Pregnancy After Concussion: A Clarion Call for Attention?

Rehabilitation Considerations in Women with Traumatic Brain Injury

This review highlights the physiological, hormonal, and hematological changes following traumatic brain injury (TBI) in women. Younger women may experience worse outcomes due to higher cerebral pressures, while hormonal changes during menstruation, pregnancy, and menopause further influence TBI recovery. Postmenopausal women face higher risks of osteoporosis and fall-related TBIs. Psychological impacts include higher rates of depression, anxiety, and posttraumatic stress disorder. Social challenges and sexual dysfunction are prevalent, impacting community and vocational reintegration. Tailored rehabilitation addressing these gender-specific factors is crucial for improving outcomes for female patients with TBI across their lifespan.

"To Be Vaccinated or Not to Be Vaccinated": Factors Influencing COVID-19 Vaccine Hesitancy and Future Vaccination Willingness Amongst US Women of Reproductive Age

Background & Objectives

Growing data on the impact of herd immunity and susceptibility of unvaccinated persons to chronic COVID sequelae requires deeper understanding of vaccine stigma and hesitancy to facilitate population needs. Reproductive-aged women (18-45 years) were at a "vaccine paradox" during COVID-19 - hesitant to receive the vaccine, yet at increased risk for COVID infection. In this study, we sought to: identify demographic predictors, reasons, geographic location of vaccine hesitancy, and COVID-specific attributes that predict future vaccination willingness. We hypothesized that high COVID risk perception and high COVID stress would be predictors of willingness.

Methods

Study Design: Cross-sectional survey of women across the United States. Main Outcomes and Measures: Vaccine hesitancy was defined as responding "No/Not Sure" to the question "Have you received any of the COVID-19 vaccines?" The COVID-Risk scale evaluate perceived COVID Risk, and the COVID-19 Perceived Stress Scale (PSS-10-c) evaluated COVID stress. Open ended questions inquired about participants' vaccine concerns.

Results

Of the 1,037 women who accessed the survey, 948 (91%) consented and completed. Predictors of vaccine hesitancy included younger aged parents (p=0.005), non-white race (p=0.003), and having high school or lower educational attainment (p<0.0001). Using smoking as a proxy measure of "health behavior", we found long-term smokers or quitters were more hesitant than those who never smoked (p=0.03). Geographic analyses showed the most vaccine hesitant women resided in Southeast and Midwest US. Hesitancy reasons included side effects (21%) and fertility/pregnancy concerns (4%). High COVID risk perception (p=0.0004) and high COVID stress (p=0.01) significantly predicted future willingness to get vaccinated.

Conclusions and Relevance

This research provides insights for managing the "vaccine paradox" in reproductive age women, and identifying factors that influence COVID-19 vaccine hesitancy and future vaccination willingness. Public health and policy advocates could target messaging around COVID risk and stress in Southeastern and Midwestern regions; as well as address women's concerns around fertility and other side effects.

Society for Birth Defects Research and Prevention Symposium: Health Disparities Within Communities of Color

BACKGROUND

High-risk pregnancies and birth defects are often greater within communities of color where resources for a healthy pregnancy are generally lacking. Infant and maternal mortality, preterm birth, and instances of increased developmental and physical defects are related to environmental exposures (e.g., pesticides, lead in water, wildfire smoke), dietary additives, and lack of access to adequate healthcare. More frequently people of color and other under-served groups, are affected by historical inequality and unconscious bias. Compounding these disparities, research into these issues and efforts to address them are poorly supported.

METHODS

The speakers in this symposium presented evidence for health disparities within communities of color to foster research aimed at identifying toxic levels of potentially hazardous dietary chemicals, or exposures in the pediatric population can focus on addressing the current inadequacy of translating scientific findings into enforceable policies.

RESULTS

The disparities discussed within this symposium highlighted key areas in desperate need of policy reform. In the United States, regulatory exposure levels have been established for lead exposures but frequently exceed these limits without mitigation. Neural tube defects can be prevented by a simple dietary solution such as fortification of staple foods with folic acid. Recent literature on gender as a social determinant of health has determined women suffer more negative health consequences due to social attitudes.

