Intimate partner violence significantly increased the risk of pregnancy trauma and placental abruption — pointing up the need for intimate partner violence screening and intervention during this vulnerable period, researchers found.
In fact, women who reported intimate partner violence during the prenatal period had a more than 30 times greater risk of clinical pregnancy trauma (P<0.01) and 5 times the odds of experiencing placental abruption (P<0.05) compared with women who did not report intimate partner violence, according to Janel M. Leone, PhD, of Syracuse University in New York, and colleagues. A review of medical records for more than 2,800 women found that 3.7% had reported intimate partner violence during the prenatal period and, even after adjusting for social demographic variables associated with pregnancy trauma and placental abruption, intimate partner violence was found to be an independent and significant risk factor for these factors, Leone and co-authors wrote in the August issue of the Journal of Women's Health. Pregnancy can be an especially vulnerable period for women who suffer intimate partner violence. Studies estimate that up to 9% of women suffer physical or sexual violence by a male partner -- and between 40% and 59% of those women continue to experience intimate partner violence once they become pregnant, the authors noted. Physical and sexual violence during pregnancy threatens both maternal and child health because it is often chronic and ongoing; more than 80% of women who suffer intimate partner violence during pregnancy have been prior victims of partner abuse, according to background provided by Leone and colleagues. Intimate partner violence during pregnancy is associated with adverse pregnancy outcomes including preterm birth and having a low birthweight baby, as well as increased risk of cesarean delivery, uterine rupture, hemorrhage and antenatal hospitalization. Intimate partner violence also is linked with higher rates of maternal morbidity, including low weight gain, anemia, kidney infections, and first- and second-trimester bleeding, as well as depression and other psychological problems. Placental abruption accounts for approximately 12% of perinatal deaths and has been discussed as a potential consequence of intimate partner violence, but evidence linking the two is sparse, Leone and colleagues wrote. Some risk factors for placental abruption are only indirectly associated with intimate partner violence. For example, violence and assault (e.g., blunt force to the abdomen) by a partner is the second leading cause of pregnancy trauma and represents 22% of all pregnancy trauma cases, according to background provided by the authors. But to date, no study has linked placental abruption to intimate partner violence after controlling for known biological risk factors, such as hypertension during pregnancy and advanced maternal age. The current study was designed to examine factors associated with intimate partner violence reported during prenatal care and the extent to which the abuse and other risk factors (i.e., tobacco, alcohol, and drug use; preeclampsia; and gestational diabetes) were associated with pregnancy trauma and placental abruption. The authors examined prenatal and obstetrical hospital charts for 2,873 women who gave birth between January 2000 and March 2002 in a large urban hospital in Syracuse, New York. Among the study cohort, 48.5% were African American and 40.6% were white, with a mean age of 24; 3.7%, or 105 study participants, reported intimate partner violence (either during screening at first prenatal office visit or through intimate partner violence screening as part of the Syracuse Healthy Start program). Sociodemographic variables included maternal age, ethnicity/race, educational level, employment, relationship status, Medicaid use, and whether the pregnancy was unintended. Health-related variables included tobacco, alcohol, and drug use during pregnancy, as well as a diagnosis of preeclampsia and gestational diabetes. Around 5% of the women had preeclampsia or gestational diabetes; 33% reported tobacco use, 5% reported drug use, and 1.6% reported alcohol use. More than 25% of the pregnancies were unintended. After controlling for these variables, those women who reported intimate partner violence in the prenatal period had greater adjusted odds of pregnancy trauma (OR 32.08, 95% CI 14.33 to 71.80, P<0.01) and placental abruption (OR 5.17, 95% CI 1.37 to 19.51, P<0.05), compared with women who did not report intimate partner violence, Leone and colleagues reported. Multivariate analyses indicated that intimate partner violence during prenatal care (OR 5.17, 95% CI 1.37-19.51, p<0.05) and alcohol use during pregnancy (OR 5.06, 95% CI 1.03 to 24.94, P<0.05) significantly and independently predicted placental abruption. Women ages 25 or older had nearly half the risk of experiencing pregnancy trauma compared with women less than 25 (OR 0.39, 95% CI 0.16 to 0.92, P<0.05) in the mulitvariate analysis. Being under age 25 also predicted pregnancy trauma in the univariate analysis (P<0.01). Univariate analysis found that women who reported intimate partner violence during prenatal care had more than 14 times the risk of a clinical diagnosis of pregnancy trauma compared with women who did not report intimate partner violence (P<0.01). Two other variables linked intimate partner violence and pregnancy trauma: •Having less than/equal to a high school education (P<0.01). •Receiving Medicaid (P<0.01). The authors called for further research that can adequately and reliably distinguish between violence types with regard to pregnancy-related outcomes to better inform current medical screening practices and intervention programs, "as both researchers and practitioners now consider violence during pregnancy to be a 'quintessential threat' to maternal and child health." The findings "highlight the need for practitioner-oriented education about the complexities of intimate partner violence, knowledge of economic and social resources available to women subjected to intimate partner violence, and strategies that can efficiently and effectively increase screening for intimate partner violence and intervention on behalf of intimate partner violence victims," Leone and co-authors concluded. The authors cited several limitations to their study, including the use of self-reported data, data abstracted from hospital charts rather than through patient interviews, the hospital-based nature of the study, and the use of prenatal charts from different sources. There was also no way to accurately assess the use of drugs other than alcohol. The study was also limited to women giving birth at a single urban hospital in the Northeast.