Pregnancy outcomes of women hospitalized for physical assault, sexual assault, and intimate partner violence.

Author(s): 
Auger, N., Low, N., Lee, G.E., Ayoub, A., & Luu, T.M. (2021).
Source: 
Journal of Interpersonal Violence, 1 – 26.
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Summary: 

This study examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. The risk of adverse outcomes was particularly strong for women hospitalized twice or more.

Expanded Abstract: 

Prevalence data from 19 countries indicate that up to 14% of pregnant women experience intimate partner violence (Devries et al., 2010). Violence preceding and during pregnancy has negative consequences for both the woman and fetus. For example, a study of 118,579 women found that intimate partner violence a year prior to pregnancy was linked with high blood pressure, severe nausea, and kidney and urinary tract infection in gestation (Silverman et al., 2006). Similarly, a meta-analysis (examination of data from a number of independent studies on the same subject, in order to determine overall trends) of 16 studies suggested that women with a history of emotional, physical, or sexual abuse at any age before pregnancy have an elevated risk of preterm birth and low birthweight (Nesari et al., 2018).

Pregnancy outcomes of women with serious injuries due to violence receive limited attention from research. This study examined the association between assault before and during pregnancy with maternal and infant outcomes at delivery. Researchers performed a retrospective cohort study (A cohort study is a particular form of longitudinal study that samples a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation) at intervals through time. This study involved 2,193,711 births in Quebec, Canada between 1989 and 2016.

Researchers identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. They examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23–1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19–1.71), stillbirth (RR 1.83, 95% CI 1.27–2.63), preterm birth (RR 1.70, 95% CI 1.54–1.87), and low birthweight (RR 1.78, 95% CI 1.58–2.00).

In summary, physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Findings from this study suggest that screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.

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