4.1 Main findings
To the best of our knowledge, this is the first study to provide data on
reproductive behaviour in women with SCI. The chance of becoming a
mother after SCI (n=440, 16%) was comparable to that found in previous
studies from other high-income countries, which make considerable
investments in rehabilitation and health care, with reported delivery
rates between 14 and 18% (12). Time to
first delivery after the SCI was up to 5 years in almost 50% of the SCI
women. Regarding predictors for motherhood, young age at injury was
significant, similar to a previous US study
(13). In our study, an additional
significant predictor for motherhood after SCI was sustaining a
traumatic injury (e.g. traffic accidents and accidents during leisure
activities). When comparing the severity of SCI between the various
studies some discrepancies appear. For example, one retrospective cohort
study involving 25 women with SCI reported mainly those with complete
lesions (14) became mother after SCI,
while in our study mainly women with incomplete or low lesions became
mothers.
Age-related fertility decline is a general but often neglected
phenomenon in women, with fertility declining with advancing age,
especially after the mid-30s (15). To
date, there is no evidence showing that an SCI induces hormonal changes
impacting fertility (16). We observed a
similar pattern in our cohort, where women with an SCI gave birth until
the age of 44. However, we observed an important decrease in a woman’s
chance of motherhood when sustaining the SCI after the age of 35.
Moreover, in our cohort, more than 50% of the women with SCI were above
age 56 when participating in the survey, and so themes such as menopause
and related co-morbidities were predominant.