Abuse among pregnant adolescents: differences by developmental age

Risk factors for preterm labor: An Umbrella Review of meta-analyses of observational studies

Preterm birth defined as delivery before 37 gestational weeks, is a leading cause of neonatal and infant morbidity and mortality. Understanding its multifactorial nature may improve prediction, prevention and the clinical management. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risks factors associated with PTB, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by robust evidence. We included 1511 primary studies providing data on 170 associations, covering a wide range of comorbid diseases, obstetric and medical history, drugs, exposure to environmental agents, infections and vaccines. Only seven risk factors provided robust evidence. The results from synthesis of observational studies suggests that sleep quality and mental health, risk factors with robust evidence should be routinely screened in clinical practice, should be tested in large randomized trial. Identification of risk factors with robust evidence will promote the development and training of prediction models that could improve public health, in a way that offers new perspectives in health professionals.

A Rare Presentation of the Syndrome of Inappropriate Antidiuretic Hormone in a 12-Year-Old Girl as the Initial Presentation of an Immature Ovarian Teratoma

BACKGROUND

Immature ovarian teratoma is very rare in childhood. We report on a 12-year-old girl with immature ovarian teratoma who presented initially with syndrome of inappropriate antidiuretic hormone.

CASE

A 12-year-old girl presented with acute abdomen and distention. Initial laboratory tests showed hyponatremia (sodium, 123 mmol/L), that did not respond to fluid management. Computed tomography imaging showed a 15 cm × 9 cm × 20 cm mass in the right ovary with multifocal internal fat, and dystrophic calcifications. She underwent exploratory laparotomy with a right salpingo-oophorectomy, omentectomy, and peritoneal stripping. The pathology revealed metastatic immature teratoma. Hyponatremia resolved soon after the surgery.

SUMMARY AND CONCLUSION

Although a rare diagnosis, immature ovarian teratoma must be considered in a girl who presents with abdominal mass and hyponatremia.

Intimate Partner Violence Among Pregnant Young Women: A Qualitative Inquiry

This article explores intimate partner violence (IPV) as experienced by young women during the perinatal period. Using purposive sampling, data pertaining to the experiences of 10 young mothers were gathered through on-site participative observation and individual in-depth interviews. Interviews were coded in an inductive way to reflect the experiences of the participants before pregnancy and following pregnancy confirmation. Overall, the analyses of different manifestations of IPV and their contexts reveal the difficulty these young mothers experience in identifying themselves as a victim of IPV and in categorizing their partner's acts as intimate violence. The fear of family separation and the desire to protect their child contributed to the complexity of violence experienced in a context of motherhood. This article also reflects on the limits of data collection on this subject through comparison of the results of the interviews with the results of the Revised Conflict Tactics Scale (CTS-2). Further research is needed to provide more insight into victimization among young mothers and to inform interventions with the goal of helping young women overcome the intersecting challenges of violence and motherhood.

Partner support and impact on birth outcomes among teen pregnancies in the United States

PURPOSE

Despite hypothesized relationships between lack of partner support during a woman's pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.

METHODS

In a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.

RESULTS

Even after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.

CONCLUSIONS

Having partner support or involvement during a teenager's pregnancy may reduce the likelihood of having a poor birth outcome.

Forensic odontology, part 5. Child abuse issues

Child abuse, child maltreatment, non-accidental injury and child homicide: all terms that are hard to believe exist in the 21st civilised century, but non-accidental injury of children is a major problem, crossing all socioeconomic, ethnic and educational groups, and is happening all over the world. Available statistics on child abuse and deaths related to abuse are frightening, and as many cases are not reported, actual numbers are likely to be much higher. This paper aims to increase understanding of child abuse issues and encourage the dental team to be alert to the possibility of abuse, recognise the physical injuries and make referrals to the appropriate agency if necessary. In child abuse cases physical injuries to the head and facial area are common while other types of abuse are less visible but are damaging to a vulnerable child in other ways. Keeping children safe is a shared responsibility and a top priority for all of us.

[Giving birth at 16, without violence: a possible reality? Empirical data and critical reflection]

Violence between adolescents during teen pregnancy is relatively new in terms of scientific interest and clinical preoccupations. It is an alarming situation, given that 1) its prevalence ranges from 5 % to 29 % according to the literature; 2) consequences for both the mother's and baby's health are numerous at physical, psychological and sexual levels; 3) scientific and empirical knowledge regarding the phenomenon is limited and diminishes efficacy and relevance of current interventions. It therefore appears of major importance to acquire better knowledge of various ecological factors in order to implement preventative care and services that will allow them as well as their children to thrive in adverse conditions and have access to a safe and supportive environment.

Intimate partner violence and its implication for pregnancy

Intimate partner violence (IPV) is a common occurrence in pregnancy and results in an increased risk of adverse outcomes. Homicide may be the most common cause of maternal death. Women who are pregnant and the victims of IPV have high rates of stress, are more likely to smoke or use other drugs, deliver a preterm or low birth weight infant, have an increase in infectious complications, and are less likely to obtain prenatal care. The IPV continues in the postpartum period. Adolescents may be at even higher risk than their adult counterparts. Children raised in violent homes have both immediate and life long adverse health outcomes as a result of their exposure to IPV. IPV adds substantially to healthcare costs both for direct services to treat the injuries and higher utilization of a wide range of healthcare services. Healthcare providers, particularly those who care for pregnant women, are in a unique position to identify these women and direct them and their families to the help they need to end the violence in their lives.

Empowerment and Physical Violence Throughout Women's Reproductive Life In Mexico

This article analyzes intimate partner violence (IPV) against women aged 15 to 21, 30 to 34, and 45 to 49, based on the 2003 National Survey on the Dynamics of Household Relationships (in Spanish, ENDIREH) in Mexico. The authors examined the degree of women's empowerment and autonomy in relation to their partners. Logit regression analyses showed that variables significantly associated with physical violence varied between the three age groups, suggesting that women followed specific trajectories throughout their reproductive lives. Some dimensions of empowerment reduced the risk of violence (women's ability to decide whether to work, when to have sexual relations, and the extent of their partners' participation in household chores). Other dimensions (women's decision making regarding reproductive matters) increased such risk. Thus, access to resources meant to empower women did not automatically decrease the risk of violence. The authors recommend specific interventions tailored to each age group, aimed at breaking the cycle of violence.

Stages of change: surviving intimate partner violence during and after pregnancy

This article outlines clinical approaches to pregnant and recently delivered women who have experienced intimate partner violence. Several process theories are discussed, which help providers more deeply understand the meaning women attach to abuse and the complex nature of being both pregnant and abused. Distinctions are made between patient-centered and practitioner-centered approaches. The construct of stages of change is discussed as a basis for stage-based interventions designed to assist women at various points in their struggle to survive abuse.

Nurse case management for pregnant women experiencing or at risk for abuse

OBJECTIVE

To determine whether individualized nursing case management can decrease stress among pregnant women at risk for or in abusive relationships.

DESIGN

A multisite randomized controlled trial.

SETTING

Two prenatal clinics in the Pacific Northwest and rural Midwest.

PARTICIPANTS

1,000 women who spoke English and were 13 to 23 weeks pregnant at time of recruitment.

INTERVENTION

All intervention group women (N = 499) were offered an abuse video and had access to a nurse case manager 24/7. Additionally, participants at risk for or in abusive relationships received individualized nursing care management throughout the pregnancy.

RESULTS

The most frequent nursing care management activities were providing support (38%) and assessing needs (32%). The nursing care management group received an average of 22 contacts, most (80%) by telephone and had a significant reduction in stress scores as measured by the Prenatal Psychosocial Profile. Compared to the control group, the differences were in the predicted direction, but not statistically different. A major finding was the choice by abused women to focus on basic needs and their pregnancies rather than the abuse, although all received safety planning.

CONCLUSIONS

Pregnant women at risk for or in abusive relationships experience very stressful and complex lives. Nurses need to focus on the needs they identify, which may not be the abusive relationship.

