Birth rate after major trauma in fertile-aged women: a nationwide population-based cohort study in Finland

Abstract

Background To date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman. Methods In this retrospective register-based nationwide cohort study, data on all fertile-aged (15–44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care. A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, and 1769 in hip or thigh fracture group. The data were subsequently combined with data from the National Medical Birth Register. We used Cox regression model to analyze the hazard for a woman to give birth during 5-year follow-up starting from a major trauma. Women with wrist fractures (4957 women) formed a reference group. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). Results During 5-year follow-up after major trauma, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth. The cumulative birth rate was lower in the hip or thigh fracture group in women aged 15–24 years (HR 0.72, CI 0.58–0.88) and 15–34 years (HR 0.65, CI 0.52–0.82). Women with pelvic fracture aged 25–34 years also had a lower cumulative birth rate (HR 0.79, CI 0.64–0.97). For spine fractures and TBIs, no reduction in cumulative birth rate was observed. Vaginal delivery was the primary mode of delivery in each trauma group. However, women with pelvic fractures had higher rate of cesarean section (23.9%), when compared to other trauma groups. Conclusions Our results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.

Effect of major trauma on the expected number of births in Finnish women: A nationwide population‐based public data and register analysis

“…These data add to the previous study on fertility rates following trauma by extending the period of follow-up after the trauma during which births were enumerated to provide a long-term estimate of fertility post-trauma. 15 These results have important consequences on public health policy decisions. For one, since fewer injured women are expected to give birth after their trauma, their risk of developing HDFN from receipt of an RhD-positive transfusion during their resuscitation is correspondingly lower.…”

“…A retrospective analysis of all injured WCPs between the ages of 15-49 in Finland between 1998 and 2018 found that some women with pelvic fractures and hip or thigh fractures had lower probabilities of giving birth in the 5 years following their trauma compared to women with wrist fractures. 15 The goal of that study was to analyze the short-term effects of trauma on fertility, however, given the increasing mean age at which women give birth, it is also important to consider the long-term effects of trauma on fertility rates. 16 To this end, a study 15 involving two Finnish databases on births and health care was reanalyzed using the maximum length of follow-up that was possible to provide a more comprehensive estimate of their long-term post-injury fertility so that a more accurate fertility rate percentage can be used in risk calculations of HDFN following exposure to RhD-positive RBCs or LTOWB in trauma.…”

“…The question of post‐trauma fertility has been investigated previously. A retrospective analysis of all injured WCPs between the ages of 15–49 in Finland between 1998 and 2018 found that some women with pelvic fractures and hip or thigh fractures had lower probabilities of giving birth in the 5 years following their trauma compared to women with wrist fractures 15 . The goal of that study was to analyze the short‐term effects of trauma on fertility, however, given the increasing mean age at which women give birth, it is also important to consider the long‐term effects of trauma on fertility rates 16 .…”

Multifetal gestations after traumatic brain injury: a nationwide register-based cohort study in Finland

“…Interestingly, the latest nationwide study on birth rates after traumas found that women with TBIs had a relatively high birth rate [ 1 ]. Even though TBIs are known to negatively affect the hypothalamic–pituitary complex and the endocrine system, especially the functions of gonadal hormones, [ 3 , 4 ] it appears that alterations to the hormonal system do not increase the risk for multifetal gestations.…”

“…A previous Finnish nationwide study on birth rates after different traumas found that women with pelvic or hip fractures had lower birth rates than women in the general population. However, those women who had sustained a TBI had an even higher birth rate than the control group [ 1 ]. To our knowledge, this is the first time the effects of TBI on the risk for having multifetal gestations has been studied.…”