(433) Risk Factors for Preterm Birth Among Individuals With Spinal Cord Injury: A Retrospective Cohort Analysis

People with spinal cord injury (SCI) experience disproportionately high rates of preterm birth, yet contributing factors remain poorly understood. This study aimed to identify clinical, demographic, and social risk factors for preterm birth in individuals with SCI to inform tailored perinatal care strategies.

Study Design:

We conducted a secondary analysis of the Spinal Cord Injury and Urogenital Health Project, a cross-sectional survey of 780 individuals assigned female at birth across 33 countries. A total of 386 pregnancies among participants with SCI were analyzed. We evaluated 43 potential risk factors spanning SCI-specific (e.g., injury level, ASIA score, etiology), biological, behavioral, and social domains. Multivariate logistic regression was used to assess associations with preterm birth ( < 37 weeks’ gestation), with significance set at p< 0.05.

Results:
Six factors were significantly associated with increased risk of preterm birth: higher-level SCI, greater neurologic impairment (ASIA score), gun violence as cause of injury, chronic smoking, respiratory complications due to SCI, and history of prior preterm birth. In contrast, several well-established risk factors in the general obstetric population, including education level, anxiety/depression, and urinary tract infections, did not demonstrate statistical significance in this cohort.

Conclusion:
This is the first study to identify risk factors for preterm birth specific to individuals with SCI. Our findings suggest that SCI-related physiological and behavioral factors may outweigh traditional social and biological determinants in this population. These insights support the development of SCI-informed, interdisciplinary preconception and prenatal care models.