title: Women's health outcomes after traumatic brain injury.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a major public health problem, yet little is known about how this injury may affect long-term outcomes unique to women. This research examined the health outcomes relevant to premenopausal women 5-12 years after injury.
  
  
  METHODS
  This was a retrospective cohort study at eight participating acute care/rehabilitation facilities. Participants were consecutive eligible women with moderate to severe TBI. A follow-up interview assessed menstrual functioning, fertility, and pregnancy experiences before and after injury as well as cervical cancer screening. Demographic variables, self-rated general and mental health, and functional limitations were also collected. Injury-related information was abstracted from health records. Female control participants recruited were matched on age, education, and geographic location.
  
  
  RESULTS
  Of the 104 women with TBI (W-TBI), 46% experienced amenorrhea with duration of up to 60 months. Cycles became irregular for 68% of W-TBI after the injury. These findings were significantly different from those of controls. Among W-TBI, menstrual disturbances were associated with injury severity. No differences were shown between W-TBI and controls with respect to fertility, although significantly fewer W-TBI had one or more live births, and they reported more difficulties in the postpartum period than controls. W-TBI were less likely to have regular Pap smears and reported lower mental health, self-rated health, and function.
  
  
  CONCLUSIONS
  These findings inform prognosis after TBI for women and provide evidence for long-term monitoring of health outcomes and increased support after childbirth. More research is needed in this area, particularly with respect to the neuroendocrine system.
authors.affiliation: University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario M5G 1V7, Canada. angela.colantonio@utoronto.ca
authors.forename: Angela
authors.initials: A
authors.lastname: Colantonio
authors.forename: Wanna
authors.initials: W
authors.lastname: Mar
authors.forename: Michael
authors.initials: M
authors.lastname: Escobar
authors.forename: Karen
authors.initials: K
authors.lastname: Yoshida
authors.forename: Diana
authors.initials: D
authors.lastname: Velikonja
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.forename: Michael
authors.initials: M
authors.lastname: Cusimano
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D001930:Brain Injuries / Q000145:classification / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D008599:Menstruation Disturbances / Q000209:etiology*; D011247:Pregnancy; D017697:Premenopause; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis