Background Pregnant women and their fetuses are at a major risk of traffic-related injury and death, which can be effectively prevented by using seatbelts (SB). Few data were available about the gravida-based differences in SB compliance and associated factors in pregnant women in the United Arab Emirates (UAE).

Objective We aimed to identify factors and barriers associated with SB use during pregnancy among women in the UAE across gravida strata.

Methods This is a cross-sectional analysis of data collected from May 2017 to November 2023 as part of the Mutaba’ah Study – a prospective cohort study of mothers and children in the UAE. Data on pregnant women’s SB habits and reasons for not using SB during pregnancy were collected using self-administered questionnaire. Stratified analysis was used to present findings separately for primigravidae (first pregnancy) and multigravidas (more than one pregnancy). Change in SB use before and during pregnancy was investigated using McNemar’s Chi-Square test. Factors associated with using SB during pregnancy were examined using multivariable binary logistic regression.

Results A total of 1,441 pregnant women (350 primigravidae and 1,091 multigravidas) were included in the analysis. SB use before and during pregnancy among the primigravidae was 70% (95% CI=65–75) and 65% (95% CI=59–70), respectively. Among the multigravidas, it was 69% (95% CI=66–71) and 62% (95% CI=59–65) respectively. The proportions of those who stopped using SB during pregnancy were 10.6% (p<0.001) and 11.5% (p<0.001) for primigravidae and multigravidas, respectively. The discomfort was the primary reason for SB non-compliance during pregnancy among both primigravidae (59%) and multigravidas (55%). Being in the third trimester was negatively associated with SB use among the primigravidae (aOR=0.31, 95% CI=0.09–0.95), while having a tertiary education (aOR=2.06, 95% CI=1.20–3.61) and having sufficient household income (aOR=3.87, 95% CI=1.53–9.29) were positively associated with SB use among the multigravidas.

Conclusions The use of SB among pregnant women, both the primigravidae and multigravidas, was low and showed a significant decrease compared to the period before the pregnancy. Interventions to increase awareness among pregnant women regarding the importance and safety of SB use are highly recommended.