Perinatal violence assessment: teenagers' rationale for denying violence when asked

OBJECTIVE

To describe teenagers' experiences with perinatal violence assessment.

DESIGN

A descriptive design utilizing qualitative content analysis.

SETTING

Participants were recruited from gynecologic clinics of two level III maternity units and interviewed offsite.

PARTICIPANTS

Twenty nonpregnant teenagers between the ages of 18 and 20 years who had experienced physical or sexual abuse in the year before or during (or both) a pregnancy occurring within the last 3 years were recruited for this study, regardless of past pregnancy outcome.

METHODS

Data were analyzed using categorical content analysis.

RESULTS

Participants reported a range of violence experiences from their parents, current and past intimate partners, and gangs (groups). Four categories emerged that addressed their reasons for not disclosing violence to their health care providers: Power/Powerlessness, Fear/Hope, Trust/Mistrust, and Action/Inertia.

CONCLUSIONS

Abused teenagers have unique needs and concerns that should be addressed when providing pregnancy care.

Effectiveness of a Comprehensive Psychoeducational Intervention With Pregnant and Parenting Adolescents: A Pilot Study

PROBLEM

Little is known about the effectiveness of a comprehensive psychoeducational intervention on depression, self-esteem, and parenting attitudes/beliefs of at-risk pregnant and parenting adolescents.

METHODS

Adolescents (N = 41) attending either a residential treatment facility (RTF) or a rural alternative school (RAS) participated in a psychoeducational parenting group using Bavolek's Nurturing Program during Phase I. Phase II included health promotion issues, infant massage, and CPR.

FINDINGS

Using the Parenting Semantic Differential and the AAPI-2, there was significant improvement in parenting attitudes and beliefs. No significant change was found in self-esteem.

CONCLUSIONS

A comprehensive psychoeducational parenting group can be effective in changing parenting attitudes and beliefs, which suggests an ultimate improvement in health promotion and disease prevention in adolescent women and their children.

Describing abuse of pregnant women and their healthcare workers in rural Appalachia

PURPOSE

This study compared the past and current abuse experiences in two rural populations: pregnant women and their healthcare workers, the majority of whom were nurses.

DESIGN AND METHODS

A descriptive study was conducted with pregnant and postpartum women (n=247) and healthcare workers (HCW) (n=91) in two Appalachian counties in Ohio. A written survey was used to collect the data.

RESULTS

In the HCW group, 17.6% (n=16) reported having experienced sexual abuse as children, as compared to 12.1% (n=30) of Mothers. In the HCW group 9.9% (n=9) reported violent treatment when they were children; the Mothers group reported this in 6.5% (n=16) of the cases. For the Mothers, 14.6% (n=36) reported violence during pregnancy, compared to 6.6% (n=6) of HCWs. Most HCWs (80.2%) reported times when they suspected clients might have experienced abuse or violence. Only 56% of HCWs said employers had policies about abuse assessment. Less than one half of the HCWs (40.7%) reported formal academic education preparing them to address abuse issues, and 83.5% reported needing more education to prepare them to work effectively with client abuse issues.

CLINICAL IMPLICATIONS

Assessment for abuse during pregnancy is an ongoing need. It is not known whether nurses and other healthcare workers who share the community's culture can effectively assess for abuse, due to their personal experiences involving abuse. Insufficient educational preparation for abuse assessment is common among healthcare professionals, and needs to be addressed. Additional research about the topic of cultural similarities and differences and their effects on abuse assessment are warranted.

Adolescents' experiences of dating and intimate partner violence: "once is not enough"

Pregnant and parenting adolescents represent a significant proportion of the individuals directly affected by intimate partner violence. Although screening tools are useful, it is important to ask very specific questions to open lines of communication with adolescents. This article presents a clinical case that highlights the challenges of screening adolescents for intimate partner violence and offers suggestions for health care providers. Specific examples of screening questions are offered.

