Stressful life events and physical abuse among pregnant women in North Carolina

Association of the COVID-19 Pandemic With Unstable and/or Unsafe Living Situations and Intimate Partner Violence Among Pregnant Individuals

Importance

The social, behavioral, and economic consequences of the COVID-19 pandemic may be associated with unstable and/or unsafe living situations and intimate partner violence (IPV) among pregnant individuals.

Objective

To investigate trends in unstable and/or unsafe living situations and IPV among pregnant individuals prior to and during the COVID-19 pandemic.

Design, Setting, and Participants

A cross-sectional population-based interrupted time-series analysis was conducted among Kaiser Permanente Northern California members who were pregnant and screened for unstable and/or unsafe living situation and IPV as part of standard prenatal care between January 1, 2019, and December 31, 2020.

Exposures

COVID-19 pandemic (prepandemic period: January 1, 2019, to March 31, 2020; during pandemic period: April 1 to December 31, 2020).

Main Outcomes and Measures

The 2 outcomes were unstable and/or unsafe living situations and IPV. Data were extracted from electronic health records. Interrupted time-series models were fit and adjusted for age and race and ethnicity.

Results

The study sample included 77 310 pregnancies (74 663 individuals); 27.4% of the individuals were Asian or Pacific Islander, 6.5% were Black, 29.0% were Hispanic, 32.3% were non-Hispanic White, and 4.8% were other/unknown/multiracial, with a mean (SD) age of 30.9 (5.3) years. Across the 24-month study period there was an increasing trend in the standardized rate of unsafe and/or unstable living situations (2.2%; rate ratio [RR], 1.022; 95% CI, 1.016-1.029 per month) and IPV (4.9%; RR, 1.049; 95% CI, 1.021-1.078 per month). The ITS model indicated a 38% increase (RR, 1.38; 95% CI, 1.13-1.69) in the first month of the pandemic for unsafe and/or unstable living situation, with a return to the overall trend afterward for the study period. For IPV, the interrupted time-series model suggested an increase of 101% (RR, 2.01; 95% CI, 1.20-3.37) in the first 2 months of the pandemic.

Conclusions and Relevance

This cross-sectional study noted an overall increase in unstable and/or unsafe living situations and IPV over the 24-month period, with a temporary increase associated with the COVID-19 pandemic. It may be useful for emergency response plans to include IPV safeguards for future pandemics. These findings suggest the need for prenatal screening for unsafe and/or unstable living situations and IPV coupled with referral to appropriate support services and preventive interventions.

Pregnancy Outcomes of Women Hospitalized for Physical Assault, Sexual Assault, and Intimate Partner Violence

Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. 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). 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. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.

Perceived stress and its associated factors among pregnant women in Bale zone Hospitals, Southeast Ethiopia: a cross-sectional study

Objectives

Even though perceived stresses during pregnancy adversely affect the mother and her baby, there is still a scarcity of data from developing countries including Ethiopia. Therefore, this study assessed the prevalence of perceived stress and associated factors among pregnant women in Bale zone hospitals, Southeast Ethiopia. Cross-sectional study was conducted from November 2016 to April 2017. A total of 396 pregnant women were successfully interviewed using structured and pre-tested questionnaires. Perceived stress scale was employed to assess the women’s stress status. A systematic random sampling technique was used. Logistic regression was applied to identify factors associated with perceived stress and statistical significance was considered at p-value < 0.05.

Results

In this study, the prevalence of perceived stress among pregnant women was 11.6% (95% CI 8.30, 14.60). Having 2–5 pregnancies previously (AOR = 9.82; CI 1.08, 89.5) and gestational age less than 12 weeks (AOR = 3.53; CI 1.03, 12.08) were associated with perceived stress among pregnant women. In this study, the prevalence of perceived stress among pregnant women was relatively low. Health care providers should give due attention to the screening of stress in the first trimester to reduce the likelihood of pregnancy-specific stress.

Addressing Intimate Partner Violence to Improve Women's Preconception Health

Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV.

