenblatt JF, Dannenberg AL, Johnson CJ. Incidence of hospitalized injuries among pregnant women in Maryland, 1979 -1990. Am J Prev Med 1997;13(5):374-79.
  7. Hyde LK, Cook LJ, Olson LM, Weiss HB, Dean JM. Effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol 2003;102(2):279-86.
  8. El-Kady D, Gilbert WM, Anderson J, Danielsen B, Towner D, Smith LH. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol 2004;190(6):1661-8.
  9. Schiff MA, Holt VL. Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001. Am J Epidemiol 2005;161(6):503-10.
  10. Weiss HB. Pregnancy-associated injury hospitalizations in Pennsylvania, 1995. Ann Emerg Med 1999;34(5):626-36.
  11. Kuo C, Jamieson DJ, McPheeters ML, Meikle SF, Posner SF. Injury hospitalizations of pregnant women in the United States, 2002. Am J Obstet Gynecol 2007;196(2):161 e1-6.
  12. Schiff MA, Holt VL. The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death. J Trauma 2002;53(5):946-9.
  13. Baerga-Varela Y, Zietlow SP, Bannon MP, Harmsen WS, Ilstrup DM. Trauma in pregnancy.[In Process Citation]. Mayo Clin Proc 2000;75(12):1243-8.
  14. Schiff MA, Holt VL, Daling JR. Maternal and infant outcomes after injury during pregnancy in Washington State from 1989 to 1997. J Trauma 2002;53(5):939-45.
  15. Poole GV, Martin JN, Jr., Perry KG, Jr., Griswold JA, Lambert CJ, Rhodes RS. Trauma in pregnancy: the role of interpersonal violence. Am J Obstet Gynecol 1996;174(6):1873-7; discussion 1877-8.
  16. Agran PF, Dunkle DE, Winn DG, Deryck K. Fetal death in motor vehicle accidents. Ann Emerg Med 1987;16(12):1355-1358.
  17. Esposito TJ, Gens DR, Smith LG, Scorpio R, Buchman T. Trauma during pregnancy -- a review of 79 cases. Arch Surg 1991;126(9):1073-78.
  18. Fries MH, Hankins GD, Lackland AFB. Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise. Ann Emerg Med 1989;18(3):301-304.

Back to top