| Motor vehicle crashes are the leading cause of hospitalized maternal injury morbidity and mortality and traumatic fetal mortality among pregnant women in the United States, yet little is known about their determinants. Ongoing pregnancy-related crash surveillance is lacking and crash-related maternal and fetal outcomes are underreported.;Using linked vital records and crash reports we estimated the risk and examined risk factors for being a pregnant driver in a crash and examined the association between crashes and adverse pregnancy outcomes among 878,546 pregnant North Carolina residents, 16-46 years, who reached the 20 th week of pregnancy and delivered a singleton infant between 2001-2008. We also examined injury risk factors among pregnant drivers who were in crashes after the 20th week (n=11,052).;The estimated driver crash risk was 12.6 per 1,000 pregnant women. Women who were 18-24 years (vs. 25-34, adjusted risk difference, RD, 0.8, 95% confidence interval, CI, 0.5, 1.1), non-Hispanic black (vs. non-Hispanic white, RD=1.2, 95% CI 0.8, 1.5), unmarried (RD=1.6, 95% CI 1.3, 1.9), or had high school diplomas only (vs. college graduates, RD=1.5, 95% CI 1.1, 1.8) were at higher risk of being pregnant drivers in crashes. The highest rates of preterm birth (adjusted rate ratio, RR, 1.16, 95% CI 0.94, 1.44), stillbirth (RR=4.68, 95% CI 2.77, 7.91), placental abruption (RR=2.20, 95% CI 1.18, 4.09), and premature rupture of the membranes (RR=1. 48, 95% CI 0.96, 2.27) were observed following pregnant drivers' second or subsequent crashes, compared to no crashes. Pregnant drivers who were unbelted (RD=20.2, 95% CI 12.7, 27.8) or were in crashes severe enough for substantial vehicle damage (RD=18.1, 95% CI 15.9, 20.4) or airbag deployment (RD=27.9, 95% CI 24.8, 31.0) were at greatly increased risk of injury.;Young age, black race, low educational attainment, and unmarried status are associated with an increased risk of being a pregnant driver in a crash. Multiple crashes while driving during pregnancy are associated with elevated rates of adverse pregnancy outcomes. Seat belts reduce the risk of crash-related maternal injury. More research is needed to examine the effect of vehicle safety devices on adverse pregnancy outcomes. |