Effects of Aromatherapy Massage on Pregnant Women's Stress and Immune Function: A Longitudinal, Prospective, Randomized Controlled Trial

OBJECTIVES

This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy.

METHODS

This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay.

RESULTS

The pregnant women in the intervention group had lower salivary cortisol (p < 0.001) and higher IgA (p < 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p < 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline).

CONCLUSIONS

This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

Relationships between Psychosocial Difficulties and Oxidative Stress Biomarkers in Women Subject to Intimate Partner Violence

Women subject to violence by their intimate partners often experience a range of psychosocial problems such as depression, excessive alcohol use, and stressful life events that, in turn, lead to health issues. This study examined psychosocial difficulties and oxidative stress levels in abused and non-abused Korean women and analyzed the relationship between psychosocial outcomes and oxidative stress levels. Markers were determined in 16 women (seven abused, nine non-abused). The two groups of women (abused and non-abused) were compared with respect to scores in depression, alcohol use, life stress events, and oxidative stress biomarkers using the Mann-Whitney U test. Correlations between depression, alcohol use, life stress events, and oxidative stress biomarkers were tested by the Spearman rank correlation coefficient. The abused women had significantly higher levels of oxidative stress markers and significantly lower levels of antioxidants than the non-abused women. Life stress events and oxidative biomarker levels were significantly correlated. These findings have implications for both social services providers and medical personnel when assessing abused women to ensure that they receive the most appropriate service.

Intimate Partner Violence and Women's Depression Before and During Pregnancy

Depressive symptoms of 95 prenatal care patients were examined relative to thewomen's experiences of intimate partner violence. Women who were victims of psychological aggression during the year before pregnancy were not at elevated risk for depression except when the psychological aggression was very frequent. However, during pregnancy, psychological aggression was more closely tied to women's depression levels, regardless of its frequency. In addition, women who experienced any level of physical assault or sexual coercion by their intimate partners (before or during pregnancy) had higher levels of depressive symptoms compared to nonvictims.

The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers

Stressful life events during pregnancy negatively affect maternal and infant outcomes including breastfeeding initiation. Their impact on breastfeeding duration is uncertain. Given breastfeeding's important health benefits we analyzed stressful life event types and cessation of any and exclusive breastfeeding by 4 and 13 weeks. Methods. We collected self-administered survey data at 5–7 months postpartum from over 700 primarily urban low-income US mothers. Data covered prepregnancy, prenatal, and postpartum periods including 14 stressful life events (categorized into financial, emotional, partner-associated, traumatic). Analyses included only mothers initiating breastfeeding (n = 341). Logistic regressions controlled for maternal characteristics including a breastfeeding plan. Results. All four stress categories were associated with shorter duration of any and exclusive breastfeeding. In the adjusted models, statistically significant relationships remained for financial stress (4 weeks cessation of any breastfeeding duration) and traumatic stress (13 weeks exclusive breastfeeding cessation). Controlling for stress, a longer breastfeeding plan was significantly associated with a shorter breastfeeding duration (all models) as was depression during pregnancy and current smoking (several models). Conclusions. Among low-income women, impact of stressful life events on cessation of breastfeeding may differ by stress type and interfere with achievement of breastfeeding goal. Among these stressed mothers, breastfeeding may serve as a coping mechanism.

Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses

BACKGROUND

Pregnant women who experience domestic violence are at increased risk of adverse outcomes in addition to the risks to themselves. Inadequate prenatal care, higher incidences of high-risk behaviors, direct physical trauma, stress, and neglect are postulated mechanisms. Our objective was to systematically review birth outcomes among women who experienced domestic violence.

METHODS

Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting rates of low birth weight, preterm birth, small for gestational age births, birth weight, or gestational age at birth were included. Study quality was assessed for selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition biases. Unadjusted and adjusted data from included studies were extracted by two reviewers. Summary odds ratio (OR) and confidence intervals (CI) were calculated using the random effects model. Population-attributable risk was calculated.

