4.2 Strengths and Limitations
This study is inherently subject to several limitations. First, despite the rather extensive recruitment efforts, the obtained sample size of women with SCI who became mothers after the SCI event (n=72) was relatively small. One reason for this might be that there is no national registry for people with SCI. The SwiSCI cohort study, which collected data from four Swiss rehabilitation centres, may not represent the whole national SCI cohort and might thus underrepresent women with SCI, the elderly and those with very low lesions (L1-S5) (17). In addition, this survey includes no further information about conceiving and pregnancy outcomes. SwiSCI does not gather data on miscarriages, pregnancy outcomes (e.g. premature or term births, caesarean deliveries). Further, SwiSCI does not identify first-time pregnancies, whether women have difficulty conceiving, or whether they used assisted reproductive services to become pregnant. Finally, although some relevant variables (e.g. educational status, SCI aetiology) were considered for analysis, information on other potential predictors of the likelihood of motherhood (e.g. marital status, work status, finances, satisfaction with health and quality of life) were only available for the 3-month-period prior to the survey but not for the time of the delivery or SCI event. Despite these shortcomings, this study offers insight not only into fertile women but also in the entire cohort of women with SCI, allowing the formulation of recommendations for policy and service provision.