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2002 PRAMS Surveillance Report: Multistate Exhibits
Prenatal Care Counseling: Seat Belt Use During Pregnancy |
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Data Highlights | References | Tables
Background
Pregnant women can enhance birth outcomes and infant health by engaging in healthy behaviors and avoiding risky ones around the time of pregnancy. About 84% of pregnant women initiate prenatal care in their first trimester,1 placing prenatal care providers in a unique position to screen for risky behaviors and to promote healthy ones early in a pregnancy.
Among reproductive-aged women (15–44 years), motor vehicle crashes account for 13% of all deaths.2,3 Although there are no national-level data on the proportion of deaths among pregnant women that are caused by motor vehicle crashes, an estimated 32,800 pregnant women are involved in motor vehicle crashes each year.4 Estimates of the proportion of deaths among pregnant and recently pregnant women that are attributable to motor vehicle crashes in New York City, Cook County (Illinois), North Carolina, and Utah range from 5% to 13%;5–8 in New Mexico, the estimated proportion is substantially higher (34%).9 Motor vehicle crashes are also an important cause of fetal death from maternal injury.10
Proper seat belt use is an effective means of preventing morbidity and mortality among pregnant women and their unborn infants.11–13 Correct use of the seat belt during pregnancy requires that the lap belt be placed across the upper thighs and under the abdomen, and that the shoulder belt be placed to the side of the uterus, between the breasts, and over the midportion of the clavicle.14,15
Many pregnant women do not consistently wear a seat belt when traveling in a car. Beck and colleagues16 found that only 84% of pregnant women reported consistent seat belt use. Further, among pregnant women who wear a seatbelt, studies have found that between 28% and 32% do not have it positioned properly.15,17
The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that prenatal care providers counsel their patients to wear seat belts throughout their pregnancy,18 and evidence exists that counseling increases the rate of seat belt use among pregnant women.17 Despite this recommendation, only 48% of pregnant women in 19 states reported receiving prenatal counseling about seat belt use.16
PRAMS collects data on whether any health care provider or worker talked to women during a prenatal care visit about using a seat belt during pregnancy. State and local agencies and professional organizations can use these data to monitor counseling practices to ensure that pregnant women receive information and counseling about seat belt use during pregnancy. Prenatal counseling regarding the correct use of seat belts during pregnancy may also contribute to achieving the Healthy People 2010 objective (Objective 15–19) of increasing seat belt use from 69% of the population (1998) to 92%.19
Data Highlights
- In 2002, the proportion of women who reported that their prenatal care counseling included a discussion of seat belt use during pregnancy ranged from 35.0% (Arkansas) to 59.6% (Washington).
- During 2000–2002, the proportion of women who reported that prenatal care counseling included a discussion of seat belt use during pregnancy decreased in 1 state (Utah).
References
- Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. National Vital Statistics Reports 2003;52(10):1–113.
- Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (Web site). Leading Causes of Death Report, United States, 2002: Female, All Races, Ages 15–44 years. Available at http://www.cdc.gov/ncipc/wisqars.
- Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (Web site). 10 Leading Causes of Unintentional Injury Deaths, United States 2002: Female, All Races, Ages 15–44 years. Available at http://www.cdc.gov/ncipc/wisqars.
- Weiss HB, Strotmeyer S. Characteristics of pregnant women in motor vehicle crashes. Injury Prevention 2002;8(3):207–210.
- Fildes J, Reed L, Jones N, Martin M, Barrett J. Trauma: the leading cause of maternal death. The Journal of Trauma 1992;32(5):643–645.
- Jacob S, Bloebaum L, Shah G, Varner MW. Maternal mortality in Utah. Obstetrics and Gynecology 1998;91(2):187–191.
- Harper M, Parsons L. Maternal deaths due to homicide and other injuries in North Carolina: 1992–1994. Obstetrics and Gynecology 1997;90(6):920–923.
- Dannenberg AL, Carter DM, Lawson HW, Ashton DM, Dorfman SF, Graham EH. Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991. American Journal of Obstetrics and Gynecology 1995;172(5):1557–1564.
- Schiff M, Albers L, McFeeley P. Motor vehicle crashes and maternal mortality in New Mexico: the significance of seat belt use. The Western Journal of Medicine 1997;167(1):19–22.
- Weiss HB, Songer TJ, Fabio A. Fetal deaths related to maternal injury. The Journal of the American Medical Association 2001;286(15):1863–1868.
- Crosby WM, Costiloe JP. Safety of lap-belt restraint for pregnant victims of automobile collisions. The New England Journal of Medicine 1971;284(12):632–636.
- Wolf ME, Alexander BH, Rivara FP, Hickok DE, Maier RV, Starzyk PM. A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash. The Journal of Trauma 1993;34(1):116–119.
- Hendey GW, Votey SR. Injuries in restrained motor vehicle accident victims. Annals of Emergency Medicine 1994;24(1):77–84.
- Pearlman MD, Viano D. Automobile crash simulation with the first pregnant crash test dummy. American Journal of Obstetrics and Gynecology 1996;175(4 Pt 1):977–981.
- McGwin G Jr, Russell SR, Rux RL, Leath CA, Valent F, Rue LW. Knowledge, beliefs, and practices concerning seat belt use during pregnancy. The Journal of Trauma 2004;56(3):670–675.
