Maternal-fetal outcomes following a motor-vehicle crash: Systematic review and meta-analysis

Adverse outcomes after motor-vehicle crashes are the leading cause of death among individuals aged 5-29 years. The objective was to assess the risks of maternal and fetal complications associated with traffic accidents during pregnancy. This systematic review and meta-analysis included searches in PubMed, MEDLINE, EMBASE, LILACS, SciELO, Scopus, and COCHRANE databases up to February 2024, focusing on observational cohort studies. Article selection was performed independently by two authors. Fixed and random-effects meta-analyses with odds ratios (OR) were conducted. Analyses were performed using R software. The study was registered with PROSPERO (CRD42024508710). A total of 6147 articles were identified, with 1519 duplicates. From the 4628 articles reviewed, 108 were selected for full-text review, and finally, seven studies were included in the systematic review, with six included in the meta-analysis. The combined effect sizes for evaluated outcomes were as follows: maternal mortality [OR = 1.66, 95% CI 0.78-3.53], placental abruption [OR = 2.43, 95% CI 1.12-5.29], premature rupture of membranes [OR = 1.05, 95% CI 0.98-1.13], preterm birth [OR = 2.02, 95% CI 0.63-6.44], and cesarean delivery [OR = 1.12, 95% CI 0.92-1.36]. In conclusion, motor-vehicle crashes during pregnancy may increase the risk of maternal mortality, premature rupture of membranes, preterm birth, cesarean delivery, and placental abruption. However, statistical significance was observed only for placental abruption. These findings highlight the importance of understanding country-specific statistics to develop tailored protocols aimed at improving prehospital and hospital care for this vulnerable population.