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  • In the U.S., more pregnant women probably die from intentional & unintentional injury than all “maternal mortality” related conditions combineda, yet these cases are poorly reported.
     
  • Motor vehicle injuries are the leading cause of maternal and fetal injury death, maternal injury hospitalization and probably maternal injury ED visits (Figure 1 and (Figure 2)b, yet these cases are poorly reported.
     
  • There are about 5 times as many fetal deaths due to pregnancy related crashes then there are infant motor vehicle related occupant deaths (Figure 3),c yet the fetal deaths are not reported.
     
  • On average, more than one fetus a day dies from a motor vehicle crash.
     
  • A fetus is 15 times more likely to die from a motor vehicle crash than a child 0-14 is likely to die from a firearm death.
     
  • Each year there are probably more fetal deaths due to pregnancy-related crashes then there are motor vehicle occupant deaths to ALL children ages 0-9, yet the fetal deaths are not reported.
     
  • In a recent statewide study in Utah, ~3% of births linked to a driver MV crash report during pregnancy.d
     
  • Extrapolating from this study, with information about the ratio of pregnant related drivers to non-drivers in another study, it is estimated that about 4% of all births or about 160,000 births per year are involved in utero in a police reported crash. This is 7 times the number of infants 0-1 in crashes each year reported by the National Highway Traffic Safety Administration.e
     
  • It is estimated that there are at least 3,500 annual hospital visits in the US for a pregnancy related hospitalized motor vehicle occupant related injury, but no state or agency tracks these events on an ongoing basis.f
     
  • The risk of adverse fetal injury (defined as either placental abruption, uterine rupture, direct fetal injury, maternal death or fetal Loss) in a 16 MPH frontal crash at 28 weeks gestation has been estimated at 26% for belted drivers and 70% for unbelted drivers (Figure 4).g
     
  • The total annual miles driven by women of reproductive age increased 275% from 1969 to 1990. This probably represents a major increase in fetal exposure to crash risk over the last 30 years (Figure 5).h

    Why don't we know more about this problem?
     

  • Figure 1. Motor vehicle injuries are the leading cause of maternal injury hospitalization (and probably maternal injury ED visits but population-based ED data on pregnancy-associated visits are lacking).

  • Figure 2. Motor vehicle injuries are the leading cause of fetal injury death. These data are from a special study; states cannot and thus do not track the causes of fetal injury death from vital statistics.

  • Figure 3. MV occupant fetal death cases far outnumber many other causes of fatal childhood injury that receive much more attention by public health practitioners.  A conservative estimate is that 380 to 700 fetuses die each year from car crashes, compared to only 125 infants (0-1). This is also several times the number of children ages 0-15 who die from bike crashes (190) and ages 0-9 from firearms (179). These estimates do not include deaths to fetuses < 20 weeks gestation or cases resulting in elective or therapeutic abortion nor do they take into account risk over time since fetuses are exposed for less than a 9 month period.

  • Figure 4. The risk of modeled adverse fetal outcomes from a pregnancy-associated crash increases greatly as crash speeds increase, especially for unbelted occupants.

Figure 5. The total annual miles driven by women of reproductive age increased 275% from 1969 to 1990. This probably represents a major increase in fetal exposure to crash risk over the last 30 years, though the specific driving habits of pregnant women over this time period are not known and may never be known because they were not identified within the Omnibus Surveys conducted by the US Department of Transportation Bureau of Transportation Statistics.

 

Comparison

Hyde LK, Cook LJ, Olson LM, Weiss HB, Dean JM. Effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol. 2003; 102:279-86.

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.  Matern Child Health J. 2007; 11(5):505-10.

Weiss HB, Sauber-Schatz EK, Cook LJ. The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes. Accident Analysis & Prevention. Accepted for publication December 2007.

Weiss HB, Lawrence BA, Miller TR. Prevalence and risk of pregnancy associated motor vehicle hospitalizations. 46th Annual Proceedings of the AAAM. 2002

Weiss HB, Songer TJ, Fabio A. Fetal deaths related to maternal injury. JAMA. 2001; 286:1863-8.  

a. Weiss HB Causes of traumatic death during pregnancy". (letter) JAMA, 2001, June 13;285(22):2854-5.

b. Weiss HB, Songer TJ,, Fabio A, Fetal Deaths Related to Maternal Injury JAMA Vol. 286 No. 15, October 17, 2001.

c. Weiss HB, Songer TJ,, Fabio A, Fetal Deaths Related to Maternal Injury JAMA Vol. 286 No. 15, October 17, 2001.

d. Hyde L, Cook L, Olson L, Weiss HB, Dean J., Effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol, 2003; 102(2), 279-286.

e. Weiss HB, Strotmeyer S. "Characteristics of pregnant women in motor vehicle crashes." Injury Prevention, 2002 September; 8(3):207-210.

f. Weiss HB, Lawrence BA and Miller TR. "Prevalence & risk of pregnancy-associated motor vehicle injury hospitalizations." Proceedings of Association for the Advancement of Automotive Medicine. Tempe, Arizona. September, 2002.
Weiss HB. The epidemiology of traumatic injury-related fetal mortality in Pennsylvania, 1995-1997: the role of motor vehicle crashes. Accid Anal Prev. 2001 Jul;33(4):449-54.

g. Moorcraft et. al., Am J Obstet Gynecol, 2003.

h. Bureau of Transportation Statistics, Omnibus Surveys – US Department of Transportation.


Knowing is not enough; we must apply. Willing is not enough; we must do - Goethe

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