Car seatbelt use during pregnancy in Japan: determinants and policy implications

Towards safer motherhood: a cross-sectional study of seatbelt practice and its correlates with pregnant front passengers in Samarinda, Indonesia

BACKGROUND

The use of seatbelts in motor vehicles among pregnant women can reduce morbidity and mortality due to road traffic crashes; however, to date, there are no published studies on seatbelt usage among pregnant women in Indonesia. This research aims to promote the safety of pregnant women when using a motor vehicle. Its objective was to investigate the practices of seatbelt usage among pregnant front passengers and the associated factors.

METHODS

A cross-sectional study was conducted in Samarinda, Indonesia. Pregnant women were asked to complete a self-administered validated and published questionnaire, the SaPeIH-Q, which included sociodemographic information, and an assessment of knowledge, attitudes, and practices related to seatbelt usage among pregnant women. Multiple logistic regression (MLogR) was performed via SPSS version 27 to identify independent factors associated with seatbelt usage.

RESULTS

Among the 326 pregnant front passengers, only 34.7% used seatbelts, and only 39.3% correctly identified the placement of the three-point seatbelt. The practice of using seatbelts before pregnancy and knowledge of seatbelt usage were significantly associated with using seatbelts during pregnancy (p = 0.001 and 0.004, respectively).

CONCLUSION

The seatbelt usage rate among pregnant front passengers was low. Pregnant front passengers who used seatbelts before pregnancy were more likely to use them during pregnancy, and pregnant women with good knowledge were more likely to use seatbelts during pregnancy. The rate of seatbelt use during pregnancy may improve with increasing knowledge of seatbelt usage and the use of seatbelts before pregnancy.

Seat belt use among pregnant women in the United Arab Emirates: the Mutaba'ah Study

INTRODUCTION

Motor vehicle collisions are a major cause of death and injury among pregnant women and their fetuses. Seat belt use compliance during pregnancy varies in different populations. We aimed to study seat belt use among pregnant women and factors affecting seat belt use during pregnancy in Al Ain City, the United Arab Emirates.

METHODS

This cross-sectional analysis used the baseline data collected from pregnant women participating in the Mutaba'ah Study from May 2017 to November 2022. Data were collected using self-administered questionnaires. Variables included sociodemographic, gestation periods and seat belt-related information. All pregnant women who responded to the questions related to seat belt use were included (N=2354).

RESULTS

Seat belt use before and during pregnancy was estimated at 69.7% (95% CI 67.9% to 71.6%) and 65.5% (95% CI 63.6% to 67.4%), respectively. The reasons for not using seat belts during pregnancy included being uncomfortable to wear, habitual non-use and considering them unsafe for pregnancy. Age, higher levels of education of the pregnant woman or her spouse, being employed, having a sufficient household income, lower gestational age, and using a seat belt before pregnancy were positively associated with using a seat belt during pregnancy in the bivariate analyses. Pregnant women in their third trimester had independently significant lower odds of using a seat belt compared with those in the first trimester (OR 0.42, 95% CI 0.24 to 0.76).

CONCLUSIONS

The findings indicate decreased compliance with seat belt use during pregnancy and as gestation progressed. The decrease was related to several reasons, including feeling uncomfortable wearing seat belts, habitual non-use and unsafe for pregnancy, necessitating appropriate measures to increase awareness. Raising public awareness about the advantages of wearing seat belts during pregnancy and the involvement of healthcare professionals in educating pregnant women are warranted.

Comparison of the Injury Mechanism between Pregnant and Non-Pregnant Women Vehicle Passengers Using Car Crash Test Dummies

This paper analyzes the kinematics and applied forces of pregnant and non-pregnant women dummies sitting in the rear seat during a frontal vehicle collision to determine differences in the features of abdominal injuries. Sled tests were conducted at 29 and 48 km/h with pregnant and non-pregnant dummies (i.e., MAMA IIB and Hybrid III). The overall kinematics of the dummy, resultant acceleration at the chest, transrational acceleration along each axis at the pelvis, and loads of the lap belt and shoulder belt were examined. The belt loads were higher for the MAMA IIB than for the Hybrid III because the MAMA IIB had a higher body mass than the Hybrid III. The differences in the lap belt loads were 1119 N at 29 km/h and 1981-2365 N at 48 km/h. Therefore, for restrained pregnant women sitting in the rear seat, stronger forces may apply to the lower abdomen during a high-velocity frontal collision. Our results suggest that for restrained pregnant women sitting in the rear seat, the severity of abdominal injuries and the risk of a negative fetal outcome depend on the collision velocity.

