July 31, 2003 -- Ask many pregnant women why they don't wear a safety belt when driving and you're likely to hear a number of reasons — discomfort, forgetfulness, the inconvenience. One other reason many expectant mothers choose to avoid seat belts? Fear they may cause injury to the fetus or themselves.
But according to experts, this is a common misconception. And new research suggests pregnant women should be urged to wear safety belts throughout pregnancy.
The study, published in the latest issue of the journal Obstetrics & Gynecology, found pregnant drivers who do not wear a seat belt when involved in a car crash are nearly three times more likely to experience a fetal death and twice as likely to experience excessive internal bleeding, compared to pregnant drivers who wore safety belts.
The study was conducted by researchers at the Intermountain Injury Control Research Center at the University of Utah School of Medicine and the Center for Injury Research and Control at the University of Pittsburgh.
"The take-home message is that pregnant women should still wear safety belts even if it's uncomfortable, because it's safer for the baby and the mother," said Lisa Hyde, lead author of the study, which looked at statewide motor vehicle crash, birth and fetal death records in Utah from 1992 to 1999.
A Need to Dispel Misconceptions
One significant difference with previous studies is that belted pregnant women in crashes were not significantly more at risk for adverse fetal outcomes than pregnant women not in crashes. "In other words, wearing a belt doesn't make you any higher risk than other women," explained Hyde.
The authors added many pregnant women still do not wear seat belts despite substantial research on the overall protective value of seat belts. Since motor vehicle crashes are the leading cause of traumatic fetal death in the United States, the researchers suggest strategies be developed to improve seat belt usage among pregnant women.
Further exacerbating the misconception, the authors add, is that foreign countries such as Japan, Spain, Poland and Greece have exceptions in place for pregnant women, who don't have to use safety belts if they choose not to.
Hyde said the misconception that seat belt use is bad for the fetus and causes more injury than using nothing at all is understandable, given that pregnant women involved in car crashes often suffer from bruising and naturally fear harming the baby. But she added numerous studies show the fetus is well protected, and proper safety belt use greatly reduces harm to pregnant drivers and fetuses during car crashes.
Learning How to Use Safety Belts Correctly
Hyde also said many women are simply unaware of the correct usage in positioning of seat belts. Current recommendations by the American Medical Association, the American College of Obstetricians and Gynecologists and others suggest lap belts should be placed snugly under the abdomen and shoulder belts positioned diagonally across the chest. The shoulder portion of the belt should fit snugly between the breasts and cross the chest and abdomen diagonally.
Also, pregnant women should sit at least 10 inches back from the air bag or dashboard of the vehicle, and they should not disable the air bag, as it can provide further protection for the mother and her baby in a serious crash.
"I think there should be a lot more education about where the seat belt should be placed," said Hyde. "Providers and primary-care physicians should counsel their patients on proper use, and there should be more general publicity on this."
Dr. Laura Riley, chairwoman of ACOG's Committee on Obstetric Practice at Massachusetts General Hospital, said while the importance of using safety belts during pregnancy is nothing new, this study serves as a useful reminder that everyone needs to wear a seat belt, pregnant or not.
"Depending on how pregnant you are, I'm sure it can get uncomfortable, especially during the third trimester, but the discomfort has absolutely no impact on the baby," Riley said. "The baby is protected inside fluid surrounded by the uterus, surrounded by your abdomen, and so there's multiple levels of protection between the seat belt strap and the fetus."