- Beck LF, Colley Gilbert B, Shults RA. Prevalence of seat belt use among reproductive-aged women and prenatal counseling to wear seat belts. American Journal of Obstetrics and Gynecology 2005;192(2):580–585.
- Pearlman MD, Phillips ME. Safety belt use during pregnancy. Obstetrics and Gynecology 1996;88(6):1026–1029.
- American Academy of Pediatrics (AAP) Committee on the Fetus and Newborn and American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Guidelines for Perinatal Care. Elk Grove Village, IL and Washington, DC: AAP and ACOG; 2002.
- U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
Prevalence of Prenatal Care Discussion of Seat Belt Use During Pregnancy, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,511 |
48.5 |
1.6 |
45.3–51.6 |
| Alaska |
1,584 |
53.0 |
1.4 |
50.1–55.8 |
| Arkansas |
1,895 |
35.0 |
1.5 |
32.1–38.0 |
| Colorado |
2,227 |
48.0 |
1.4 |
45.3–50.7 |
| Florida |
1,976 |
47.5 |
1.7 |
44.2–50.8 |
| Hawaii |
1,762 |
48.6 |
1.4 |
45.7–51.4 |
| Illinois |
1,878 |
51.8 |
1.2 |
49.4–54.2 |
| Louisiana |
1,642 |
49.7 |
1.4 |
47.0–52.4 |
| Maine |
1,122 |
53.6 |
1.7 |
50.3–56.9 |
| Maryland |
1,430 |
51.4 |
2.0 |
47.5–55.2 |
| Michigan |
1,519 |
47.6 |
1.5 |
44.8–50.5 |
| Minnesotaa |
1,103 |
53.7 |
1.9 |
49.9–57.3 |
| Montana |
1,025 |
49.3 |
1.6 |
46.1–52.4 |
| Nebraska |
1,836 |
52.5 |
1.4 |
49.7–55.2 |
| New Jerseyb |
907 |
37.2 |
1.9 |
33.6–40.9 |
| New Mexico |
1,511 |
57.1 |
1.3 |
54.5–59.7 |
| New Yorkc |
1,179 |
35.8 |
1.8 |
32.3–39.3 |
| North Carolina |
1,504 |
55.0 |
1.6 |
51.8–58.1 |
| North Dakota |
889 |
46.0 |
1.7 |
42.7–49.2 |
| Ohio |
1,349 |
43.4 |
1.7 |
40.0–46.8 |
| Oklahoma |
1,815 |
43.8 |
1.8 |
40.3–47.4 |
| Rhode Island |
1,373 |
44.3 |
1.6 |
41.2–47.4 |
| South Carolina |
1,340 |
52.2 |
2.2 |
47.9–56.5 |
| Utah |
1,539 |
37.8 |
1.6 |
34.8–41.0 |
| Vermont |
1,087 |
55.8 |
1.5 |
52.8–58.7 |
| Washington |
1,488 |
59.6 |
1.8 |
55.9–63.1 |
| West Virginia |
1,649 |
47.1 |
1.7 |
43.7–50.5 |
| All PRAMS states§ |
40,140 |
47.8 |
0.4 |
46.9–48.6 |
† 2002 state range is 35.0–59.6%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Prenatal Care Discussion of Seat Belt Use During Pregnancy, 2002
Prevalence of Prenatal Care Discussion of Seat Belt Use During Pregnancy, 2000–2002
| State |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
49.9 |
50.3 |
48.5 |
0.552 |
| Alaska |
49.9 |
50.4 |
53.0 |
0.141 |
| Arkansas |
36.7 |
38.2 |
35.0 |
0.461 |
| Colorado |
48.3 |
48.2 |
48.0 |
0.889 |
| Florida |
45.9 |
48.2 |
47.5 |
0.507 |
| Hawaii |
48.8 |
48.0 |
48.6 |
0.907 |
| Illinois |
50.2 |
53.4 |
51.8 |
0.360 |
| Louisiana |
52.2 |
50.0 |
49.7 |
0.193 |
| Maine |
55.4 |
53.5 |
53.6 |
0.441 |
| Maryland |
— |
48.8d |
51.4 |
# # |
| Michigan |
— |
48.2e |
47.6 |
# # |
| Minnesota |
— |
— |
53.7a |
# # |
| Montana |
— |
— |
49.3 |
# # |
| Nebraska |
50.8 |
51.3 |
52.5 |
0.394 |
| New Jersey |
— |
— |
37.2b |
# # |
| New Mexico |
55.7 |
55.4 |
57.1 |
0.456 |
| New Yorkc |
38.9 |
42.3 |
35.8 |
0.227 |
| North Carolina |
55.9 |
54.5 |
55.0 |
0.674 |
| North Dakota |
— |
— |
46.0 |
# # |
| Ohio |
46.7 |
41.8 |
43.4 |
0.170 |
| Oklahoma |
42.9 |
45.4 |
43.8 |
0.715 |
| Rhode Island |
— |
— |
44.3 |
# # |
| South Carolina |
51.9 |
54.7 |
52.2 |
0.895 |
| Utah |
42.8 |
39.3 |
37.8 |
0.029* |
| Vermont |
—f |
52.4f |
55.8 |
# # |
| Washington |
56.5 |
58.8 |
59.6 |
0.227 |
| West Virginia |
46.9 |
44.5 |
47.1 |
0.940 |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001. |
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Page last reviewed: 5/13/09
Page last modified: 8/23/06
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion |
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