Adolescent pregnancy and homicide: findings from the Maryland Office of the Chief Medical Examiner, 1994-1998

Homicide has remained the third leading cause of death among girls aged 10 to 19 for more than a decade. Recent research indicates that pregnant or postpartum teens are three times more likely to be victims of homicide compared to their nonpregnant counterparts. These findings portray a compelling picture that leads the authors to investigate the relationship between homicide and pregnancy among teens in Maryland. The purpose of this study is to compare women whose deaths had been evaluated by the medical examiner and who had evidence of pregnancy to women without evidence of pregnancy, with a particular focus on adolescents; 329 (17.7%) adults and 66 (32.7%) adolescents were victims of homicide. Adolescent homicide victims were 3.7 (1.2 to 11.8) times more likely to be pregnant compared to adult homicide victims. The rate of homicide was nearly double in all women who were pregnant. Further research is necessary to evaluate factors associated with these risks so that the future generation and society are protected.

Identifying intimate partner violence at entry to prenatal care: clustering routine clinical information

Intimate partner violence (IPV) is the greatest trauma-related risk to American women. Pregnant women are no exception, and escalation of IPV frequently occurs during pregnancy. Many studies have linked IPV during pregnancy to adverse maternal and fetal outcomes. This study examined IPV at the beginning of prenatal care to identify correlates of routine entry-to-care information with responses on a validated IPV screening tool, the Abuse Assessment Screen. The purpose of the study was to identify specific data from routine, standard intake information, which could alert clinicians to the potential of violence even in the presence of a negative IPV score or no formally administered screening tool. The point prevalence of abuse, as measured by the Abuse Assessment Screen at entry to care, was slightly in excess of the national mean, reinforcing the need for continual assessment throughout pregnancy. Abused women in this study were more likely to be young, single, and without family or partner support. These women relied on friends for support, admitted to depression, and desired their pregnancies. The findings are consistent with previous studies. Further research needs to be conducted to determine if this cluster of findings at entry to care, with or without a positive score on an IPV screening tool, are consistent markers for an increased risk of IPV.

"Keep a blank face. I need to tell you what has been happening to me

PURPOSE

To explore adolescents' experiences of abuse in the year before and during pregnancy.

METHODS

This prospective study used structured and focused interviews and content analysis. Forty teens' stories of abuse were extracted from focused interview questions during a larger study of pregnant adolescents aged 18 to 20. Elements of the stories were coded and categorized according to content and meaning. Seven themes were identified using a generalized qualitative approach that blended content and thematic analysis.

RESULTS

Teens reported abuse from a variety of individuals, including intimate partners, former partners, and family members. Thirteen of the 40 teens reported being pregnant in the year before the index pregnancy, with 11 of the pregnancies ending in miscarriage, elective abortion, or fetal demise. Four of the pregnancy losses were directly attributed to abuse. Seven themes were identified that reflected the teens' stories of violence: seeking safety (self-protection with risks and benefits); losing faith (negative experiences with police and social justice institutions); experiencing loss (compromised reproductive health); living on the edge (substance abuse concerns); taking the next step (developmental concerns); crying out for help (suicide attempts); and changing and temporary relationships (loss of family bonds and serial monogamy).

CLINICAL IMPLICATIONS

Routine screening for violence prior to and during pregnancy should include questions about past pregnancies, sexual abuse, and multiple perpetrators, as well as perpetrators other than intimate partners. Adolescent developmental concerns should be incorporated in safety planning and advocacy interventions.

Negotiating motherhood: the struggles of teenage mothers

AIMS

This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

BACKGROUND

Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

DESIGN

This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

FINDINGS

The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

CONCLUSIONS

It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.

Severity, manifestations, and consequences of violence among pregnant adolescents

PURPOSE

To examine the severity, manifestations, and consequences of prenatal violence among adolescent and adult participants in a county health department prenatal care coordination program.

METHODS

The prospective cohort study design included all Medicaid-eligible program participants from 1994 to 1996. Care coordinators screened participants for prenatal violence using a validated, systematic violence assessment protocol at three times during pregnancy. This protocol was linked with prenatal care and hospital delivery records to document pregnancy outcomes. The main outcome variables were low birth weight (<2500 g) and preterm delivery (before 37 weeks' gestation).

