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Injury: A Major Cause of Pregnancy-Associated Morbidity in Massachusetts

Authors

  • Angela Nannini FNP, PhD, FNP, PhD,

    family nurse practitioner and an assistant professor, Corresponding author
    1. Bouvé College of Health Sciences School of Nursing at Northeastern University.
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  • Jane Lazar RN, MPH,

    1. clinical practice at Beth Israel Deaconess Medical Center in Labor & Delivery and is a statistical analyst in the Bouvé College of Health Sciences School of Nursing at Northeastern University.
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  • Cynthia Berg MD, MPH,

    1. obstetrician and a medical epidemiologist in the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.
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  • Kay Tomashek MD, MPH,

    1. pediatrician and medical epidemiologist at the Centers for Disease Control and Prevention. She is stationed at CDC's Division of Vector-Borne Infectious Disease, Dengue Branch, in San Juan, Puerto Rico.
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  • Howard Cabral PhD,

    MPH, associate professor of biostatistics
    1. Boston University School of Public Health.
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  • Mary Barger CNM, MPH,

    1. clinical practice at Harvard Vanguard and is an assistant professor of maternal and child health at Boston University School of Public Health.
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  • Wanda Barfield MD, MPH,

    Senior Scientist and Neonatal-Perinatal Medicine Specialist
    1. Maternal and Child Health Epidemiology Program within the Division of Reproductive Health at the Centers for Disease Control and Prevention.
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  • Milton Kotelchuck PhD, MPH

    Developmental psychologist, is Professor and Chairman
    1. Maternal and Child Health Department at Boston University School of Public Health.
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Bouvé College of Health Sciences, School of Nursing, Northeastern University, 106D Robinson Hall, 360 Huntington Ave., Boston, MA 02115–5000. E-mail: a.nannini@neu.edu

Abstract

Hospital visits (inpatient, observation, and emergency department) for injury occurring during pregnancy and 1 year postpartum (the pregnancy-associated period) were examined to determine groups at risk for injuries. The dataset included maternally linked vital records and hospital visit data for a population-based cohort of women residing in Massachusetts who delivered between 2002 and 2003 (n = 100,051). Injury morbidity (injury visits with International Classification of Diseases, Ninth Revision, Clinical Modification codes 800–999.99 or selected E-codes) was evaluated by individual woman-and visit-based analyses. Overall, one in seven women sought hospital care for pregnancy-associated injuries, and rates were as high as one in four for some subgroups. Most pregnancy-associated injury visits (91%) occurred in emergency departments. More than 4% of women had a motor vehicle collision, which was the leading cause of injury. The risk for injury was significantly higher among women who were adolescents (relative risk [RR] = 1.88; 95% confidence interval [CI], 1.78–1.98), black non-Hispanic (RR = 1.88; 95% CI, 1.80–1.97), those who had public insurance (RR = 2.50; 95% CI, 2.41–2.56), or those who had less than a high school education (RR = 2.48; 95% CI, 2.39–2.58) when compared with referent groups. Clinical guidelines for preconception and pregnancy-associated periods should include recommendations for injury history assessment and preventative counseling for women.

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