Pregnancy outcomes and health care use: Effects of abuse,☆☆,,★★

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Abstract

OBJECTIVE: Our purpose was to determine whether pregnancy and neonatal outcomes differed between abused and nonabused women. STUDY DESIGN: Women (N = 1014) who completed an abuse questionnaire during pregnancy were followed up after delivery. The 242 women reporting past abuse and the 59 women reporting abuse in pregnancy were grouped in terms of recency and severity of domestic abuse, and their pregnancy and birth outcomes were compared with those of nonabused women with the χ2 test, analysis of variance, and multivariate logistic regression techniques. RESULTS: Abused women smoked more cigarettes (p < 0.0001) and took more prescription drugs (p < 0.03) and antidepressants (p > 0.05) than nonabused women; they were more likely to have epilepsy (p = 0.0002) and asthma (p = 0.0018), and also they used social work services more often (p > 0.0001). Obstetric histories revealed a higher incidence of miscarriage (p = 0.0014), two or more pregnancy terminations (p > 0.0001), and neonatal death (p = 0.0503) among the abused group. Although abused women delivered infants whose mean birth weight was 132 gm lower than that of nonabused women, the difference was not significant after adjustments were made. Mildly and moderately abused women were admitted to the hospital more frequently during pregnancy (p = 0.0067). CONCLUSION: Domestic abuse adds significantly to the cost of health care during pregnancy and is associated with poor maternal and fetal outcomes. (AM J OBSTET GYNECOL 1996;174:760-7.)

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MATERIAL AND METHODS

Medical records of 1014 pregnant women participating in an abuse prevalence survey during December 1992 at the Royal Women's Hospital, Brisbane, were reviewed after delivery. Recruitment methods and details of patient consent for the prevalence study have been published previously.1 Briefly, this involved a once-only interview with consecutive patients during a prenatal visit. The protocol for the current follow-up study was approved by the hospital's Ethics Committee.

Details of age, education,

RESULTS

Delivery details were unavailable for some women who participated in the prevalence survey. Eleven had miscarried, three had pregnancy terminations and a further 59 women did not delivery at the Royal Women's Hospital. One record was not found. However, these women did not differ significantly from the total sample in terms of abuse, age, education, or marital status, nor were they more likely to have either miscarried or terminated their pregnancies before transfer.

Of the 1014 consecutively

COMMENT

Women are admitted to the Royal Women's Hospital during pregnancy, often repeatedly, with vague symptoms and discharged without a clear diagnosis. Although evidence is available that shows an increased use of health services by those who experience domestic abuse,17 family relationships are rarely considered when these women are treated. This is not unusual; providers of health care frequently fail to recognize signs of abuse or, when abuse is suspected, fail to become involved.2, 7, 18

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From the Royal Women's Hospital (Brisbane)aand the Queensland Institute of Medical Research.b

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Supported in part by a grant from the Women's Health Policy Unit, Queensland Health.

Reprint requests: Joan Webster, BA, Assistant Director of Nursing (Research), Royal Women's Hospital, Bowen Bridge Road, Herston, Queensland 4029, Australia.

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0002-9378/96 $5.00 + 0 6/1/67803

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