RESULTS

Thirty studies of low to moderate risk of biases were included. Low birth weight (adjusted OR 1.53, 95% CI 1.28-1.82) and preterm births (adjusted OR 1.46, 95% CI 1.27-1.67) were increased among women exposed to domestic violence. As the prevalence of reported domestic violence during pregnancy was low, the population-attributable risk was low. Prospective cohort studies provided robust and consistent results.

CONCLUSIONS

Maternal exposure to domestic violence was associated with significantly increased risk of low birth weight and preterm birth. Underreporting of domestic violence is hypothesized. Effective programs to identify violence and intervene during pregnancy are essential.

Psychosocial stress during pregnancy

OBJECTIVE

We sought to identify factors associated with high antenatal psychosocial stress and describe the course of psychosocial stress during pregnancy.

STUDY DESIGN

We performed a cross-sectional analysis of data from an ongoing registry. Study participants were 1522 women receiving prenatal care at a university obstetric clinic from January 2004 through March 2008. Multiple logistic regression identified factors associated with high stress as measured by the Prenatal Psychosocial Profile stress scale.

RESULTS

The majority of participants reported antenatal psychosocial stress (78% low-moderate, 6% high). Depression (odds ratios [OR], 9.6; 95% confidence interval [CI], 5.5-17.0), panic disorder (OR, 6.8; 95% CI, 2.9-16.2), drug use (OR, 3.8; 95% CI, 1.2-12.5), domestic violence (OR, 3.3; 95% CI, 1.4-8.3), and having > or =2 medical comorbidities (OR, 3.1; 95% CI, 1.8-5.5) were significantly associated with high psychosocial stress. For women who screened twice during pregnancy, mean stress scores declined during pregnancy (14.8 +/- 3.9 vs 14.2 +/- 3.8; P < .001).

CONCLUSION

Antenatal psychosocial stress is common, and high levels are associated with maternal factors known to contribute to poor pregnancy outcomes.

Prevalence of violence during pregnancy: findings from a Jordanian survey

BACKGROUND

Violence during pregnancy is a significant health and social problem. In the last few years several factors have contributed to the emergence of family violence as a high priority social and health issue in Jordan, and the acknowledgement that abuse during pregnancy is a harmful act to the mother and the fetus. The purposes of this study were to investigate the prevalence of physical, emotional, verbal, and sexual violence on pregnant women, and to describe the relationships between violence and selected study variables.

METHODS

A descriptive study was conducted using a self-administered questionnaire. A convenience sample of 316 pregnant women was recruited from five Maternal and Child Health Centers, located in Irbid City in the North of Jordan.

RESULTS

The prevalence of physical, emotional, verbal and sexual violence by husbands during pregnancy was 10.4%, 23.4%, 23.7%, and 5.7%, respectively. Prevalence of physical, emotional and verbal violence by a family member other than the husband was 1.9%, 11.1% and 13.9%, respectively, and most perpetrators were the mother in-law. Data also showed that there was a significant association between prevalence of violence and unplanned pregnancy, the pregnant women's perception of their husband's violent attributes and the women's low self-esteem. Pre- and post-natal visits should include assessment for family violence and intervention when violence or abuse is identified. The findings support continued public awareness of family violence to bring about social and political changes that increase reporting and reduce incidence of violence in Jordan.

Poverty, near-poverty, and hardship around the time of pregnancy

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income </=100% of federal poverty level [FPL]) and 20% near-poor (101-200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship. While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships; e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.

Comparative analyses of stressors experienced by rural low-income pregnant women experiencing intimate partner violence and those who are not

OBJECTIVE

To describe the daily lives of rural pregnant women who smoked during pregnancy, with a focus on their sources of stress and the compounding effects of intimate partner violence.

DESIGN

A qualitative study using content analysis of research nurses' telephone logs from a large smoking cessation randomized controlled trial (N=695) in which 33% of the sample (n=227) experienced intimate partner violence in the past year.

PARTICIPANTS

Fifty pregnant women, 25 who had experienced intimate partner violence in the past year and 25 who had never experienced intimate partner violence, were randomly selected from those who received a nurse-delivered telephone intervention for smoking cessation (n=345). The mean age of the sample was 22 years, and the majority were White and living in a married-like relationship.

