Impact of Seat Belt Use and Motor Vehicle Crashes on Maternal Mortality in Pregnant Women: A Systematic Review Open Access

Ayantunji, Rashidat T. (2017)

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BACKGROUND: Globally, an estimated 303,000 women died in 2015 during and following pregnancy and childbirth. The majority of maternal mortalities occurred in developing countries and accounted for about 99% of all deaths in 2015. Worldwide, the leading cause of maternal mortality (pregnancy-associated deaths) and traumatic fetal mortality are motor vehicle crashes (MVC). There is a knowledge gap as to the circumstances surrounding the occurrences of motor vehicle crashes and pregnant occupants.

OBJECTIVE: To evaluate the association between seat belt use and maternal mortality during motor vehicle crashes (pregnancy-associated death) in pregnant women.

METHODS: A systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted to evaluate the association of seat belt use and maternal mortality during motor vehicle crashes (pregnancy-associated deaths) in pregnant women. The article search was performed using the terms "pregnancy" and "traffic accidents" along with listed mechanisms of mortality, in the PubMed database for studies published between December 1, 1990 and January 1, 2016. A descriptive analysis was conducted using frequencies and percentages, and odds ratio, 95% CI, and p values were calculated.

RESULTS: A total of 45 articles were screened using titles and abstracts. After reviewing for duplicates, full-text of articles were retrieved and read in their entirety, and re-evaluated with the inclusion and exclusion criteria. Fifteen articles met the criteria for inclusion. All the study designs were retrospective designs. Only five (33%) articles specified whether the pregnant women were belted (35% to 90%) or unbelted (10% to 90%). The fetal mortality percentage ranged from 0.7% to 35%. The key finding in this study was that there is no evidence supporting the association of the two variables: seat belt use and maternal mortality due to MVC.

CONCLUSION: The lack of evidence on the association between seat belt use and maternal mortality due to MVC may be because of the feasibility of conducting such research is complicated due to poor data linkage and accessibility, or sample size.

Table of Contents

CHAPTER I: INTRODUCTION------------------------------------------------------------- 1
Research Goal---------------------------------------------------------------------------------- 2
Definition of Terms----------------------------------------------------------------------------- 3
CHAPTER II: REVIEW OF THE LITERATURE--------------------------------------------- 6
Global Burden of Maternal Mortality----------------------------------------------------------- 6
Maternal Mortality and Motor Vehicle Crashes in Developing and Developed Countries---- 7
Risk Factors of Pregnancy-Associated Deaths due to Motor Vehicle Crashes--------------- 10
Global Traffic Report--------------------------------------------------------------------------- 12
Seat Belt Use----------------------------------------------------------------------------------- 13
Policy Impact of Seat Belt Use----------------------------------------------------------------- 15
Compliance with Use of Seat Belts, Especially among Pregnant Women-------------------- 18
Conclusion--------------------------------------------------------------------------------------- 19
Significance-------------------------------------------------------------------------------------- 19
Study Purpose------------------------------------------------------------------------------------ 21
IRB and Confidentiality--------------------------------------------------------------------------- 21
Data Source and Search Terms for Systematic Review----------------------------------------- 21
Data Extraction------------------------------------------------------------------------------------ 22
CHAPTER IV: RESULTS----------------------------------------------------------------------- 24
Summary of Searches and Study Selection Process-------------------------------------------- 24
CHAPTER V: DISCUSSION------------------------------------------------------------------- 33
Recommendations and Conclusion--------------------------------------------------------------- 37
REFERENCES----------------------------------------------------------------------------------- 39

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