孕期包括機動車輛碰撞在內因猛烈攻擊或事故所造成的創傷，是孕婦與胎兒非產科相關的主要死因之一。已有多數西方國家探討婦女在懷孕期間發生車禍的健康風險研究；但是，發生車禍的風險與車禍後的預後，可能會因東西方國家使用交通工具之種類、居住環境以及健康照護體系的差異，而導致健康風險的不同，不過，目前卻鮮少有文獻探討亞洲婦女於懷孕期間發生車禍的健康風險。因此，本研究有3個研究目的，分別為：1. 評估台灣婦女於懷孕期間是否增加交通事故的風險，2. 描繪本土車禍孕婦之受傷嚴重程度，3. 孕婦發生車禍後對子代的健康影響 。
首先，第一部分，採用自我對照研究設計，自出生通報檔（Birth Notification，BN）中擷取2008-2017年18-50歲分娩婦女（共1,372,664位），以每位婦女其懷孕暴露期間以自己相同的回溯時間作為非懷孕期間對照組，並比較懷孕期間與非懷孕期間不同駕駛身分發生交通事故之發生率（由警政署交通事故檔，PTAR中擷取）。本研究利用條件式卜瓦松迴歸模型分析並計算相對風險與95%信賴區間。研究結果指出，懷孕期間發生駕駛車禍率比非懷孕期間車禍率低（RR=0.69, 95% CI=0.68-0.71)，尤其是18-24歲之駕駛（0.49, 95% CI = 0.46-0.52）。而這樣的下降在摩托車駕駛（0.60, 95% CI=0.58-0.62）中比汽車駕駛明顯（0.92, 95% CI=0.89-0.96）。
第二部分，使用2006-2017期間PTAR中共23,559位發生交通事故懷孕者，以年齡與事故年代別匹配發生交通事故之非懷孕者，共94,236位。以發生事故後3天內的診斷碼經由ICDPIC-R軟體取得MAIS分數作為事故傷害嚴重分類，並當作本研究依變項。採用多項式邏輯斯迴歸模型計算不同嚴重程度與懷孕相關之勝算比與95%信賴區間（以未就醫為對照事件）。結果指出，懷孕事故者相比非懷孕事故者有近2倍較容易嚴重的事故傷害（aOR=1.79, 95% CI=1.54-2.08）。尤其是摩托車事故者，懷孕相比非懷孕容易嚴重高達4倍（aOR=4.25, 95% CI=3.58-5.04）。但是懷孕事故者比非懷孕事故者更多於事故後傾向非受傷就醫（aOR=17.18，95% CI=16.18-18.25）。
第三部分，本研究分析2007-2016年期間共19,277位新生兒其母親在孕期曾經發生車禍，另外76,015位兒童為對照組，從所有母親在孕期未發生車禍之活產子代中以匹配母親年齡與車禍時之相同孕期選出。追蹤兩組樣本至健保資料庫，並控制相關的危險因子後，以廣義估計方程式與Cox比例危害模式分別估計子代於新生兒期，以及兒童時期發生不良的健康風險。結果顯示，孕期發生車禍之子代於新生兒期發生出生缺陷的風險顯著增加（aOR=1.21, 95% CI=1.04-1.42）。至於兒童期（最長追蹤至11歲）的發展障礙結果，腦麻（adjusted hazard ratio（aHR）=3.16, 95% CI=1.03-9.65）與智能不足（aHR=3.00, 95% CI=1.31-6.84）的風險在孕期發生嚴重車禍的子代中也呈現顯著增加。
本研究顯示，研究期間台灣婦女於懷孕期間以駕駛身分車禍發生率相比非懷孕期間普遍降低；此外也發現，一旦孕婦發生車禍後，相比非懷孕的事故者更容易非受傷就醫。本研究數據顯示：車禍對孕婦有許多顯著的不良健康影響，子代也有較高的發展障礙問題。未來的研究應持續探討孕婦發生車禍的風險因子，以及針對孕婦發展有效能夠降低車禍風險的介入方案；同時也需進一步探討孕期車禍對母親與子代健康影響之相關疾病機轉。

Trauma from violent attacks or events, including motor vehicle crashes (MVCs) are one of the primary causes of non-obstetric trauma during pregnancy. Evidence concerning the health risk associated with MVCs during pregnancy is available from studies conducted in Western countries. However, the magnitude of health risks associated with MVCs in pregnant women might be different between Western and Eastern societies due to commonly used vehicle type, living environment, and healthcare systems. Nonetheless, very few research was conducted in Asia to investigate the health risk of women involved in MVCs during pregnancy. Hence, our study had 3 aims: 1. To estimate and compare the risk of MVC events among pregnant women before and during pregnancy; 2. To investigate the levels of injury severity in association with pregnancy among driver victims of MVCs. 3. To assess the relationship between maternal MVCs and the risks of adverse neonatal and developed disorders in offspring.
Part 1: It was a self-controlled before-after design. A total of 1,372,664 pregnant women with a successful delivery at 18 to 50 years of age between 2008 and 2017 were identified from Taiwan’s Birth Notification (BN) dataset. For each enrolled woman, the nonpregnant period as long as their pregnant period was determined to compare the MVC events (retrieved from National Police-reported Traffic Accident Registry, PTAR) rates between the pregnant and non-pregnant periods. We calculated the rate ratio (RR) with a 95% confidence interval (CI) using the conditional Poisson regression model. The overall rate of driver MVC events significantly reduced after pregnancy (RR=0.69, 95% CI=0.68-0.71), especially among mother drivers aged 18-24 years (0.49, 95% CI = 0.46-0.52). Such reduction in RR was greater among scooter rider MVC events (0.60, 95% CI=0.58-0.62) than in car driver MVC events (0.92, 95% CI=0.89-0.96).
Part 2: A total of 20,844 deliveries of mothers who had been involved in MVCs during pregnancy were obtained from the BN database. We randomly selected, using density sampling method, 83,274 control deliveries with a ratio of 1:4 from the BN matched on age, gestational age, and crash date. All study pregnant women were linked to the NHI outpatient / inpatient medical claims and Death Registry to identify the adverse maternal outcomes after crashes. Generalized estimating equation (GEE) were established to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy. Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.48, 95% CI=1.28-1.71), prolonged uterine contractions (aOR=1.28, 95% CI=1.10-1.48), antepartum hemorrhage (aOR=1.17, 95% CI=1.11-1.25), and cesarean delivery (aOR=1.05, 95% CI=1.02-1.09) than the controls.
Part 3: Between 2007 and 2016, a total of 19,277 offspring with a mother involved in MVCs during pregnancy and 76,015 controls were identified from BN and PTAR. Controls were selected using time density matching on maternal age and gestation weeks. Both groups of study offspring were linked to the NHI medical claims for identifying neonatal adverse medical conditions and developmental disorders in offspring up to 11 years. We used the GEE and Cox proportional hazards model, respectively, to assess the association of neonatal and developmental disorder problems with MVCs during pregnancy. For the neonatal health outcome, the results showed that the offspring exposed to maternal MVCs during pregnancy had a significantly higher risk of birth defect (aOR=1.21, 95% CI=1.04-1.42). For the developmental disorders in up to 10 years, the findings demonstrated that infantile cerebral palsy (adjusted hazard ratio(aHR)=3.16, 95% CI=1.03-9.65) and mental retardation (aHR=3.00, 95 CI=1.31-6.84) were significantly associated with maternal severe injury from MVC during pregnancy.
This study found MVCs even rate was reduced after pregnancy in the study period. It also found once the MVCs happened, pregnant women without any injury were much more likely to visit medical institutions. The data showed that MVCs occurring to pregnant women were significantly associated with various adverse developmental disorders in offspring. Future research is needed to explore the risk factors associated with MVCs, and develop interventions that can effectively reduce the risk of MVCs in pregnant women. The underlying mechanisms for the relationship between maternal MVCs and maternal / offspring health risks also warrant investigations.