RESULTS

Among teens, 16.1% reported prenatal violence, including 9.4% who reported severe violence such as hitting, kicking, or stabbing. Among adults, 11.6% reported prenatal violence, including 4.8% who reported severe violence. Teens were more likely than adults to report abdominal trauma (56% vs. 22%) and violence perpetrated by a relative (23% vs. 5%). Teens who reported severe prenatal violence were more likely to report alcohol use. They were significantly more likely to deliver preterm than teens who reported "other" or "no" prenatal violence (odds ratio 3.5, 95% confidence interval 1.1-10.8) when adjusting for race, adequacy of prenatal care, prior preterm delivery, and alcohol use. For adults, the relationship between prenatal violence and preterm delivery was not statistically significant. The relationship between prenatal violence and low birth weight was not significant for either age cohort.

CONCLUSIONS

Prenatal violence was a significant risk factor for preterm birth in this population, especially among teens.

Perinatal nursing research: a 25-year review--1976-2000

Parent-infant nursing research from 1976-2000 is reviewed through four groups of studies: development of research instruments, studies of mothers and fathers through the childbearing years, studies of newborns (both healthy and at risk), and studies of special populations. Potential directions for maternal/parent/newborn nursing research in the 21st century are suggested.

Violence and reproductive health: current knowledge and future research directions

OBJECTIVES

Despite the scope of violence against women and its importance for reproductive health, very few scientific data about the relationship between violence and reproductive health issues are available.

METHODS

The current knowledge base for several issues specific to violence and reproductive health, including association of violence with pregnancy, pregnancy intention, contraception use, pregnancy terminations, and pregnancy outcomes, are reviewed and suggestions are provided for future research.

RESULTS

Despite the limitations of current research and some inconclusive results, the existing research base clearly documents several important points: (1) violence occurs commonly during pregnancy (an estimated 4%-8% of pregnancies): (2) violence is associated with unintended pregnancies and may be related to inconsistent contraceptive use; and (3) the research is inconclusive about the relationship between violence and pregnancy outcomes.

CONCLUSIONS

Improved knowledge of the risk factors for violence is critical for effective intervention design and implementation. Four areas that need improvement for development of new research studies examining violence and reproductive-related issues include (1) broadening of study populations, (2) refining data collection methodologies, (3) obtaining additional information about violence and other factors, and (4) developing and evaluating screening and intervention programs. The research and health care communities should act collaboratively to improve our understanding of why violence against women occurs, how it specifically affects reproductive health status, and what prevention strategies may be effective.

Past physical abuse is significantly correlated with pregnancy as an adolescent

STUDY OBJECTIVE

To determine which type or types of childhood abuse are associated with adolescent pregnancy and other adverse health outcomes.

DESIGN

100 females between the ages of 12 and 24 years of age, attending either an adolescent/young adult clinic (for ages 12 to 24), or teen obstetrics clinic (for ages 13 to 18) at an urban academic medical center, were recruited to participate in an interview study during their clinic visit. The clinician or research assistant used a 186-item structured interview form to record answers to detailed questions on abuse, in addition to traditional questions about the patient's feelings on home, education, activities, drugs and depression, sex and suicide (HEADS).

RESULTS

32% of subjects reported a history of sexual abuse, 29% reported physical abuse, and 46% reported past emotional abuse. The frequency of any past abuse was significantly higher in girls who had ever been pregnant (29 of 50, 58%), compared with "never pregnant" girls (19 of 49, 38%)( P < .05). A past history of physical abuse (P = .04), but not sexual or emotional abuse, was significantly associated with pregnancy as a teen. Other factors significantly correlated with teen pregnancy were: frequent alcohol use, older age, and Mexican-American or African-American ethnicity. Past history of abuse was significantly correlated with depression, suicidal thoughts, absent father, school failure, alcohol and tobacco use, and delinquency.

CONCLUSIONS

A history of past physical abuse is strongly associated with adolescent pregnancy, and questions about all types of abuse should be routinely asked of adolescent patients.