Belts on bones, not over the bump: reported seat belt use and positioning among pregnant and nonpregnant drivers and passengers in the U.S.

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Objective: Seat belts reduce the risk of crash-related injury and fatality and are important for pregnant occupants. Previous research is mixed on whether belt use increases during pregnancy, but has consistently found that pregnant occupants misposition their belts. This study examined reported seat belt use and positioning among pregnant and nonpregnant people in the U.S to examine whether there are changes in use during pregnancy and rates of correct positioning. Methods: An online survey was administered to a nationally representative sample of U.S. men and women who were at least 21 years old and drove or rode in a vehicle at least once per week and a comparison sample of pregnant people. Respondents were asked about the frequency of belt use, reasons for nonuse, belt positioning, and information received about belt use during pregnancy. The final sample included 1,187 nonpregnant respondents and 824 pregnant respondents. Results: Overall, 90% of nonpregnant respondents and 87% of pregnant respondents reported they always used a belt; this difference was not statistically significant. However, the odds that pregnant respondents "always" used a belt during pregnancy was twice that of "always" using a belt before pregnancy. Discomfort, forgetting, and traveling a short distance were common reasons why nonpregnant respondents did not use a belt. Discomfort, forgetting, and the baby’s safety were common reasons for pregnant respondents. Pregnant respondents reported significantly more discomfort from the belt than nonpregnant respondents. Only 21% of pregnant respondents positioned the lap and shoulder belt correctly compared with 39% of nonpregnant respondents. Conclusions: Reported seat belt use among pregnant people before pregnancy increased during pregnancy, but use during pregnancy did not differ from the nonpregnant sample. Most pregnant respondents reported always using a belt, but only a small proportion positioned it correctly. Discomfort is a key barrier to positioning a seat belt correctly, whether an occupant is pregnant or not. Restraint system design should be improved to accommodate larger abdomens and other physical changes associated with pregnancy. Educational campaigns should target nonpregnant and pregnant people with information about correct belt positioning and address misconceptions that belt use compromises fetal safety.