Janssen, Patti A.; PhD
UNIVERSITY OF WASHINGTON, 2001
HEALTH SCIENCES, NURSING (0569); HEALTH SCIENCES, OBSTETRICS AND GYNECOLOGY (0380)
<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 1.38–10.4),
intrauterine growth
restriction (OR: 3.06, 95% CI 1.02–9.14) and perinatal death (OR:
8.06, 1.42–45.63).
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,
1.27–9.72) and with perinatal death (OR: 7.28, 1.28–41.3)
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,
0.94–8.50). <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
death.
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Systems Simulation Group
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