Pregnancy and delivery after traumatic brain injury: a nationwide population-based cohort study in Finland

Vaajala, Matias; Kuitunen, Ilari; Nyrhi, Lauri; Ponkilainen, Ville; Kekki, Maiju; Luoto, Teemu; Mattila, Ville M.

doi:10.1080/14767058.2022.2050899

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…The risk of maternal and neonatal morbidity was increased if individuals attempted TOLAC and had cesarean delivery. [7][8][9]13 In a birth registry study from Norway, TOLAC compared with elective cesarean delivery had a higher risk of neonatal mortality and a 5-minute Apgar score <4 even if TOLAC was successful. 14 The increased relative risk of neonatal morbidity was also reported in the population-based cohort study from the United States.…”

Section: Discussionmentioning

confidence: 99%

Trial of Labor versus Repeat Cesarean Delivery in Individuals with Morbid Obesity after Previous Cesarean Delivery

Lee,

Almeida,

Saade

et al. 2024

Am J Perinatol

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Objective This study aimed to compare adverse neonatal outcomes associated with the trial of labor after cesarean (TOLAC) at term in pregnancies according to maternal prepregnancy body mass index (BMI; kg/m2) and the presence of previous vaginal delivery (VD). Study Design This was a repeated cross-sectional analysis of individuals with singleton, cephalic, and term deliveries with a history of one or two cesarean deliveries in the Linked Birth/Infant Death data from 2011 to 2020. Outcomes were examined according to the BMI category including BMI <30, 30 to 39.9, and 40 to 69.9 kg/m2. The primary outcome was a composite neonatal outcome, defined as any presence of neonatal death, neonatal intensive care unit admission, assisted ventilation, surfactant therapy, or seizures. Outcomes were compared between TOLAC and elective repeat cesarean delivery (eRCD) after stratifying by BMI category and previous VD. Log-binomial regression was performed to obtain adjusted relative risk (aRR) with 99% confidence intervals, controlling for covariates. Results Of 4,055,440 individuals, 2,627,131 had BMI <30 kg/m2, 1,108,278 had BMI 30 to 39.9 kg/m2, and 320,031 had BMI 40 to 69.9 kg/m2. In individuals with no previous VD, VD rates after TOLAC were 66.7, 57.2, and 48.1%, respectively. In individuals with previous VD, VD rates after TOLAC were 81.4, 74.7, and 67.3%, respectively. In individuals without previous VD, compared with those who had an eRCD, those who had TOLAC were more likely to experience composite neonatal outcomes in individuals with BMI < 30 kg/m2 (5.0 vs. 6.5%; aRR 1.33 [1.30–1.36]), BMI 30 to 39.9 kg/m2 (6.1 vs. 7.8%; aRR 1.29 [1.24–1.34]), and BMI 40 to 69.9 kg/m2 (8.2 vs. 9.0%; aRR 1.15 [1.07–1.23]). In individuals with previous VD, there was no difference in the composite neonatal outcomes in BMI < 30 kg/m2 (6.2 vs. 5.8%; aRR 0.98 [0.96–1.00]), BMI 30 to 39.9 kg/m2 (7.4 vs. 7.1%; aRR 0.99 [0.95–1.02]), and BMI 40 to 69.9 kg/m2 (9.4 vs. 8.7%; aRR 0.96 [0.91–1.02]). Conclusion TOLAC among obese individuals could be offered in selected cases. Key Points

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Section: Discussionmentioning

confidence: 99%

Trial of Labor versus Repeat Cesarean Delivery in Individuals with Morbid Obesity after Previous Cesarean Delivery

Lee,

Almeida,

Saade

et al. 2024

Am J Perinatol

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“…In comparison to non-pregnant females, the occurrence of TBI in a pregnancy increases the risk of complications both to mother and foetus including increase rate of instrumental vaginal deliveries, unplanned caesarean sections, preterm birth, increased need of analgesia during labour and there will be an increased health impairment risk to neonate 3,23,45) . In addition pharmacologic therapies and diagnostic studies where the ionizing radiation is used will increase the risk teratogenicity, placental abruption, and risk of preterm labour 1) .…”

