title: Adverse pregnancy outcomes following motor vehicle crashes.
abstract: BACKGROUND
  Motor vehicle crashes are a leading cause of serious trauma during pregnancy, but little is known about their relationships with pregnancy outcomes.
  
  
  OBJECTIVE
  To estimate the association between motor vehicle crashes and adverse pregnancy outcomes.
  
  
  METHODS
  A retrospective cohort study of 878,546 pregnant women, aged 16-46 years, who delivered a singleton infant in North Carolina from 2001 to 2008. Pregnant drivers in crashes were identified by probabilistic linkage of vital records and crash reports. Poisson regression modeled the association among crashes, vehicle safety features, and adverse pregnancy outcomes. Analyses were conducted in 2012.
  
  
  RESULTS
  In 2001-2008, 2.9% of pregnant North Carolina women were drivers in one or more crashes. After a single crash, compared to not being in a crash, pregnant drivers had slightly elevated rates of preterm birth (adjusted rate ratio [aRR]=1.23, 95% CI=1.19, 1.28); placental abruption (aRR=1.34, 95% CI=1.15, 1.56); and premature rupture of the membranes (PROM; aRR=1.32, 95% CI=1.21, 1.43). Following a second or subsequent crash, pregnant drivers had more highly elevated rates of preterm birth (aRR=1.54, 95% CI=1.24, 1.90); stillbirth (aRR=4.82, 95% CI=2.85, 8.14); placental abruption (aRR=2.97, 95% CI=1.60, 5.53); and PROM (aRR=1.95, 95% CI=1.27, 2.99). Stillbirth rates were elevated following crashes involving unbelted pregnant drivers (aRR=2.77, 95% CI=1.22, 6.28) compared to belted pregnant drivers.
  
  
  CONCLUSIONS
  Crashes while driving during pregnancy were associated with elevated rates of adverse pregnancy outcomes, and multiple crashes were associated with even higher rates of adverse pregnancy outcomes. Crashes were especially harmful if drivers were unbelted.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States; Injury Prevention Research Center University of North Carolina, Chapel Hill, North Carolina, United States. Electronic address: cvladutiu@unc.edu.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Vladutiu
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Carri
authors.initials: C
authors.lastname: Casteel
authors.forename: M Kathryn
authors.initials: MK
authors.lastname: Menard
authors.forename: Harold B
authors.initials: HB
authors.lastname: Weiss
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology / Q000209:etiology; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001334:Automobile Driving / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012622:Seat Belts / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult