Women's health outcomes after traumatic brain injury.
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.
Colantonio
Angela
A
University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario M5G 1V7, Canada. angela.colantonio@utoronto.ca
Mar
Wanna
W
Escobar
Michael
M
Yoshida
Karen
K
Velikonja
Diana
D
Rizoli
Sandro
S
Cusimano
Michael
M
Cullen
Nora
N
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