Prenatal counseling on seat belt use and crash-related medical care

Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis

OBJECTIVES

To systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes.

DESIGN

Systematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register.

PARTICIPANTS

Studies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care.

DATA SYNTHESIS

For incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle-Ottawa Scale.

RESULTS

We included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25-10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81-10.12; 8 studies, 47 992 women; I2=92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95% CI 1.27-1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95% CI 110.60-369.95; 1 study, 1 094 559 women).

CONCLUSION

Pregnant women involved in MVC were at higher risk of maternal death and complications than those not involved.

PROSPERO REGISTRATION NUMBER

CRD42018100788.

Effect of an educational leaflet on the frequency of seat belt use and the rate of motor vehicle accidents during pregnancy in Japan in 2018: a prospective, non-randomised control trial with a questionnaire survey

OBJECTIVE

To determine whether an educational leaflet had any effect on seat belt use, seat preference and motor vehicle accidents rate during pregnancy in Japan.

DESIGN

Prospective, non-randomised control trial with a questionnaire survey.

SETTING

Eight obstetric hospitals in Sapporo, Japan.

PARTICIPANTS

2216 pregnant women, of whom 1105 received the leaflet (intervention group) and 1111 did not (control group).

INTERVENTIONS

Distribution of an educational leaflet on seat belt use to women in the intervention group.

PRIMARY OUTCOME MEASURES

The effect of an educational leaflet on seat belt use, each pregnant woman's seat preference and the women's rates of motor vehicle accidents rate during their pregnancies. To evaluate the effects, the intervention group's responses to the questionnaires were compared with those of the control group.

RESULTS

The proportion of subjects who always used seat belts during pregnancy was significantly higher in the intervention group (91.3%) than in the control group (86.7%; p=0.0005). Among all subjects, the percentage of women who preferred the driver's seat was lower during pregnancy (27.0%) than before pregnancy (38.7%), and the percentage of women who preferred the rear seat was higher during pregnancy (28.8%) than before pregnancy (21.0%). These two rates did not differ between two groups. Seventy-one women (3.2%) reported experiencing a motor vehicle accident during pregnancy. The motor vehicle accident rate for the intervention group (3.3%) was similar to that for the control group (3.2%).

CONCLUSIONS

An educational seat belt leaflet was effective in raising the rate of consistent seat belt use during pregnancy, but it did not decrease the rate of motor vehicle accidents. The wearing of seat belts should be promoted more extensively among pregnant women to decrease rates of pregnancy-related morbidity and mortality from motor vehicle accidents.

Chest compression of a pregnant woman by a seatbelt might affect fetal outcome, even in minor to moderate frontal vehicle collisions

INTRODUCTION

Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus.

MATERIAL AND METHODS

The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured.

RESULTS

Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h.

CONCLUSIONS

Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.

Women from racial or ethnic minority and low socioeconomic backgrounds receive more prenatal education: Results from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System

BACKGROUND

Racial or ethnic and socioeconomic disparities in adverse birth outcomes are well known, but few studies have examined disparities in the receipt of prenatal health education. The objectives of this study were to examine racial or ethnic and socioeconomic variations in receiving (1) comprehensive prenatal health education and (2) education about human immunodeficiency virus (HIV) testing, breastfeeding, alcohol, and smoking cessation from health care practitioners.

METHODS

Data were drawn from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System (PRAMS). Twenty-seven states were included with an analysis sample size of 68 025 participants. Receiving counseling on all listed health topics during prenatal care visits was denoted as comprehensive prenatal health education. Logistic regression was used to examine the association of racial or ethnic and socioeconomic variables with receiving comprehensive prenatal health education, and HIV testing, breastfeeding, alcohol, and smoking cessation advice separately.

RESULTS

Multivariable results showed that racial or ethnic minorities and women with a high school degree or less; receiving Women, Infant, and Children (WIC) assistance; and on Medicaid during pregnancy have higher odds of receiving comprehensive prenatal health education (all P  ≤0 .001). Results were similar for receiving HIV testing, breastfeeding, alcohol, and smoking counseling. Low household income was associated with receiving counseling on HIV testing, alcohol, and smoking (all P ≤ 0.001).

CONCLUSION

Despite reporting higher levels of prenatal health education on a variety of health-related topics, disadvantaged women continue to experience disparities in adverse birth outcomes suggesting that education is insufficient in promoting positive behaviors and birth outcomes.