{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:16:33Z","timestamp":1778145393023,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"abstract":"<jats:p>\n                    Spinal cord injury (SCI) is a challenging clinical entity necessitating multidisciplinary management. While the impact of SCI on male fertility is relatively well-understood, its impact on prepartum, peripartum, and fetal outcomes remains understudied. This study seeks to elucidate prepartum and delivery-related outcomes associated with a history of SCI in pregnant patients. We identified all pregnant patients admitted to United States hospitals with and without a history of SCI in the National Inpatient Sample from 2016 to 2019. For all patients, five outcomes were analyzed: in-hospital death, discharge disposition, prepartum complications, length of stay (LOS), and cost. For patients undergoing delivery during admissions, five additional outcomes were studied: preterm labor, epidural anesthesia administration, performance of cesarean section (CS), delivery-related complications, and fetal outcome. Unadjusted outcomes were summarized using survey-weighted estimates. Adjusted associations between SCI and maternal outcomes were estimated using stabilized inverse probability of treatment weighting (IPTW) with doubly robust models. We identified 367 unweighted SCI admissions, corresponding to a survey-weighted national estimate of 1,835 SCI admissions (0.01%) among 15,073,815 pregnancy admissions. 91.6% of admissions were for delivery, with 32.5% undergoing CS. Pregnant patients with SCI had an average age of 30.3 years, and a plurality of injuries was lumbosacral (20.7%). Among all pregnant admissions, patients with a history of SCI had higher odds of inpatient mortality (OR = 45.54 [95% CI: 8.45\u2013245.40],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), lower rates of routine discharge disposition (OR = 0.17,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), greater LOS (+50%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), and elevated costs (+49%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). SCI patients were more likely to have prepartum complications of venous thromboembolism (VTE) (OR = 4.01,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.041) and genitourinary infections (OR = 4.26,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). SCI patients were significantly less likely to be admitted electively (39.5% vs. 47.9%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) or for delivery (OR = 0.38,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Among admissions for delivery, there were no differences in preterm labor or epidural anesthesia administration, but patients with SCI were less likely to experience delivery-related complications (OR = 0.56,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.017) and stillbirth (OR = 0.05,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.003). SCI patients had significantly higher odds of undergoing CS (OR = 1.88,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.006). These findings suggest that SCI confers substantial excess maternal risk, particularly for mortality, as well as VTE, urinary tract infection, CS, and overall resource utilization. Future work using SCI-specific registries with detailed neurological characterization and longitudinal follow-up is needed to refine risk stratification and inform multidisciplinary guidelines for pregnancy management in this population.\n                  <\/jats:p>","DOI":"10.1177\/08977151261438979","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:13:36Z","timestamp":1777878816000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Labor and Disability: A Nation-Wide Analysis of Pregnancy Outcomes after Spinal Cord Injury"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3437-274X","authenticated-orcid":false,"given":"Madison J.","family":"Michles","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-0475","authenticated-orcid":false,"given":"Weston C. de","family":"Lomba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia W.","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver Y.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Reavis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."},{"name":"Frank H. Netter School of Medicine, Quinnipiac University, North Haven, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen P.","family":"Leary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Bergsneider","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Bispo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaina J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul A.","family":"Sastry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared S.","family":"Fridley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adetokunbo A.","family":"Oyelese","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia L. Zadnik","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"1.Obstetric Management of Patients with Spinal Cord Injuries. 2020;135(5).","DOI":"10.1097\/AOG.0000000000003842"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.03.017"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(99)90253-8"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.1994.83"},{"issue":"6","key":"e_1_3_2_6_1","first-page":"926","article-title":"Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980\u20131991","volume":"81","author":"Westgren N","year":"1993","unstructured":"5.Westgren N, , Hultling C, , Levi R, et al. Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980\u20131991. Obstetreics Gynecol 1993;81(6):926\u2013930.","journal-title":"Obstetreics Gynecol"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12122"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)31046-X"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.1992.166"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2021.2018155"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-2752-2"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2015.205"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.0542"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03798-2"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1274"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2016.138"},{"issue":"1","key":"e_1_3_2_17_1","first-page":"1","article-title":"Births: Final Data for 2022","volume":"73","author":"Osterman MJK","year":"2025","unstructured":"16.Osterman MJK, , Hamilton BE, , Martin JA, et al. Births: Final Data for 2022. Natl Vital Stat Rep 2025;73(1):1\u201356.","journal-title":"Natl Vital Stat Rep"},{"issue":"5","key":"e_1_3_2_18_1","first-page":"607","article-title":"Pregnancy following spinal cord injury","volume":"154","author":"Cross LL","year":"1991","unstructured":"17.Cross LL, , Meythaler JM, , Tuel SM, et al. Pregnancy following spinal cord injury. West J Med 1991;154(5):607\u2013611.","journal-title":"West J Med"},{"issue":"2","key":"e_1_3_2_19_1","first-page":"49","article-title":"Why Epidurals Do Not Always Work","volume":"1","author":"Arendt K","year":"2008","unstructured":"18.Arendt K, , Segal S. Why Epidurals Do Not Always Work. Rev Obstet Gynecol 2008;1(2):49\u201355.","journal-title":"Rev Obstet Gynecol"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-72487-0_62"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4472.191594"},{"key":"e_1_3_2_22_1","doi-asserted-by":"crossref","unstructured":"21.Urinary Tract Infections in Pregnant Individuals. Obstet Gynecol 2023;142(2).","DOI":"10.1097\/AOG.0000000000005269"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S404537"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1310\/sci2203-209"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-022-00765-2"}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08977151261438979","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08977151261438979","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08977151261438979","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:48:54Z","timestamp":1778143734000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08977151261438979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":24,"alternative-id":["10.1177\/08977151261438979"],"URL":"https:\/\/doi.org\/10.1177\/08977151261438979","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"08977151261438979"}}