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.