Seatbelts prevent fetal death

A study led by Contemporary OB/GYN Editorial Advisory Board member Haywood L. Brown, MD, has found that lack of seatbelt use during pregnancy is associated with an increased risk of fetal death. The study was published online by the American Journal of Obstetrics and Gynecology on February 25, 2013.

Dr. Brown, of Duke University in Durham, North Carolina, and other researchers examined the association between restraint use, race, and perinatal outcome after motor vehicle accidents (MVA) during pregnancy. They searched the Duke Trauma Registry and medical records for information on women at >14 weeks' gestation who were involved in MVAs and who received care through the emergency department and the obstetric units.

Between January 1994 and December 2010, 126 women were identified. Variables collected included type of trauma, gestational age at presentation, and delivery outcomes. A prognostic study evaluated the associations among maternal demographics, details of the accidents that included restraint use, and maternal treatment that was related to the accidents in relationship to perinatal outcomes.

The researchers found no difference in the mean age or median gravidity or parity by race among pregnant women who were cared for after a MVA. There was no difference in mean age or racial distribution between women who were restrained compared with women who were unrestrained; unrestrained women were more likely to be nulliparous and to require nonobstetric surgery related to the trauma. The overall rate of placental abruption was 6%. There were 6 intrauterine fetal deaths, 3 each in the unrestrained (25%) and restrained groups (3.5%; P = .018). Airbags deployed in 17 accidents. Among the 7 women with placenta abruption, 4 women (57%) experienced air bag deployment.

“We were not surprised by the findings, because the study confirmed previous studies,” Dr. Brown told Contemporary OB/GYN. “We had also hypothesized that women of minority race (African Americans) may be less likely to wear seat belts in pregnancy. We did not show a statistically significant difference in restraint use by race, which is likely related to sample size and the racial distribution of the automobile accident population.

“Clinicians must stress the importance of proper seatbelt use for all pregnant women, irrespective of gestational age, whether driver or passenger, in the back seat and the front seat.”