RESULTS

Women experiencing intimate partner violence discussed certain stressors significantly more often than nonabused women. These stressors included finances, lack of social support, legal issues, transportation issues, and abuse by the intimate partner and others.

CONCLUSION

Health care providers need to recognize that intimate partner violence creates a stress, which can compound the stressors of pregnancy and poverty in rural areas. Offering these women a chance to talk about their lives can help them not only to locate necessary resources, but also to break down the barriers of isolation.

Physical abuse during pregnancy and preterm delivery

OBJECTIVE

This study was undertaken to assess the relationship between physical abuse during pregnancy and preterm delivery.

STUDY DESIGN

We conducted a hospital-based survey on physical abuse during pregnancy, which included 2660 women with consecutive live births. Women were interviewed and violence was assessed using the Abuse Assessment Screen. Data on sociodemographic, behavioral, and obstetric variables were also obtained. Mothers of preterm (<37 weeks; n = 217) were contrasted with mothers of term newborn infants (n = 2428). Logistic regression analysis was performed to estimate adjusted odds ratios.

RESULTS

Twenty-four percent of mothers of preterm newborn infants had experienced physical abuse during pregnancy compared with 8% of mothers of term newborn infants (P < .0001). Violence was associated with preterm birth even after controlling for age, marital status, education, income, parity, planned pregnancy, antenatal care, smoking, alcohol, and illicit drugs use (odds ratio = 3.14, 95% confidence interval, 2.00-4.93).

CONCLUSION

Women who have had physical abuse during pregnancy present a large increase in the risk of preterm delivery, independently from a large set of sociodemographic and behavioral characteristics usually recognized as determinants of preterm birth.

Interactions between victims of intimate partner violence against women and the health care system: policy and practice implications

Intimate partner violence (IPV) affects the use of health care by increasing the risk of poor health outcomes. IPV victims seek health services as often as others but are less likely to receive needed services, more likely to overuse services, and more likely to have a poor relationship with their health care provider. This stems from patient and provider barriers to care that are exacerbated by the lack of a clear and consistent health care system response to IPV. Most health care systems are not equipped to assist either victims or providers seeking to help victims. There are a few models of system-wide interventions, but these are not the current standard. A strong health policy framework is needed, but the decision of the U.S. Preventative Task Force not to recommend universal screening is a setback. Overall, there is limited progress in moving the health care system toward assisting IPV victims.

Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba

OBJECTIVE

To describe the prevalence and correlates of physical abuse during the year of pregnancy and to explore the association between physical abuse and other risk factors for preterm birth.

DESIGN

Secondary analysis of data from a case-control study of risk factors for preterm birth.

SETTING

Two tertiary care hospitals in the Canadian province of Manitoba.

PARTICIPANTS

Six hundred eighty postpartum women who delivered a live singleton newborn after spontaneous onset of labor.

MAIN OUTCOME MEASURES

Instruments included the Abuse Assessment Screen, Prenatal Psychosocial Profile, Perceived Stress Scale, and a questionnaire to collect data on demographic characteristics, complications during pregnancy, and lifestyle behaviors.

RESULTS

Sixty-four women (9.4%) reported being physically abused during the year of pregnancy. Abused women were significantly more likely to be younger, single, of lower income, and less educated than nonabused women. Significant correlates of abuse, after adjusting for other factors in a logistic regression, included the following: illicit drug use, low support from partner, moving two or more times in the past year, high life event stress, bladder infection during pregnancy, Aboriginal race/ethnicity, and single marital status.

CONCLUSION

This study suggests that physical abuse during pregnancy is associated with other risk factors for preterm birth, particularly stress and behavioral risk factors such as substance abuse.

Domestic violence risk during and after pregnancy: findings from a British longitudinal study

OBJECTIVE

The objectives of this study were to examine the rates of domestic violence reported during and after pregnancy and to assess the importance of family adversity.

DESIGN

Prospective longitudinal cohort study.

SETTING

Bristol Avon, Southwest England.

