Domestic violence and adverse pregnancy outcomes

                         Janssen, Patti A.; PhD

                         UNIVERSITY OF WASHINGTON, 2001



                         <italic>Objectives</italic>. Pregnancy is known to be a time when abuse from an intimate partner can
                         begin or escalate. The purpose of this study was to measure the prevalence of exposure to domestic
                         violence during pregnancy in an unselected population and to determine whether exposure to
                         interpersonal violence during pregnancy is associated with adverse pregnancy outcomes. <italic>Study
                         design</italic>. In this prospective cohort study, we adapted Rogers' innovation-diffusion model to
                         develop and implement a protocol for domestic violence assessment among 300 nurses working in two
                         hospitals that together provide obstetrical care to the City of Vancouver British Columbia, Canada. We
                         measured the prevalence of exposure to interpersonal violence and fear of a partner during pregnancy
                         among 4750 residents of Vancouver, who gave birth between January, 1999 and December, 2000. We
                         calculated unadjusted relative risks and 95% confidence intervals to examine bivariate relationships
                         between violence and adverse pregnancy outcomes, including antepartum hemorrhage, preterm labour
                         and delivery, intrauterine growth restriction, and perinatal death. Maternal demographic and obstetric
                         characteristics were adjusted for using unconditional logistic regression. <italic>Results</italic>. We
                         report a prevalence rate of 1.2% for exposure to physical violence by an intimate partner during
                         pregnancy and 1.5% for fear of a partner. Physical violence was associated with an increased risk of
                         antepartum hemorrhage (adjusted odds ratio: 3.79, 95% CI 1.38&ndash;10.4), intrauterine growth
                         restriction (OR: 3.06, 95% CI 1.02&ndash;9.14) and perinatal death (OR: 8.06, 1.42&ndash;45.63).
                         Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse
                         pregnancy outcomes. Associations of interpersonal violence with antepartum hemorrhage (OR: 3.51,
                         1.27&ndash;9.72) and with perinatal death (OR: 7.28, 1.28&ndash;41.3) remained statistically
                         significant after further adjustment for use of substances. The odds ratio for the association of
                         intrauterine growth restriction was no longer significant after adjustment for substance use (OR:2.83,
                         0.94&ndash;8.50). <italic>Conclusions</italic>. Our study confirms prior work reporting an association of
                         physical abuse during pregnancy with intrauterine growth retardation and additionally, reports an
                         association with 2<super>nd</super> or 3<super>rd</super> trimester hemorrhage and perinatal

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