A Major Public Health Issue: The High Incidence of Falls during Pregnancy

Kari Dunning; Grace LeMasters; Amit Bhattacharya

Disclosures

Maternal and Child Health Journal. 2010;14(5):720-725. 

In This Article

Results

Study Sample

Of the 6217 eligible women, 3997 (64.3%) participated (resulting in 1639 phone, 506 Internet, and 1852 mail completions), 144 (2.3%) refused, 151 (2.4%) had no viable address or phone number, and 1925 (31.0%) did not respond. The 2220 non participants were characterized by birth certificate data analysis as being younger (P< 0001) and more likely to have given birth at a public hospital (P<.0001) compared to the 3997 participants. The average age of the participants was 29.9 years; 83.4% were Caucasian and 51.8% had graduated from college. Over 70% had been employed during their pregnancy. Table 1 shows participant characteristics by whether they fell during pregnancy.

Falls during Pregnancy by Survey Method

Of the 3997 participants, 26.8% (n = 1070) reported falling during pregnancy. The fall rate for those responding by telephone (23.6%) were significantly lower (P<.01) from those responding by internet and mail surveys with fall rates of 28.9% and 29.0%, respectively. There were 380 women who did not participate in the phone, internet or mail survey but replied to the non-participant postcard asking if they had fallen during their pregnancy. These ''non-participants'' reported the highest incidence of falling during pregnancy at 30.8% which suggests that falls were not over reported by the survey participants.

Timing and Factors Associated with Falls

As shown in Fig. 1, almost two-thirds (61.3%) fell during gestational months six through eight with month seven being the worst. Of the 1070 women who fell, over a third (35.3%) reported falling two or more times during the pregnancy.

Figure 1.

Falls by gestational age. Each subject is represented once; if a woman reported they fell [1 time during pregnancy, their ''most serious fall'' was used (n = 1046 due to 24 were unable to remember the gestational month of fall)

Table 2 shows the injury, medical attention and situational factors related to falls. Of those who fell, 630 (58.9%) reported an injury, 210 (19.6%) received medical attention and one in five experienced restricted activity for two or more days. In addition, 16 (1.5%) reported premature labor or delivery due to fall.

The two factors accounting for 72.5% of the falls were stairs and slippery surfaces. Of those falling on stairs over half reported not using available handrails and of the 720women wearing shoes when falling, 31.0% reported their shoes were loose, backless, or slick and/or their shoes had a heel height of least one inch or higher (15%) (data not shown). The women at highest risk for fall were those <24 years old (Table 3); these younger women experienced an almost two fold higher risk of falling compared to women >34 years old (odds ratio of 1.9; 95% confidence interval of 1.4, 2.7).

Reliability and Validity

A test retest reliability assessment for fall and fall with any injury was completed on a 10% sample of the participants (415/3997). Kappa values were excellent for fall (k = .85) and good for any injury (k = .58), with percent agreement of 92.8% and 84.6%, respectively. Of the 210 women who reported obtaining medical attention due to a fall, only 14.3% (n = 30) provided written authorization to review their medical record and all were validated.

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