Infant car seat use in Japan after the antepartum distribution of an educational leaflet: A prospective, nonrandomized controlled trial with a questionnaire survey

<b>Objective:</b> To determine whether an antepartum educational leaflet distributed to parents before infant delivery affected the rate of infant car-seat (ICS) use 1 month after delivery, because to the best of our knowledge, only few reports have evaluated systematic attempts to improve the rate of always ICS use by mothers driving infants <b>Methods:</b> A multicenter questionnaire survey targeting pregnant Japanese women seeking antenatal care at the outpatient clinics of eight hospitals was designed. Women enrolled during the first half of the study period did not receive leaflets describing ICS safety guidelines (control group). Women enrolled during the latter half of the study period received the leaflet between gestational week 35 and 37 (intervention group). All women were requested to anonymously respond to the questionnaires within 1 month postpartum. The rates of ICS use, position, and direction after delivery were compared between both groups. <b>Results:</b> Of the 3534 women who responded to the questionnaire survey (response rate, 81.9%), 1772 women (50.1%) were assigned to the intervention group and 1762 (49.9%) women to the control group. The rates of ICS attachments (86.8% vs. 82.4% in the intervention and control groups, respectively, <i>p</i> = 0.0003), always ICS use (80.5% vs. 76.2%, respectively, <i>p</i> = 0.0019), ICS placement on the rear seat (78.6% vs. 74.1%, respectively, <i>p</i> = 0.0020), and ICS placement in a rear-facing position (62.2% vs. 56.7%, respectively, <i>p</i> = 0.0008) were significantly higher in the intervention group than those in the control group. The motor vehicle accident (MVA) rates within 1 month postpartum were similar between the intervention and control groups (0.51% vs. 0.57%, respectively, <i>p</i> = 0.8229). <b>Conclusions:</b> Antepartum minimal intervention via the distribution of an educational leaflet recommending ICS safety guidelines was associated with increased rates of ICS attachments, always ICS use, and ICS placement on the rear seat and in rear-facing positions; however, it did not contribute to reduced MVA rates after delivery.

**研究目的：** 旨在明确产前向待产父母分发的婴儿汽车安全座椅（Infant Car-Seat, ICS）宣传手册，是否会对产后1个月内的婴儿汽车安全座椅使用比例产生影响。据我们所知，目前仅有少数研究评估了通过系统性手段提升母亲携带婴儿驾车时始终正确使用婴儿汽车安全座椅比例的尝试。
**研究方法：** 本研究设计了一项多中心问卷调查，研究对象为在8家医院门诊接受产前检查的日本孕妇。研究前期入组的孕妇未获得婴儿汽车安全座椅安全指南宣传手册（对照组）；研究后期入组的孕妇则在妊娠35~37周时领取该宣传手册（干预组）。本研究要求所有孕妇在产后1个月内匿名填写问卷，随后对比两组产妇产后的婴儿汽车安全座椅使用比例、安装位置与朝向情况。
**研究结果：** 本次问卷调查共回收有效问卷3534份，有效回收率为81.9%，其中干预组1772人（占比50.1%），对照组1762人（占比49.9%）。干预组的婴儿汽车安全座椅安装率（86.8% vs 对照组82.4%，*p*=0.0003）、始终正确使用比例（80.5% vs 76.2%，*p*=0.0019）、安装于后排座椅的比例（78.6% vs 74.1%，*p*=0.0020）以及后向安装比例（62.2% vs 56.7%，*p*=0.0008）均显著高于对照组。两组产妇产后1个月内的机动车交通事故（Motor Vehicle Accident, MVA）发生率无显著差异（0.51% vs 0.57%，*p*=0.8229）。
**结论：** 产前通过分发推荐婴儿汽车安全座椅安全指南的宣传手册进行轻度干预，可显著提升婴儿汽车安全座椅的安装率、始终正确使用率以及后排座椅安装率与后向安装比例，但未降低产后机动车事故发生率。