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Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury
Rachel Sayko Adams1, Ilhom Akobirshoev, Lisa A Brenner
1Institute for Behavioral Health (Dr Adams) and Lurie Institute for Disability Policy (Drs Akobirshoev and Mitra), The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts; VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Drs Adams and Brenner); University of Colorado, Anschutz Medical Campus, Aurora (Dr Brenner); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington (Dr Katon); and Department of Health Systems and Population Health, University of Washington, Seattle (Dr Katon).
Objective:
There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery hospitalization compared with women without TBI.
Setting:
In this cross-sectional study, we identified women with delivery hospitalizations using 2004-2014 data from the Nationwide Inpatient Sample of the Health Care and Cost Utilization Project.
Participants:
We identified deliveries to women with a TBI diagnosis on hospital discharge records, which included all diagnoses recorded during the delivery, and compared them with deliveries of women without a TBI diagnosis.
Main Measures:
Pregnancy outcomes included gestational diabetes; preeclampsia/eclampsia; placental abruption; cesarean delivery; and others. Fetal/neonatal outcomes included preterm birth; stillbirth; and small or large gestational age.
Design:
We modeled risk for each outcome among deliveries to women with TBI compared with women without TBI, using multivariate Poisson regression. Models included sociodemographic and hospital characteristics; secondary models added clinical characteristics (eg, psychiatric disorders) that may be influenced by TBI.
Results:
We identified 3 597 deliveries to women with a TBI diagnosis and 9 106 312 deliveries to women without TBI. Women with TBI were at an increased risk for placental abruption (relative risk [RR] = 2.73; 95% CI, 2.26-3.30) and associated sequelae (ie, antepartum hemorrhage, cesarean delivery). Women with TBI were at an increased risk for stillbirth (RR = 2.55; 95% CI, 1.97-3.29) and having a baby large for gestational age (RR = 1.30; 95% CI, 1.09-1.56). Findings persisted after controlling for clinical characteristics.
Conclusions:
Risk for adverse pregnancy outcomes, including placental abruption and stillbirth, were increased among women with TBI. Future research is needed to examine the association between TBI and pregnancy outcomes using longitudinal and prospective data and to investigate potential mechanisms that may heighten risk for adverse outcomes.
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