Injury during the perinatal period can have significant health effects on the pregnant woman, the fetus, and the child; therefore, injuries during pregnancy and during labor and delivery in the form of birth trauma were the focus of this dissertation. Through a three papers format, this dissertation addressed three unique research questions that fell under the overarching theme of injury during the perinatal period. The first paper tested the association between injury during pregnancy and nervous system birth defects through a case control study and the utilization of the Texas Birth Defects Registry. The second paper applied an underutilized semi-automated method of sensitivity analysis to determine the effect of misclassification of injury during pregnancy on the association tested in the first paper. The third paper primarily determined the rate of birth trauma overall and specific types of birth trauma in the United States through the utilization of the HCUP Kids Inpatient Database. Through sophisticated statistical analyses it was determined that there is was an association between injury during pregnancy and nervous system birth defects among breech presentation infants, but no association among normal presentation infants or among the entire study population, even when accounting for exposure misclassification. Additionally, it was found that the national rate estimate of birth trauma in the United States for 2003 was 29 per 1,000 in-hospital births. This rate is higher than a majority of previously published studies; therefore, the occurrence and subsequent burden of birth trauma is higher than previously thought. The public health significance of this dissertation was to determine if injury during pregnancy could account for some of the 65-70% of unknown causes of birth defects, to determine where in the range of 0.2-37 per 1,000 births the rate of birth trauma actually falls, and to further explore an area of maternal and child health and injury research that is inadequately studied. Therefore, the results of this dissertation suggest that strategies to prevent injuries during pregnancy and birth trauma should be explored, implemented, and subsequently evaluated for effectiveness to reduce maternal, fetal, and infant morbidity and mortality.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12042008-213805 |
| Date | 29 January 2009 |
| Creators | Sauber-Schatz, Erin Kristine |
| Contributors | Lisa M. Bodnar, Mark D. Pearlman, John W. Wilson, Harold B. Weiss, Nina Markovic |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12042008-213805/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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