Traumatic brain injury during pregnancy is associated with increased rate of cesarean section: a nationwide multi-register study in Finland

Objective The literature on the incidence of traumatic brain injury (TBI) during pregnancy is lacking. Furthermore, only studies with small sample size have analyzed the impact of TBI during pregnancy to maternal and fetal outcomes. Thus, we aim to report the incidence of TBIs during pregnancy and study the pregnancy outcomes using nationwide high-quality registers. Methods This nationwide retrospective register-based matched cohort study utilized two national registers. All fertile-aged (15-49 years) women with a TBI hospitalization period during pregnancy were retrieved the Care Register for Health Care. Data were then linked with the data from the National Medical Birth Register (MBR). Propensity score matching was conducted according to maternal age during pregnancy, previous cesarean section (CS), maternal smoking status, maternal body mass index, and maternal gestational diabetes. The matching was conducted using the nearest neighbor methods with a caliber width if 0.15, and with a ratio 1:3 (patients/references). Adverse maternal and fetal outcomes were compared between patient group and reference group using Chi-squared tests. Results A total of 392 women having a TBI during pregnancy were found. The control group consisted of 722,497 women without TBI during pregnancy. Of the TBIs occurring during pregnancy, the most common types of TBIs were concussion (S06.0) (n = 359, 91.6%), diffuse traumatic brain injury (S06.2) (n = 11, 2.8%), traumatic subdural hemorrhage (n = 7, 1.8%), and unspecified intracranial injury S06.9 (n = 6, 1.5%). The incidence rates of pregnancies with a TBI have remained similar during pregnancy in Finland, peaking at 0.8 per 1000 pregnancies in 2016. The Chi-squared test showed higher rate for CS among women with TBI than for their matched references (21.4% vs. 15.5%, p = .008). Especially, women with TBI during 3rd trimester had higher rate for CS (29.0 vs. 15.0%, p = .016). Conclusions The main findings of this study were that the incidence rates for TBI during pregnancy have remained similar during our study period (2004-2018). TBI during pregnancy, even a mild one, is associated with an increased rate for CS. Especially, TBI during the 3rd trimester was associated with high rate for CS, but the etiology behind this remains unknown. In addition, we found no evidence of difference in fetal outcomes, such as preterm birth, low birth weight, or need for intensive care unit. Future studies should focus on the indications for elective CS, and reasons for unplanned CS among women with TBI during pregnancy, as these could possibly provide important information on the effects of TBI on the course of childbirth.

Automated summary

This study aimed to investigate the incidence of traumatic brain injury (TBI) during pregnancy and its impact on pregnancy outcomes. The results showed that even mild TBI was associated with an increased rate of cesarean section (CS), especially during the third trimester. However, there was no evidence of difference in fetal outcomes, such as preterm birth, low birth weight, or need for intensive care unit.