Mechanisms of Negative Fetal Outcome in Frontal Vehicle Colli-Sions Involving Unbelted Pregnant Drivers

To determine the cause of negative fetal outcomes and the causative mechanism in a frontal collision, we analyzed the kinematics and mechanisms of injuries using an unbelted pregnant dummy, the Maternal Anthropometric Measurement Apparatus dummy, version 2B. Sled tests were performed to recreate frontal impact situations with impact speeds of 13, 26, and 40 km/h. Overall kinematics of the dummy were examined through high-speed video imaging. Quantitative dummy responses-such as time courses of the abdominal pressure, chest deflection, neck injury criteria (Nij), and displacement of the pelvis during impact-were also measured. The maximum abdominal pressure of 103.3 kPa was obtained at an impact speed of 13 km/h. The maximum chest deflection of 38.5 mm and Nij of 0.36 were obtained at an impact speed of 26 km/h. The highest maximum chest deflection of >40.9 mm, Nij of 0.61, and forward pelvis displacement of 478 mm were obtained at an impact speed of 40 km/h. Although the kinematics and mechanism of injuries of the dummy were different for different collision speeds, we found that unbelted pregnant drivers suffer severe or fatal injuries to the fetus even in low-speed collisions.

Factors that Associate Japanese University Students' Use of Rear Seat Belts on General Roads and Expressways

This study clarifies the prevalence of rear seat belt use among university students and explores the factors that influence seat belt use on general roads and expressways. Questionnaires were distributed to 1,091 students who attended health education lectures: 893 students (81.9%) agreed to participate and met the criteria; among them, 660 (73.9%) provided complete responses. While one-third (33.0%) of rear seat passengers "always" used seat belts on general traffic roads, three-fourths (73.2%) "always" used them on expressways. Multivariate analysis revealed that being male and the perception of obligation and recognition of the benefits of rear seat belt use were associated with use on general roads, whereas the possession of a driver's license and recognition of benefits were associated with use on expressways. Finally, we suggest that educational programs on seat belt use be developed and delivered to general road and expressway users to promote seat belt use.

Seatbelt Use in Females of Childbearing Age at an Urban Safety-Net Level 1 Trauma Center

BACKGROUND

Safety restraint system (SRS) use is known to improve maternal and fetal outcomes in pregnant women. Factors associated with seatbelt use in females of childbearing age are largely unstudied despite global public health endeavors to increase use. We sought to define its use and uncover risk factors for not using a restraint system in this vulnerable patient cohort.

MATERIALS AND METHODS

A retrospective chart review of all female patients aged 15-35 y presenting from 2007 to 2017 was performed using our institutional level 1 trauma database. Age, pregnancy, insurance status (commercial or private, Medicaid plan, and uninsured), race, and Injury Severity Score (ISS) were examined in unmatched data. A matched cohort was created to evaluate the impact of pregnancy on SRS use based on ISS, age, race, and insurance status with blinding to belt use during matching (two nonpregnant to one pregnant). Differences in restraint use were then examined using Mann-Whitney U and Chi-square tests.

RESULTS

A total of 779 patients met inclusion criteria, of which 140 were pregnant. In unmatched data, there was no difference in belt use with regard to age, race, or insurance type. Overall belt use was 59%. Twenty-five percent of patients were uninsured, and 39% used a Medicaid plan. Pregnant patients were statistically more likely to wear belts (71% versus 57%, P = 0.003). In ISS-matched data, this difference was not upheld (63% pregnant belt use versus 58%, P = 0.615).

CONCLUSIONS

Pregnancy did not induce improved safety behavior in our population. More study is needed to confirm our findings. Overall SRS use in our urban population is very poor, lags behind the national average, and requires additional public health attention.

Prevalence of rear seat belt use among pregnant women in a suburban area of Japan

AIM

The aim of this study was to clarify the prevalence and influencing factors of rear seat belt use among pregnant women.

METHODS

Questionnaires were given to 1546 pregnant women who visited obstetrics clinics and hospitals for prenatal checkups from October to December 2013. A total of 1494 pregnant women (96.6%) agreed to participate in this study and completed the questionnaire.

RESULTS

Fewer than 20% of the rear-seat passengers 'always' used seat belts before and during pregnancy, whereas a third 'never' used a seat belt before or during pregnancy. There was no significant decrease in seat belt use by rear-seat passengers during compared to before pregnancy. Multivariate analysis revealed that age, knowledge of how to use a seat belt during pregnancy, belief in the compulsory use of a rear seat belt and driver behavioral characteristics before pregnancy were associated with rear seat belt use during pregnancy.

CONCLUSIONS

The prevalence of fastening seat belts was substantially low. The provision of information regarding proper seat belt use and its role in protecting the fetus may increase use.

Buckling up in Singapore: residency and other risk factors for seatbelt non-compliance - a cross-sectional study based on trauma registry data

BACKGROUND

Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals.

METHODS

This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011-2014. Seatbelt data was obtained from paramedic and patient history.

RESULTS

There were 4,576 patients studied. Most were Singapore citizens (83.4 %) or permanent residents (2.4 %), with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001-1.021, p < 0.0001); drivers, followed by front passengers (OR 0.65, 95 % CI 0.51-0.83, p < 0.0001), were more compliant than rear passengers (OR 0.08, 0.06-0.09, p < 0.0001); occupants of larger vehicle types (buses, heavy transport vehicles, minibuses and vans) were more non-compliant compared to occupants of private cars and taxis. Morning peak travel (0700 h-0900 h) and being a non-resident were other risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001-1.014, p = 0.03) was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18-0.99, p = 0.05), seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48-0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05-0.09, p < 0.0001), vehicle type (bus compared to car, OR 0.04, 95 % CI 0.017-0.11, p < 0.0001, van compared to car, OR 0.55, 95 % CI 0.36-0.83, p = 0.004), and travel at morning peak periods were independent predictors of seatbelt non-compliance. When the sub-group of drivers was analysed, only vehicle type was a significant predictor of seatbelt compliance, with bus drivers least likely to be compliant to seatbelts (multivariable analysis, OR 0.057 compared to cars, 95 % CI 0.019-0.18, p < 0.0001).

