Perinatal morbidity associated with violence experienced by pregnant women,☆☆,,★★

Presented at the Sixty-first Annual Meeting of The Central Association of Obstetricians and Gynecologists, White Sulphur Springs, West Virginia, October 28-30, 1993.
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Abstract

OBJECTIVE: We investigated whether physical assault is independently associated with an adverse obstetric outcome. STUDY DESIGN: We compared the perinatal outcomes of 32 indigent women who reported being physically abused during pregnancy with those of 352 control subjects who denied ever being assaulted. Patients were classified into the appropriate category on the basis of a structured interview. Logistic regression analyses were performed to estimate the relative risk of adverse outcome while adjusting for confounders. RESULTS: Women assaulted in the current pregnancy were twice as likely to have preterm labor as compared with those who denied assault. In addition, crude odds ratios showed a twofold increased risk of chorioamnionitis in assault victims. No difference between abused and nonabused women was noted in the prevalence of preterm delivery, pregnancy-induced hypertension, cesarean section, meconium staining, infant birth weight, Apgar scores, intrauterine growth retardation, fetal distress, fetal death, neonatal seizures, sepsis, or admission to the intensive care unit. CONCLUSIONS: This study demonstrates that physical assault during pregnancy is associated with preterm labor and chorioamnionitis. Screening for ongoing assault should be incorporated into routine prenatal care to identify women at risk of complications. (AM J Obstet Gynecol 1994;170:1760-9.)

Section snippets

Study cohort

The study population consisted of women examined at The University of Texas Medical Branch low-risk prenatal clinic in Galveston, Texas, between May 8 and Dec. 1, 1989. This facility serves an indigent, low-risk population. Women with serious medical illnesses, including diabetes mellitus, chronic hypertension, seizures, connective tissue disorders, heart disease, kidney problems, or sickle cell anemia, are referred to a different facility. A low-risk patient population was selected to limit

RESULTS

Thirty-two of the 440 subjects (7.2%) reported experiencing violence in the current pregnancy whereas 352 women (80.0%) denied ever being assaulted. There were no differences in age, financial status, employment status, highest level of education achieved, use of alcohol, average estimated gestational age at entry into care, prevalence of anemia, or mean weight gain between these two groups (Tables I and II). Victims of violence were more likely to be divorced as opposed to single or married,

COMMENT

This study is one of the first to examine the relationship between assault during the current pregnancy and perinatal outcome with the use of medical record documentation. Although our results should be considered preliminary because of the small sample size, we demonstrated that physical assault of pregnant women is associated with an increased risk of both preterm labor and chorioamnionitis.

Our findings of an increased risk of preterm labor in assaulted women are similar to those reported in

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  • Cited by (0)

    From the Departments of Obstetrics and Gynecology and Preventive Medicine and Community Health, The University of Texas Medical Branch.

    ☆☆

    Supported by the John Sealy Memorial Fund.

    Reprint requests: Abbey Berenson, MD, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX 77555-0587.

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    0002-9378/94 $3.00 + .20 6/6/55076

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