POPULATION

Seven thousand five hundred and ninety-one pregnant women with due dates between 1.4.91 and 31.12.92.

METHODS

Questionnaires administered at 18 weeks of gestation and 8 weeks, 8 months, 21 months and 33 months postpartum.

MAIN OUTCOME MEASURES

The experience of emotional or physical cruelty by an intimate partner at each time point.

RESULTS

Fewer women reported domestic violence victimization during pregnancy than they did postpartum (18 weeks of gestation: 1% physical cruelty, 4.8% emotional cruelty, 5.1% any victimization; 33 months postpartum: 2.9% physical, 10.8% emotional, 11% any victimization). Women who reported being victimized during pregnancy also reported significantly higher levels of social adversity during pregnancy. The number of social adversities reported during pregnancy also predicted postpartum victimization. Women who reported only one adversity during pregnancy were 2.73 (95% CI, 2.16-3.45) times more likely to report physical victimization at 33 months postpartum. Women who reported 5 adversities during pregnancy were 14.69 (95% CI, 7.35-29.37) times more likely to report such victimization at 33 months postpartum. For emotional cruelty, women who reported only one adversity during pregnancy were 2.10 (95% CI 1.80-2.46) times more likely to report emotional victimization at 33 months postpartum and 6.10 (95% CI 3.51-10.59) times more likely to report such victimization when five or more adversities were present during pregnancy.

CONCLUSIONS

Levels of social adversity reported in pregnancy are important predictors of concurrent and future victimization. Screening for social adversity factors could help identify women at high risk for future domestic violence.

Prevalence of major life events among patients and community dwellers

BACKGROUND

Life events have been shown to be associated with health and illness.

METHODS

We studied the number of life events experienced by hip fracture patients, nonfracture rheumatology patients, and community-dwelling asymptomatic residents in the year before interview. Fifty-four hip fracture patients, 63 ambulatory patients, and 115 community-dwelling residents participated in the study. All were older than 65 years. Descriptive statistics and nonparametric analyses were performed.

RESULTS

The number of events reported in the previous 12 months was higher for hip fracture patients than for community participants (p = 0.02). At least one bereavement was reported by 32% of hip fracture patients, 27% of ambulatory patients, and 26% of community dwellers (p = 0.8). Ten percent of all respondents reported experiencing more than one bereavement.

CONCLUSION

This has important consequences when considering the care of these patients and the mental distress they may be experiencing, especially in the aftermath of local disasters or trauma. Medications may not always be the best treatment, and better psychosocial assessments and delivery systems are needed.

Substance use before and during pregnancy: links to intimate partner violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non-victims, and they evidenced a greater number of substance disorder symptoms compared with the non-victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance-using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.

Physically abused pregnant women's perceptions about the quality of their relationships with their male partners

OBJECTIVES

Most studies of pregnant victims of intimate partner violence have focused on the violent behaviors, without examining other potentially important dimensions of the relationships. This research studies pregnant abuse victims to examine the frequency of violent behaviors occurring during pregnancy, how women characterize the quality of their relationships, and the association between violence frequency and women's perceptions concerning the overall quality of their relationships.

METHODS

Eighty-one women who were physically abused by intimate partners during pregnancy were interviewed. Information was collected concerning the women's: experiences of partner violence during pregnancy; perceptions of other aspects of the quality of their relationships; and sociodemographic characteristics.

RESULTS

The most frequent type of violent behavior occurring during pregnancy was verbal aggression, followed by minor violence, and then severe violence. Men perpetrated each type of violent behavior at significantly higher rates than did their female partners. In general, the women were quite negative in their characterizations of many dimensions of their relationships, as well as in their perceptions concerning the overall quality of their relationships, with women who had been victims of more frequent violence being significantly more likely to characterize their relationships as being of lower overall quality (OR = 3.5, 95% CI = 1.4-8.7).

CONCLUSIONS

Prenatal care providers are encouraged to screen their patients for intimate partner violence, and to work with others in their community to assure that women in abusive situations are offered appropriate services/interventions including safe and feasible alternatives to staying in unsatisfactory relationships with abusive partners.