Section: Complicationsmentioning

confidence: 99%

“…TBIs not only can lead to impairment of physical, cognitive, and/or emotional well-being of the mother, but also compromise the well-being of the foetus and can impair the healthy outcome of pregnancy 2) . There are only few studies which have reported the impact of TBI in this vulnerable population which include mother and foetus 2,3) . These studies have emphasized that emergency stabilization set the priorities so the risk of further injuries to mother and foetus can be avoided or minimized 2) .…”

Section: Introductionmentioning

confidence: 99%

Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy

Haldar

Raj

Maurya

et al. 2023

J Neurointensive Care

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Trauma is a leading cause of morbidity and mortality amongst females of childbearing age, and traumatic brain injury (TBI) carries a significant proportion of share amongst trauma of all kinds. Trauma during pregnancy has a twofold impact on the patient and the foetus, who, most of the time, remains unnoticed. Understanding and managing altered maternal physiology in the background of TBI is a challenge and requires close monitoring to avoid any unwanted outcome. The challenges initiate right from the resuscitation following trauma to the rehabilitation of these patients with TBI during pregnancy. Good collaboration with the interdisciplinary departments is the backbone to avoid teratogenicity, a better pregnancy outcome and prevention of expected complications in these complex clinical scenarios.

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“…In women, TBI can affect the reproductive system, causing disorders in the menstrual cycle and amenorrhea [ 2 , 3 ]. Moreover, according to a recent nationwide study carried out in the Finnish population, the incidence of TBIs among fertile-aged women has increased dramatically during the last few decades [ 4 ]. These findings are, however, contradicted by another recent study that found that fertility was not impaired in women who sustained a TBI [ 5 ].…”

Section: Aimsmentioning

confidence: 99%

Previous traumatic brain injury is associated with an increased odds for gestational diabetes: a nationwide register-based cohort study in finland

et al. 2023

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Aims Despite recent findings that traumatic brain injury (TBI) is a possible risk factor for type 2 diabetes (DM2) and that a strong association exists between gestational diabetes (GDM) and the risk for the development of DM2, no previous studies have investigated the effects of TBI on the risk for the development of GDM. Therefore, this study aims to determine the possible association between a previous traumatic brain injury and later gestational diabetes. Methods In this retrospective register-based cohort study, data from the National Medical Birth Register were combined with data from the Care Register for Health Care. Women who had sustained a TBI before pregnancy were included in the patient group. Women who had sustained previous fractures of the upper extremity, pelvis, or lower extremity were included in the control group. A logistic regression model was used to assess the risk for the development of GDM during pregnancy. Adjusted odds ratios (aOR) with 95% confidence intervals between the groups were compared. The model was adjusted by prepregnancy body mass index (BMI) and maternal age during pregnancy, the use of in vitro fertilization (IVF), maternal smoking status, and multiple pregnancies. The risk for the development of GDM during different periods following the injury (0–3 years, 3–6 years, 6–9 years, and 9+ years) was calculated. Results In total, a 75 g 2-h oral glucose tolerance test (OGTT) was performed on 6802 pregnancies of women who had sustained a TBI and on 11 717 pregnancies of women who sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 1889 (27.8%) pregnancies were diagnosed with GDM in the patient group and 3117 (26.6%) in the control group. The total odds for GDM were higher after TBI compared to the other traumas (aOR 1.14, CI 1.06–1.22). The odds were highest at 9 + years after the injury (aOR 1.22, CI 1.07–1.39). Conclusion The total odds for the development of GDM after TBI were higher when compared to the control group. Based on our findings, more research on this topic is warranted. Moreover, a history of TBI should be considered a possible risk factor for the development of GDM.

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Pregnancy and delivery after traumatic brain injury: a nationwide population-based cohort study in Finland

Cited by 6 publications

References 26 publications

Trial of Labor versus Repeat Cesarean Delivery in Individuals with Morbid Obesity after Previous Cesarean Delivery

Trial of Labor versus Repeat Cesarean Delivery in Individuals with Morbid Obesity after Previous Cesarean Delivery

Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy

Previous traumatic brain injury is associated with an increased odds for gestational diabetes: a nationwide register-based cohort study in finland

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