Do pregnant women have improved outcomes after traumatic brain injury?



      Pregnant women, who have significantly elevated levels of estrogen and progesterone, might benefit from the neuroprotective effect of steroid hormones.


      Pregnant patients were identified and compared with their nonpregnant counterparts with respect to demographics and outcome.


      Of the 18,800 female, moderate to severe TBI patients, 71 were pregnant. Similar mortalities were noted in pregnant and nonpregnant TBI patients (9.9% vs 9.3%, P = .84). Adjusting for confounding variables, pregnant TBI patients had a trend toward increased mortality (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI], .9–5.1; P = .07). In patients aged 15 to 47 years (n = 8,854), similar mortalities were noted in pregnant and nonpregnant TBI patients (9.9% vs 6.8%, P = .34). After adjusting for risk factors, again there was a trend toward increased mortality in the pregnant TBI group (AOR = 2.0; 95% CI, .8–4.6; P = .12).


      Pregnant patients with moderate to severe TBI show no statistically significant difference in mortality compared with their nonpregnant counterparts.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wang K.K.
        • Larner S.F.
        • Robinson G.
        • et al.
        Neuroprotection targets after traumatic brain injury.
        Curr Opin Neurol. 2006; 19: 514-519
        • Roof R.L.
        • Hall E.D.
        Estrogen-related gender difference in survival rate and cortical blood flow after impact-acceleration head injury in rats.
        J Neurotrauma. 2000; 17: 1155-1169
        • Dubal D.B.
        • Zhu H.
        • Yu J.
        • et al.
        Estrogen receptor α, not β, is a critical link in estradiol-mediated protection against brain injury.
        Proc Natl Acad Sci U S A. 2001; 98: 1952-1957
        • Kondo Y.
        • Suzuki K.
        • Sakuma Y.
        Estrogen alleviates cognitive dysfunction following transient brain ischemia in ovariectomized gerbils.
        Neurosci Lett. 1997; 238: 45-48
        • Chen X.
        • Kline A.E.
        • Dixon C.E.
        • et al.
        Gender and environmental effects on regional brain-derived neurotrophic factor expression after experimental traumatic brain injury.
        Neuroscience. 2005; 135: 11-17
        • Rogers E.
        • Wagner A.K.
        Gender, sex steroids, and neuroprotection following traumatic brain injury.
        J Head Trauma Rehabil. 2006; 21: 279-281
        • Amantea D.
        • Russo R.
        • Bagetta G.
        • et al.
        From clinical evidence to molecular mechanisms underlying neuroprotection afforded by estrogens.
        Pharmacol Res. 2005; 52: 119-132
        • Phelan H.
        Use of a pediatric cohort to examine gender and sex hormone influences on outcome after trauma.
        J Trauma. 2007; 63: 1127-1131
        • Ottochian M.
        • Salim A.
        • Berry C.
        • et al.
        Severe traumatic brain injury: is there a gender difference in mortality?.
        Am J Surg. 2009; 197: 155-158
        • Davis D.P.
        • Douglas D.J.
        • Smith W.
        • et al.
        Traumatic brain injury outcomes in pre- and post-menopausal females versus age-matched males.
        J Neurotrauma. 2006; 23: 140-148
        • Berry C.
        • Ley E.J.
        • Tillou A.
        • et al.
        The effect of gender on patients with moderate to severe head injuries.
        J Trauma. 2009; 67: 950-953
        • Coimbra R.
        • Hoyt D.B.
        • Potenza B.M.
        • et al.
        Does sexual dimorphism influence outcome of traumatic brain injury patients?.
        J Trauma. 2003; 54: 689-700
        • Farace E.
        • Alves W.
        Do women fare worse: a meta-analysis of gender differences in traumatic brain injury outcome.
        J Neurosurg. 2000; 93: 539-545
        • Wafaisade A.
        • Lefering R.
        • Tjardes T.
        • et al.
        Acute coagulopathy in isolated blunt traumatic injury.
        Neurocrit Care. 2010; 12: 211-219
        • Sperry J.L.
        • Nathens A.B.
        • Frankel H.L.
        • et al.
        Characterization of the gender dimorphism after injury and hemorrhagic shock: Are hormonal differences responsible?.
        Crit Care Med. 2008; 36: 1838-1845
        • Bernasconi D.
        • Del Monte P.
        • Meozzi M.
        • et al.
        The impact of obesity on hormonal parameters in hirsute and nonhirsute women.
        Metabolis. 1996; 45: 72-75
        • Kirschner M.A.
        • Samojlik E.
        • Drejka M.
        • et al.
        Androgen-estrogen metabolism in women with upper body versus lower body obesity.
        J Clin Endocrinol Metab. 1990; 70: 473-479
        • Samojlik E.
        • Kirschner M.A.
        • Silber D.
        • et al.
        Elevated production and metabolic clearance rates of androgens in morbidly obese women.
        J Clin Endocrinol Metab. 1984; 59: 949-954