Harold Burton Weiss

Objectives: Motor vehicle crashes are the leading cause of hospitalized trauma during pregnancy. Maternal injury puts the fetus at great risk, yet little is known about the incidence, risks, and characteristics of pregnant women in crashes. Setting and methods: Police reported crashes were analyzed from the National Automotive Sampling System Crashworthiness Data System. Since 1995, this system recorded pregnancy/trimester status. Pregnant and non-pregnant women 15–39 years of age were compared by age, driver status, seat belt use, and treatment. Belt use and seating position were examined by trimester. Results: There were 427 pregnant occupants identified (weighted n=32 810, 2.6%, SE 12 585, rate 13/1000 person years). The mean age was 24.9 compared with 24.8 years (pregnant v non-pregnant). Cases were distributed by trimester as follows: first 29.8%, second 36.4%, and third 33.8%. Pregnant women were drivers 70% of the time compared with 71% for non-pregnant women. No belt use was 14% compared with 13% (pregnant v non-pregnant). Mean injury severity was lower for pregnant women but they were more likely to transported or hospitalized. Improper belt use decreased after the first trimester and there was little change in driver proportion by trimester. Third trimester hospitalization rates increased. Conclusions: Pregnant occupants in crashes have similar profiles of restraint use, driver status, and seat position but different treatment indicators compared to non-pregnant occupants. Trimester status has relatively little impact on crash risk, seating position or restraint use. Undercounting of pregnant cases was possible, even so, 1% of all births were reported to be involved in utero in crashes. Little research has focused on developmental outcomes to infants and children previously involved in exposure to these crashes.

Trauma during pregnancy has been recognized as an important cause of adverse fetal and maternal outcomes.¹ While early reports described incidents resulting from falls, blows, and assaults,² later reports increasingly involved automobile crashes.^3,4 By the mid-1960s, the problem of pregnancy and motor vehicle crashes was recognized by trauma and obstetric specialists.^5-7 Over the next decade, many hospital-based case series of fetal outcome following maternal trauma were published.^8-17 However, even for the most severe outcomes resulting in fetal or neonatal death, the lack of inclusion of such cases in vital statistics reports and exclusion from injury surveillance systems have led to a lack of population-based statistics. These data are needed to understand the relative public health burden and the proportional contributions of different injury mechanisms. Such understanding is needed to put these incidents in context with other injury-related deaths and to target prevention efforts.

THE CLOSE ASSOCIATION between humans and domesticated dogs began at least 12000 years ago.¹ Since then, people have been intimately involved in domesticating the wild dog into hunter, guard, and companion. However, the domesticated dog retains many of its wild instincts, including behaviors that all too often lead to human attacks. This risk has always been present. Only now, however, are we beginning to gain a full understanding of the impact of dog bites on populations.²