CONCLUSIONS

Ultimately, this symposium provided an understanding of the experience of disadvantaged and marginalized persons during pregnancy, illustrated the disparities that exist in reproductive health, and described the need to address and prevent them.

Coronavirus Disease 2019 (COVID-19)-Related Stress and Menstrual Changes

OBJECTIVE

To evaluate how stress related to the coronavirus disease 2019 (COVID-19) pandemic has affected women's menstrual cycles. We hypothesized that women with high levels of COVID-19-related stress would have more menstrual changes compared with those with lower levels of stress.

METHODS

Using a cross-sectional study design, we recruited a representative sample of U.S. adult women of reproductive age (18-45 years) using nonhormonal birth control to participate in an online REDCap (Research Electronic Data Capture, Vanderbilt University) survey. COVID-19-related stress was assessed with the PSS-10-C (COVID-19 Pandemic-related Perceived Stress Scale) and dichotomized as low stress (scores lower than 25) and high stress (scores 25 or higher). Self-reported menstrual outcomes were identified as changes in cycle length, duration, or flow and increased frequency of spotting between cycles. We used χ 2 and Fisher exact tests to compare differences in outcome between the two stress groups and logistic regression models for effect estimates.

RESULTS

A total of 354 women of reproductive age across the United States completed both the menstrual and COVID-19-related stress components of our survey. More than half of these women reported at least one change in their menstrual cycles since the start of the pandemic (n=191), and 10.5% reported high COVID-19-related stress (n=37). Compared with those with low COVID-19-related stress, a greater proportion of women with high COVID-19-related stress reported changes in cycle length (shorter or longer; P =.008), changes in period duration (shorter or longer; P <.001), heavier menstrual flow ( P =.035), and increased frequency of spotting between cycles ( P =.006) compared with prepandemic times. After adjusting for age, smoking history, obesity, education, and mental health history, high COVID-19-related stress was associated with increased odds of changes in menstrual cycle length (adjusted odds ratio [aOR] 2.32; 95% CI 1.12-4.85), duration (aOR 2.38; 95% CI 1.14-4.98), and spotting (aOR 2.32; 95% CI 1.03-5.22). Our data also demonstrated a nonsignificant trend of heavier menstrual flow among women with high COVID-19-related stress (aOR 1.61; 95% CI 0.77-3.34).

CONCLUSION

High COVID-19-related stress is associated with significant changes in menstrual cycle length, alterations in period duration, and increased intermenstrual spotting as compared with before the pandemic. Given that menstrual health is frequently an indicator of women's overall well-being, clinicians, researchers, and public health officials must consider the association between COVID-19-related stress and menstrual disturbances.

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

OBJECTIVES

Few studies have assessed pregnancies and deliveries after traumatic brain injury (TBI). We report the incidence of TBIs and TBI-related surgeries in fertile-aged females and investigate subsequent pregnancy outcomes.

METHODS

All fertile-aged (15-49) women with TBI diagnosis during our study period (1998-2018) were retrieved from the Care Register for Health Care and combined with data from the National Medical Birth Register. TBIs were categorized into three subgroups based on the length of the hospitalization period and the need for neurosurgery. Logistic regression was used to analyze preterm deliveries, cesarean sections (CS) and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI).

RESULTS

The incidence of TBIs increased from 103 per 100 000 person-years in 1998 to 257 per 100 000 (149.5%) in 2018. The incidence of TBI-related surgeries remained stable during our study period. The rate of preterm deliveries was 5.6% in the TBI group and 3.0% in the control group (AOR 1.23, CI 1.17-1.28). The CS rate in the TBI group was 19.2% and 15.9% in the control group (AOR 1.23, CI 1.18-1.29). The use of labor analgesia was higher among women with previous TBI. The rate of neonates requiring intensive care in the TBI group was 13.1% and 9.9% in the control group (AOR 1.30, CI 1.24-1.37).

CONCLUSION

The incidence of TBI hospitalizations increased during our study period, whereas the number of surgically treated TBI remained stable. Preterm deliveries, CS, instrumental vaginal deliveries and labor analgesia were more prevalent in women with previous TBI. Furthermore, more neonates required intensive care in this group. Therefore, a history of TBI should be acknowledged as a possible factor affecting the delivery and health of the neonate.