Aboutanos MB, Aboutanos SZ, Dompkowski D, Duane TM, Malhotra AK, Ivatury RR. Significance of motor vehicle crashes and pelvic injury on fetal mortality: a five-year institutional review. J Trauma. 2008;65:616–20.
Adair-Kirk TL, Atkinson JJ, Kelley DG, Arch RH, Miner JH, Senior RM. A chemotactic peptide from laminin alpha 5 functions as a regulator of inflammatory immune responses via TNF alpha-mediated signaling. J Immunol. 2005;174:1621–9.
Amezcua-Prieto C, Ross J, Rogozińska E, et al. Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis. BMJ Open. 2020;10:e035562.
Auriault F, Brandt C, Chopin A, et al. Pregnant women in vehicles: driving habits, position and risk of injury. Accid Anal Prev. 2016;89:57–61.
Austin PC. A Tutorial on multilevel survival analysis: methods, models and applications. Int Stat Rev. 2017;85:185–203.
Azar T, Longo C, Oddy L, Abenhaim HA. Motor vehicle collision- related accidents in pregnancy. J Obstet Gynaecol Res. 2015;41:1370–6.
Baethmann M, Kahn T, Lenard HG, Voit T. Fetal CNS damage after exposure to maternal trauma during pregnancy. Acta Paediatrica. 1996;85:1331–8.
Barker DJP. Rise and fall of Western diseases. Nature. 1989;338:371–2.
Battaloglu E, McDonnell D, Chu J, Lecky F, Porter K. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury. 2016;47:184–7.
Beversdorf D. Stress during pregnancy linked to autism. San Diego, CA:Society for Neuroscience, 2001.
Brown H. Trauma in pregnancy. Obstet Gynecol. 2009;114:147–60.
Buckwalter JG, Buckwalter DK, Bluestein BW, Stanczyk FZ. Pregnancy and postpartum: changes in cognition and mood. Prog Brain Res. 2001;133:303–19.
Burr JF, Jamnik V, Gledhill N. A cross-sectional examination of the physical fitness and selected health attributes of recreational all-terrain vehicle riders and off-road motorcyclists. J Sports Sci. 2010;28:1423–33.
Cakmak B, Ribeiro AP, Inanir A. Postural balance and the risk of falling during pregnancy. J Matern Fetal Neonatal Med. 2016;29:1623–5.
Chalya PL, Mabula JB, Dass RM, et al. Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. J Trauma Management Outcomes. 2012;6:1.
Chang YH, Cheng YY, Hou WH, et al. Risk of mortality in association with pregnancy in women following motor vehicle crashes: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19:911.
Chang YH, Hou WH, Wu KF, Li CY, Hsu IL. Risk of motorcycle collisions among patients with type 2 diabetes: a population-based cohort study with age and sex stratifications in Taiwan. Acta Diabetol. 2022;59:1625–34.
Chang YH, Li CY, Lu TH, Artanti KD, Hou WH. Risk of injury and mortality among driver victims involved in single-vehicle crashes in Taiwan: comparisons between vehicle types. Int J Environ Res Public Health. 2020;17:4687.
Chang YH, Lu TH, Hsu IL, Chen BL, Li CY. Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs. J Epidemiol Community Health. 2020;74:815–23.
Chen HF, Ho CA, Li CY. Risk of heart failure in a population with type 2 diabetes versus a population without diabetes with and without coronary heart disease. Diabetes Obes Metab. 2019;21:112–9.
Chen PL, Jou RC, Saleh W, Pai CW. Accidents involving pedestrians with their backs to traffic or facing traffic: an evaluation of crash characteristics and injuries. J Adv Transp. 2016;50:736–51.
Chen YY, Yu S, Hu YH, et al. Risk of suicide among patients with Parkinson disease. JAMA Psychiatry. 2021;78:293–301.
Cheng HT, Wang YC, Lo HC, et al. Trauma during pregnancy: a population-based analysis of maternal outcome. World J Surg. 2012;36:2767–75.
Chibber R, Al-Harmi J, Fouda M, El-Saleh E. Motor–vehicle injury in pregnancy and subsequent feto-maternal outcomes: of grave concern. J Matern Fetal Neonatal Med. 2015;28:399–402.
Chou HH, Chiou MJ, Liang FW, Chen LH, Lu TH, Li CY. Association of maternal chronic disease with risk of congenital heart disease in offspring. CMAJ. 2016;188:E438–46.
Christensen H, Leach LS, Mackinnon A. Cognition in pregnancy and motherhood: prospective cohort study. Br J Psychiatry. 2010;196:126–32.
Christian MA, Samms-Vaughan M, Lee M, et al. Maternal exposures associated with autism spectrum disorder in Jamaican children. J Autism Dev Disord. 2018;48:2766–78.
Clark DE, Black AW, Skavdahl DH, Hallagan LD. Open-access programs for injury categorization using ICD-9 or ICD-10. Inj Epidemiol. 2018;5:11.
Crawley RA, Dennison K, Carter C. Cognition in pregnancy and the first year post-partum. Psychol Psychother. 2003;76:69–84.
Cunningham FG, Leveno KJ, Bloom SL, et al. Maternal physiology. In Williams Obstetrics, 25th ed. Mc Graw Hill: New York; 2018; pp. 49–78.
Deshpande NA, Kucirka LM, Smith RN, et al. Pregnant trauma victims experience nearly 2-fold higher mortality compared to their nonpregnant counterparts. Am J Obstet Gynecol. 2017;217:590.e1–9.
Dietz PM, England LJ, Callaghan WM, Pearl M, Wier ML, Kharrazi M. A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records. Paediatr Perinat Epidemiol. 2007;21:62–71.
Division of reproductive health, national center for chronic disease prevention and health promotion. Pregnancy mortality surveillance system. Reproductive health. CDC. Available online: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (accessed on 19 January 2021).
El Kady D, Gilbert WM, Xing G, Smith LH. Association of maternal fractures with adverse perinatal outcomes. Am J Obstet Gynecol. 2006;195:711–6.
Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283:2701–11.
Ershova OA. Pregnant women’s perception of themselves and other drivers as road users. Social Psychology and Society. 2018;9:61–73. [in Russian]
Fridman L, Rothman L, Howard AW, Hagel BE, Macarthur C. Methodological considerations in MVC epidemiological research. Injury Prev. 2021;27:155–60.
Gennarelli T, Wodzin EE. Abbreviated Injury Scale (c) 2005 Update 2008. Association for the Advancement of Automotive Medicine; 2016.
Greiss FC. Uterine vascular response to hemorrhage during pregnancy. Obstetrics Gynecol. 1966;27:549–54.
Haneuse S, VanderWeele TJ, Arterburn D. Using the E-value to assess the potential effect of unmeasured confounding in observational studies. JAMA 2019;321:602–3.
Herzog-Petropaki N, Derksen C, Lippke S. Health behaviors and behavior change during pregnancy: theory-based investigation of predictors and interrelations. Sexes. 2022;3:351–66.
Hsu YH, Chen CW, Lin YJ, Li CY. Urban-rural disparity in the incidence of diagnosed autism spectrum disorder in Taiwan: a 10-year National Birth Cohort follow-up study. J Autism Dev Disord. 2023;53:2127–37.
Hyde L, Cook L, Olson L, Weiss HB, Dean JM. Effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol. 2003;102:279–86.
Ikossi DG, Lazar AA, Morabito D, et al. Profile of mothers at risk: an analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg. 2005;200:49–56.
Koh S, Hitosugi M, Moriguchi S, et al. Comparison of motor vehicle collision Injuries between pregnant and non-pregnant women: a nationwide collision data-based study. Healthc. 2021;9:1414.
Krywko DM, Toy FK, Mahan ME, Kiel J. Pregnancy Trauma. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK430926/ [accessed 26 March 2023]
Kuwahara A, Hitosugi M, Takeda A, Tsujimura S, Miyata Y. Comparison of the injury mechanism between pregnant and non-pregnant women vehicle passengers using car crash test dummies. Healthcare (Basel). 2022;10:884.
Lam C, Lin MR, Chu SF, Tsai SH, Bai CH, Chiu WT. The effect of various types of motorcycle helmets on cervical spine injury in head injury patients: a multicenter study in Taiwan. Biomed Res Int. 2015;2015:487985.
Leroy-Malherbe V, Bonnier C, Papiernik E, Groos E, Landrieu P. The association between developmental handicaps and traumatic brain injury during pregnancy: an issue that deserves more systematic evaluation. Brain Injury. 2006; 20:1355–65.
Lin CY, Liao Y. Perceptions of activity-supportive environment and motorcycle use among urban Taiwanese adults. BMC Public Health. 2017;17:665.
Lin LP, Lee JT, Lin FG, et al. Disability and hospital care expenses among national health insurance beneficiaries: analyses of population-based data in Taiwan. Res Dev Disabil. 2011;32:1589–95
Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag. 2006;4:1–22.
Lu CL, Chang YH, Sun Y, Li CY. A population-based study of epilepsy incidence in association with type 2 diabetes and severe hypoglycaemia. Diabetes Res Clin Pract. 2018;140:97–106.
Lu TH, Lee MC, Chou MC. Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics. Int J Epidemiol. 2000;29:336–43.
Luley T, Fitzpatrick CB, Grotegut CA, Hocker MB, Myers ER, Brown HL. Perinatal implications of motor vehicle accident trauma during pregnancy: identifying populations at risk. Am J Obstet Gynecol. 2013;208:466.e1–5.
Lynch CD, Zhang J. The research implications of the selection of a gestational age estimation method. Paediatr Perinat Epidemiol. 2007;21:86–96.
Manoogian S. Comparison of pregnant and non-pregnant occupant crash and injury characteristics based on national crash data. Accid Ana Prev. 2015;74:69–76.
Mathur MB, Ding P, Riddell CA, VanderWeele TJ. Web site and R package for computing e-values. Epidemiology. 2018;29:e45–7.
Mayou R, Bryant B. Consequences of road traffic accidents for different types of road user. Injury. 2003;34:197–202.
McCall SJ, Bhattacharya S. High risk of traffic crashes in pregnancy: are there any explanations? CMAJ. 2014;186:733–4.
Menendez ME, Ring D. Factors associated with hospital admission for proximal humerus fracture. Am J Emerg Med. 2015;33:155–8.
Metz TD, Abbott JT. Uterine trauma in pregnancy after motor vehicle crashes with airbag deployment: a 30-case series. J Trauma. 2006;61:658–61.
Mikkelsen TB, Osler M, Orozova-Bekkevold I, Knudsen VK, Olsen SF. Association between fruit and vegetable consumption and birth weight: a prospective study among 43,585 Danish women. Scand J Public Health. 2006;34:616–22.
Miller N, Biron-Shental T, Peleg K, et al. Are pregnant women safer in motor vehicle accidents? J Perinat Med. 2016;44:329–32.
Ministry of transportation and communications. 2018 Small private passenger cars usage survey (Public access data). Survey research data archive, Academia Sinica. 2020 in Chinese.
Morikawa M, Yamada T, Kato-Hirayama E, et al. Seatbelt use and seat preference among pregnant women in Sapporo, Japan, in 2013. J Obstet Gynaecol Res. 2016;42:810–15.
Morikawa M, Yamada T, Kogo H, et al. Effect of an educational leaflet on the frequency of seat belt use and the rate of motor vehicle accidents during pregnancy in Japan in 2018: a prospective, non-randomised control trial with a questionnaire survey. Bmj Open. 2019;9:e031839
Morrison CN, Rundle AG, Branas CC , Chihuri S, Mehranbod C, Li G. The unknown denominator problem in population studies of disease frequency. Spat Spatiotemporal Epidemiol. 2020;35:100361.
Muench M, Canterino J. Trauma in pregnancy. Obstet Gynecol Clin North Am. 2007;34:555–83.
Ochsenbein-Kölble N, von Mering R, Zimmermann R, Hummel T. Changes in olfactory function in pregnancy and postpartum. Int J Gynaecol Obstet. 2007;97:10–4.
Oh P, Cho JS, Jang JH, Choi JY, Choi WS, Yu B. Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents. J Trauma Inj. 2022;35:240–7.
Oni OOA, Okpere EE, Tabowei O, Omu EA. Severe road traffic injuries in the third trimester of pregnancy. Injury. 1984;15:376–8.
Pai CW, Wiratama BS, Lin HY, Chen PL. Association of traumatic injury with adverse pregnancy outcomes in Taiwan, 2004 to 2014. JAMA Netw Open. 2021;4:e217072.
Patteson SK, Snider CC, Meyer DS, et al. The consequences of high-risk behaviors: Trauma during pregnancy. J Trauma. 2007;62:1015–20.
Pearce C, Martin SR. Trauma and considerations unique to pregnancy. Obstet Gyn Clin N Am. 2016;43:791–808.
Petrone P, Jiménez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg. 2019;45:383–92.
Pinto E, Barros H, dos Santos Silva I. Dietary intake and nutritional adequacy prior to conception and during pregnancy: a follow-up study in the north of Portugal. Public Health Nutr. 2009;12:922–31.
Redelmeier DA, May SC, Thiruchelvam D, Barrett JF. Pregnancy and the risk of a traffic crash. Can Med Assoc J. 2014;186:742–50.
Richards ID. Congenital malformations and environmental influences in pregnancy. Br J Prev Soc Med. 1969;23:218–25.
Rodriguez A, Bohlin G, Lindmark G. Symptoms across pregnancy in relation to psychosocial and biomedical factors. Acta Obstet Gynecol Scand. 2001;80:213–23.
Ronald A, Pennell CE, Whitehouse AJO. Prenatal maternal stress associated with ADHD and autistic traits in early childhood. Front Psychol. 2011;1:223.
Rusenfeld C. Barton MD. Mcschia G. Effects of epinephrine on distribution of blood flow in the pregnant ewe. Am J Obstet Gynecol. 1976:124:156–63.
Sakamoto J, Michels C, Eisfelder B, Joshi N. Trauma in Pregnancy. Emerg Med Clin North Am. 2019;37:317–38.
Sasser SM, Hunt RC, Faul M, et al. Centers for disease control and prevention (CDC). Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61:1–20.
Sauber‐Schatz EK, Bodnar LM, Weiss HB, Wilson JW, Pearlman MD, Markovic N. Injury during pregnancy and nervous system birth defects: Texas, 1999 to 2003. Birth Defects Res Part Clin Mol Teratol. 2013;97:641–8.
Schiff MA, Holt VL, Daling JR. Maternal and infant outcomes after injury during pregnancy in Washington state from 1989 to 1997. J Trauma Inj Infect Critical Care. 2002;53:939–45.
Schiff MA, Holt VL. Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001. Am J Epidemiol. 2005;161:503–10.
Schiff MA, Holt VL. The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death. J Trauma. 2002;53:946–9.
Schiff MA, Mack CD, Kaufman RP, Holt VL, Grossman DC. The effect of air bags on pregnancy outcomes in Washington state. Obstet Gynecol. 2010;115:85–92.
Schuster M, Becker N, Young A, Paglia MJ, Mackeen AD. Trauma in pregnancy: a review of the Pennsylvania trauma systems foundation database. Trauma. 2018;20:30–7.
Shen HN, Lu CL, Li CY. Dementia increases the risks of acute organ dysfunction, severe sepsis and mortality in hospitalized older patients: a national population-based study. PLoS One. 2012;7:e42751.
Shih P, Huang C, Pan S, Chiang TL, Guo YL. Hyperactivity disorder in children related to traffic-based air pollution during pregnancy. Environ Res. 2020;188:109588.
Sirin H, Weiss HB, Sauber-Schatz EK, Dunning K. Seat belt use, counseling and motor-vehicle injury during pregnancy: results from a multi-state population-based survey. Matern Child Health J. 2007;11:505–10.
Sivak M. Female drivers in the United States, 1963-2010: from a minority to a majority? Traffic Inj Prev. 2013;14:259–60.
Strigini FA, Cioni G, Canapicchi R, Nardini V, Capriello P, Carmignani A. Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor? Ultrasound Obstet Gynecol. 2001;18:335–42.
Su WL, Lu CL, Martini S, Hsu YH, Li CY. A population-based study on the prevalence of gestational diabetes mellitus in association with temperature in Taiwan. Sci Total Environ. 2020;714:136747.
Taiwan ministry of transportation and communication. 2013 daily transportation report. Ministry of transportation and communication, 2014 in Chinese.
Taylor AH, Dorn L. Stress, fatigue, health, and risk of road traffic accidents among professional drivers: the contribution of physical inactivity. Annu Rev Public Health. 2006;27:371–91.
Tinker SC, Reefhuis J, Dellinger AM, Jamieson DJ. Maternal injuries during the periconceptional period and the risk of birth defects, National Birth Defects Prevention Study, 1997–2005. Paediatr Perinat Epidemiol. 2011;25:487–96.
Troisi R, Hyer M, Titus L, et al. Prenatal diethylstilbestrol exposure and risk of diabetes, gallbladder disease, and pancreatic disorders and malignancies. J Dev Orig Health Dis. 2021;12:619–26.
van Gelder MM, Reefhuis J, Caton AR, et al. Maternal periconceptional illicit drug use and the risk of congenital malformations. Epidemiology. 2009;20:60–6.
Vinikoor LC, Messer LC, Laraia BA, Kaufman JS. Reliability of variables on the North Carolina birth certificate: a comparison with directly queried values from a cohort study. Paediatr Perinat Epidemiol. 2010;24:102–12.
Vivian-Taylor J, Roberts CL, Chen JS, Ford JB. Motor vehicle accidents during pregnancy: a population-based study. BJOG. 2012;119:499–503.
Vladutiu CJ, Evenson KR, Marshall SW. Physical activity and injuries during pregnancy. J Phys Activity Heal. 2010;7:761–9.
Vladutiu CJ, Marshall SW, Poole C, Casteel C, Menard MK, Weiss HB. Adverse pregnancy outcomes following motor vehicle crashes. Am J Prev Med. 2013;45:629–36.
Vladutiu CJ, Poole C, Marshall SW, Casteel C, Menard MK, Weiss HB. Pregnant driver-associated motor vehicle crashes in North Carolina, 2001–2008. Accid Analysis Prev. 2013;55:165–71.
Vladutiu CJ, Weiss HB. Motor vehicle safety during pregnancy. Am J Lifestyle Med. 2012;6:241–9.
Vostrikov NA, Ponomareva IV, Cheremisinov OV, Sherman MA. Severe brain trauma to the fetus in a car accident: literature review and a clinical case. Alm Clin Medicine. 2021;49:231–8. [in Russian]
Wang Y, Yang M. Long commutes to work during pregnancy and infant health at birth. Econ Hum Biol. 2019;35:1–17.
Weiss HB, Sauber-Schatz EK, Herring AH. Motor-vehicle crashes during pregnancy: a retrospective cohort study. Open J Obstetrics Gynecol. 2011;1:202–7.
Weiss HB, Songer TJ, Fabio A. Fetal deaths related to maternal injury. JAMA. 2001;286:1863–8.
Weiss HB, Strotmeyer S. Characteristics of pregnant women in motor vehicle crashes. Inj Prev. 2002;8:207–10.
Weiss HB. Hidden epidemic of maternal, fetal, and neonatal mortality and injury from crashes. Transport Res Rec. 2006;1956:133–40.
Weißleder A, Kulla M, Annecke T, Beese A, Lang P. Akutbehandlung schwangerer Patientinnen nach schwerem trauma— eine retrospektive multicenteranalyse. Der Unf. 2020;123:944–53. [in German].
William s Obstetrics 24 / E Author: F. Cunningham, Kennet h Leveno, St even Bloom, Cat herine Y. Spong, Jodi Dashe ISBN- 13: 9780071798938