Birth Outcomes and Maternal Morbidity in Abused Pregnant Women With Public Versus Private Health Insurance

"It is like a curse". The lived experiences of the intersection of intergenerational violence, pregnancy, and intimate partner violence among urban Wisconsin Indigenous women

BACKGROUND

Intimate Partner Violence (IPV) is a significant public health concern that disproportionately impacts Indigenous American women more than any other ethnic/racial group in the United States.

PURPOSE

This study aims to inform the work of nurses and allied health professionals by providing insight into the lived realities of Indigenous women in urban areas and how IPV manifests in the lives of Indigenous women.

METHODS

Postcolonial and Indigenous feminist frameworks informed this qualitative study. Using thematic analysis, we analyzed data from semi-structured individual interviews with 34 Indigenous women in large urban areas in the upper Midwest.

FINDINGS

This manuscript discusses one broad theme: experiences of IPV during pregnancy and the devastating impacts on women and their children in the form of intergenerational trauma. Under this broad theme, we identified two sub-themes: impacts of IPV on individual pregnancy experiences and linkages to adverse pregnancy-related outcomes related to physical IPV during the childbearing years.

CONCLUSION

This Indigenous-led study informs the development of effective Indigenous-specific interventions to minimize barriers to accessing prenatal care and help-seeking when experiencing IPV to reduce the devastating consequences for Indigenous women and their families.

Intimate partner violence during pregnancy and its association with birth asphyxia in hospitals of Tigray region, Ethiopia

BACKGROUND

Birth asphyxia is the main cause of neonatal mortality and morbidity worldwide. Some studies indicate intimate partner violence during pregnancy is a risk factor for birth asphyxia. In Ethiopia, intimate partner violence during pregnancy is reported to be high. Despite this high prevalence, there is a lack of data about the association of birth asphyxia and intimate partner violence. The aim of this study was to assess the prevalence of intimate partner violence during pregnancy and its associated factors with birth asphyxia in health facilities in the Tigray region of northern Ethiopia.

METHODS

This was an institutional-based cross-sectional study conducted at select health facilities in the Tigray region of Ethiopia. Random sampling technique was employed to select health facilities and systematic sampling was used to select 648 study participants. Data was entered by using Epi info version 3.5.1 and was analyzed using SPSS version 20. Bivariate and multivariate analysis was done to assess the association between exposure to intimate partner violence during pregnancy and birth asphyxia after adjusting for possible confounders.

RESULTS

The prevalence of intimate partner violence during pregnancy was 47(7.3%). Eighty two (12.7%) babies were delivered with birth asphyxia. Intimate partner violence during pregnancy had a significant association with birth asphyxia, AOR (95% CI) = 4.4(2-9.8). In addition to this, other factors that were associated with birth asphyxia include place of residence [ AOR (95% CI) = 2.7(1.55-4.8)], age > 19 [AOR (95% CI) = 2.9(1.29-6.5)], age 20-35 [AOR (95% CI) = 3.1(1.06-9.3)], gestational age < 37 weeks [AOR(95% CI) = 7.2(3.5-14.8)] and low birth weight [AOR(95% CI) = 3.9(2.1-7.3)].

CONCLUSIONS

The prevalence of birth asphyxia in this study is high and is further increased by intimate partner violence during pregnancy. Health care providers and policy makers should take measures aimed at preventing intimate partner violence during pregnancy to reduce harm to the mother and adverse birth outcomes.

The prevalence of intimate partner violence among Iranian pregnant women: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence against pregnant women is an important public health concern and human rights issue. According to the various findings of previous studies, this study was conducted to assess the pooled prevalence of intimate partner violence against Iranian women.

METHODS

In this systematic review and meta-analysis, a literature search was conducted in databases such as PubMed, Scopus, Web of Science, MagIran, and Scientific Information Database without a time limit. Heterogeneity was assessed by Cochrane Q test statistics and the I2 test, and the results were incorporated into a random effects model to estimate the prevalence of intimate partner violence. Data analysis was performed using R software version 4.3.2.