CONCLUSIONS

While overall seatbelt compliance in our study is high, efforts can be made to increase compliance for morning rush hour passengers, rear seat passengers, and occupants of buses, heavy transport vehicles, and vans or pickups.

Effects of seat belts worn by pregnant drivers during low-impact collisions

OBJECTIVE

The aim of this study was to understand the injury mechanisms of pregnant drivers and associated fetal outcomes.

STUDY DESIGN

Frontal and rear impact tests using a dummy representing the anthropometry of a pregnant woman were conducted.

RESULTS

In frontal impact tests without a seat belt, abdominal pressure peaked at the point where the dummy contacted the steering wheel. Rear impact tests without a seat belt showed that the dummy moved forward because of rebound and contacted the steering wheel, which was avoided when a seat belt was worn.

CONCLUSION

Wearing a seat belt reduces abdominal pressure or prevents contact with the steering wheel during collisions.

Analysis of seating position and anthropometric parameters of pregnant Japanese drivers

OBJECTIVE

An anthropometric study was performed to understand the quantitative characteristics of the seating posture of Japanese pregnant drivers.

METHODS

Twenty pregnant women with a mean gestation of 31.4 +/- 1.9 weeks and 20 age-matched, non-pregnant women provided written informed consent to participate in this study. A mid-sized, sedan-type passenger vehicle was used for measurement. The subjects, wearing light clothing, sat in the driver's seat of the vehicle and fastened the seatbelt after adjusting the seat to their usual driving posture. Longitudinal displacement of the slide adjuster and the reclining angle of the seat back were measured, relative to the reference position. Seating posture was investigated by measuring the coordinates of the anthropometric datum points of the drivers (head, shoulder, hip joint, knee joint, and the clearance between the steering wheel and the upper torso).

RESULTS

The mean horizontal clearance between the lower rim of the steering wheel and the abdomen of the pregnant women was 146 +/- 56 mm, significantly smaller than that of the non-pregnant women (251 +/- 51 mm), due to the protrusion of the abdomen. There was no significant difference in seat adjustment position between the two groups. The height of the pregnant women and the horizontal distance from the lower rim of the steering wheel to the abdomen showed a moderate linear correlation in the pregnant group (R2 = 0.56).

CONCLUSIONS

Compared to previous studies, the differences of longitudinal distance were found between American and Japanese subjects without significant differences of body heights, due to the difference of body weights and abdominal circumferences. This is the first report to analyze the seating position and anthropometric parameters of pregnant drivers in an Asian population.

Magazine information on safety belt use for pregnant women and young children

To assess the information on safety belt use for pregnant women and infants in maternity and baby magazines, we reviewed 2003 issues of the three top-selling monthly baby and maternity magazines. Articles on safety belt use during pregnancy and child safety seat (CSS) use for infants, and advertisements of the CSS, automobiles, or CSS-related products were examined for their informational content. Of the 9418 pages in the maternity magazines, 46 pages were on infants, 16 pages on pregnant women and 162 pages displayed advertisements. Of the 9750 pages in the baby magazines, 34 pages of articles addressed CSS use; no articles addressed the issue of pregnant women; 83 pages were advertisements. Although the magazines showed accurate information in general; its amount was not sufficient, and little specific information on appropriate use and selection of a CSS was seen. Some information was misleading and even incorrect: specifically related to when to start using a forward-facing seat, what products are attachable to the CSS, and the reuse of a CSS. Greater amounts and accuracy of safety information in these magazines would help pregnant women and parents acquire important safety knowledge that healthcare providers are falling short of providing in Japan.

Seatbelt use during pregnancy: a comparison of women in two prenatal care settings

OBJECTIVES

This study examines knowledge of proper automobile restraint use during pregnancy and attitudes toward restraint use. This manuscript, the second in a series, compares knowledge and attitudes in two populations of pregnant women, those receiving prenatal care at several county clinics and those receiving care in a private practice.

METHODS

A survey requesting demographic information and frequency and knowledge of proper automobile restraint use was administered during prenatal visits.

RESULTS

County clinic patients (n = 450, 70% black) were younger and less educated than private practice patients (n = 203, 75% non-Hispanic white). Fewer county patients (49%) always wore seatbelts prior to the pregnancy than private practice patients (88%). Correct use was reported by fewer county clinic patients (67%) than private practice patients (83%). Few (25-28%) in either setting reported receiving information on seatbelt use.

CONCLUSIONS

Despite existing knowledge with respect to the consequences of seatbelt non-use in pregnant women, the proportion of women receiving information about correct seatbelt use during pregnancy appears to be low, regardless of care source.