title: Injury: a major cause of pregnancy-associated morbidity in Massachusetts.
abstract: Hospital visits (inpatient, observation, and emergency department) for injury occurring during pregnancy and 1 year postpartum (the pregnancy-associated period) were examined to determine groups at risk for injuries. The dataset included maternally linked vital records and hospital visit data for a population-based cohort of women residing in Massachusetts who delivered between 2002 and 2003 (n = 100,051). Injury morbidity (injury visits with International Classification of Diseases, Ninth Revision, Clinical Modification codes 800-999.99 or selected E-codes) was evaluated by individual woman- and visit-based analyses. Overall, one in seven women sought hospital care for pregnancy-associated injuries, and rates were as high as one in four for some subgroups. Most pregnancy-associated injury visits (91%) occurred in emergency departments. More than 4% of women had a motor vehicle collision, which was the leading cause of injury. The risk for injury was significantly higher among women who were adolescents (relative risk [RR] = 1.88; 95% confidence interval [CI], 1.78-1.98), black non-Hispanic (RR = 1.88; 95% CI, 1.80-1.97), those who had public insurance (RR = 2.50; 95% CI, 2.41-2.56), or those who had less than a high school education (RR = 2.48; 95% CI, 2.39-2.58) when compared with referent groups. Clinical guidelines for preconception and pregnancy-associated periods should include recommendations for injury history assessment and preventative counseling for women.
authors.affiliation: Bouvé College of Health Sciences School of Nursing at Northeastern University, Boston, MA 02115-5000, USA. a.nannini@neu.edu
authors.forename: Angela
authors.initials: A
authors.lastname: Nannini
authors.forename: Jane
authors.initials: J
authors.lastname: Lazar
authors.forename: Cynthia
authors.initials: C
authors.lastname: Berg
authors.forename: Kay
authors.initials: K
authors.lastname: Tomashek
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Mary
authors.initials: M
authors.lastname: Barger
authors.forename: Wanda
authors.initials: W
authors.lastname: Barfield
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011256:Pregnancy Outcome; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy