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Public health
Original research
Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis
  1. Carmen Amezcua-Prieto1,2,3,
  2. Jennifer Ross4,
  3. Ewelina Rogozińska5,6,
  4. Patritia Mighiu5,
  5. Virginia Martínez-Ruiz1,2,3,
  6. Karim Brohi4,
  7. Aurora Bueno-Cavanillas1,2,3,
  8. Khalid Saeed Khan1,2,5,
  9. Shakila Thangaratinam5
  1. 1Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
  2. 2CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
  3. 3Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
  4. 4Centre for Trauma Sciences, Queen Mary University of London, London, UK
  5. 5Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
  6. 6Meta-analysis Group, MRC Clinical Trials Unit, University College London, London, UK
  1. Correspondence to Dr Aurora Bueno-Cavanillas; abueno{at}ugr.es

Abstract

Objectives To systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes.

Design Systematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register.

Participants Studies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care.

Data synthesis For incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle–Ottawa Scale.

Results We included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25–10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81–10.12; 8 studies, 47 992 women; I2=92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95% CI 1.27–1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95% CI 110.60–369.95; 1 study, 1 094 559 women).

Conclusion Pregnant women involved in MVC were at higher risk of maternal death and complications than those not involved.

PROSPERO registration number CRD42018100788.

  • pregnancy
  • motor vehicle crashes
  • pregnancy complications
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-035562

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    Footnotes

    • Contributors PM conducted literature searches and screened publications jointly with JR. CA-P and JR extracted the data. CA-P and ER drafted the manuscript and conducted the statistical analyses. KSK and ST designed the study review. CA-P is the guarantor. VM-R, KB, ABC, ST and KSK gave critical revision of the manuscript. All authors had full access to the data and take responsibility for the data analyses.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.