Effects of Automobile Crashes Occurring During = Pregnancy - March 1, 2004

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Effects of Automobile Crashes Occurring During = Pregnancy

Increased automobile travel by pregnant = women=20 increases the likelihood of fetal injury or pregnancy complications from = crashes, but relatively little is known about the factors involved in = such=20 outcomes. Studies have been limited by consideration of only fetal = mortality or=20 only pregnant women treated at hospitals following crashes. Hyde and = colleagues=20 used statewide databases on crashes and pregnancy outcomes to determine = the=20 effect of crashes during pregnancy and the effect, if any, of seatbelt = use.

The authors used data from police records, birth certificates, and=20 certificates of fetal death from Utah between 1992 and 1999. These data = were=20 only able to identify pregnant women drivers and not all pregnant women = involved=20 in vehicle crashes. The data were further limited to crashes occurring = on public=20 roadways and crashes resulting in injury, fatality, or at least $1,000 = in=20 property damage. The pregnancy outcomes were limited to those re-corded = on birth=20 or fetal death certificates and included abruptio placentae, fetal = distress,=20 birth weight less than 2,500 g (5 lb, 8 oz), birth before 37 weeks' = gestation,=20 excessive maternal bleeding, delivery within 48 hours of the crash, = cesarean=20 delivery, fetal mortality, and abnormal conditions such as seizures, = birth=20 injury, or assisted ventilation.

Of the 322,704 live singleton births during the study period, 8,938 = (2.8=20 percent) were linked to a motor vehicle crash during pregnancy. Women = drivers=20 who crashed during pregnancy were slightly younger, more likely to = smoke, more=20 likely to have fewer previous births, and more likely to have begun = prenatal=20 care during the first trimester than pregnant women who were not = involved in=20 crashes. Overall, women who crashed had pregnancy outcomes similar to = outcomes=20 of those who did not, but the outcomes varied considerably by seatbelt = use. The=20 12 percent of drivers who crashed while not using a seatbelt differed=20 significantly from the 80 percent who used a seatbelt. (It was not = possible to=20 ascertain seatbelt usage for the remaining 8 percent.) Those who did not = use a=20 seatbelt were younger, had less education, used more tobacco and alcohol = during=20 pregnancy, and usually did not begin prenatal care during the first=20 trimester.

Women who did not use a seatbelt at the time of a crash were = significantly=20 more likely to have excessive bleeding during labor and increased rates = of low=20 birth weight, fetal distress, and cesarean delivery than women who = crashed while=20 wearing a seatbelt. Pregnant women who were wearing a seatbelt at the = time of a=20 crash were no more likely to experience adverse outcomes than pregnant = women who=20 were not involved in a crash. Maternal injury was the principal cause of = the 45=20 fetal deaths associated with crashes after 20 weeks' gestation that were = recorded during the study.

The authors conclude that nearly 3 percent of births can be linked to = a=20 significant automobile crash in which the pregnant mother was the = driver. If a=20 seatbelt is worn, pregnancy outcomes do not appear to be significantly = altered=20 by crashes. Conversely, pregnant drivers who do not use a seatbelt are = more=20 likely to experience significant bleeding and to have a low-birth-weight = infant,=20 and three times more likely to have a fetal death than pregnant women = who crash=20 while wearing a seatbelt.

anne d. walling, m.d.

Hyde LK, et al. Effect of motor vehicle crashes on adverse = fetal=20 outcomes. Obstet Gynecol August 2003;102;279-86.

editor's note: The list of = questions=20 family physicians are supposed to ask for "prevention" keeps getting = longer. If=20 we screened for and counseled on everything the experts recommend, there = would=20 be little time to address the presenting complaint, let alone deal with = all the=20 other agendas of a typical office visit. Nevertheless, seatbelt use is a = "high=20 payoff" item for all patients, especially pregnant women. It is = important to=20 convey the message in a supportive and positive manner and not to "nag." = The=20 concept of prospective care always seems much more positive than = "prevention."=20 The risk factors, including not using a seatbelt, tend to cluster in our = most=20 vulnerable patients, as shown in this study. These patients need our = extra time=20 and support to reduce their burden of risk. The rewards could be=20 substantial.-a.d.w.

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Copyright =A9 2004 by the American Academy of = Family=20 Physicians.
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