RESULTS

The overall prevalence of intimate partner violence was reported to be 51.5% (95% confidence interval (CI) 45.0-58.1), and the prevalence rate of physical, sexual, and psychological intimate partner violence was 18.0% (95% CI 15.1-20.9), 22.1% (95% CI 17.7-26.60) and 43.2% (95% CI 36.6-49.8), respectively. The lowest level of physical, sexual, and emotional intimate partner violence rate was observed in district 1 of Iran (includes Tehran, the capital of Iran and the surrounding provinces). The rate of physical and sexual intimate partner violence prevalence decreased with the increased mean age of the husband (P=0.005) and the mean age of the wife (P=0.035), respectively.

CONCLUSIONS

Studies included in this review report that more than half of Iranian women experience violence during pregnancy. In order to prevent adverse maternal and neonatal consequences, it is necessary to identify these women and introduce them to support centres.

Is intimate partner violence and obstetrics characteristics of pregnant women associated with preterm birth in Ethiopia? Umbrella review on preterm birth

BACKGROUND

Preterm birth is a significant contributor to newborns morbidity and mortality. Despite the availability of highly effective and powerful interventions, the burden of preterm birth has not decreased. Given the relevance of the topic to clinical decision-making, strong conclusive and supporting evidence emanating from the umbrella review is required. To this end, this umbrella review study sought to determine the association between intimate partner violence and obstetrics characteristics of women with preterm birth in Ethiopia.

METHODS

Six systematic review and meta-analysis studies searched across multiple databases were included in this umbrella review. The quality of the included systematic review and meta-analysis studies was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR-2) checklist. STATA version 18 was used for the statistical analysis. A random-effects model was used to calculate the overall effect measurement.

RESULTS

A total of 114 observational studies in the six systematic review and meta-analysis studies involving 75,624 pregnant women were included in this comprehensive analysis. The preterm birth rate among mothers in Ethiopia was 11% (95% CI 10-13%; I2 = 98.08). Preterm birth was significantly associated with intimate partner violence (POR: 2.32; 95% CI 1.74-2.90), multiple pregnancies (POR: 3.36; 95% CI 2.41-4.32), pregnancy-induced hypertension (POR: 4.13; 95% CI 3.17-5.10), anemia (POR: 2.76; 95% CI 1.97-3.56), and premature rupture of pregnancy (POR: 5.1; 95% CI 3.45-6.75).

CONCLUSIONS

More than one out of ten pregnant women experienced preterm birth in Ethiopia. Intimate partner violence is significantly associated with preterm birth. Furthermore, multiple pregnancies, pregnancy-induced hypertension, anemia, and premature rupture of the membrane were significant predictors of preterm birth. Therefore, policymakers should consider further instigations and implementations of policies and strategies closely related to reductions of intimate partner violence. It is also crucial to the early identification and treatment of high-risk pregnancies.

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries

Background

Scientific literature has provided clear evidence of the profound impact of sexual violence on women’s health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia.

Methods

We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview.

Results

Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India.

Conclusions

Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.

The Efficacy of Father Attachment Education on the Severity of Domestic Violence in Primegravida Women

Purpose: In addition to physical and psychological tension imposed on women through pregnancy, the stress of the spouses' violence can cause harmful effects on both the fetus and mother. In Iran, there are limited data on this subject. Thus, learning attachment skills may be effective in reducing adaptation and domestic violence. This study aimed to investigate the efficacy of paternal attachment on the severity of domestic violence in primgravida women.

Methods: This quasi-experiment research was conducted on 150 pregnant women who were eligible and selected through simple convenience sampling. In the intervention group, four 90-minute training sessions were designed on father attachment, while the control group received routine prenatal care. A violence questionnaire was completed both before and after the intervention (36-38 weeks of pregnancy) in both case and control groups. Data analysis was done in SPSS software, using paired t-test and independent t-test.

Results: According to the results of an independent t-test, there was no significant difference in psychological violence, physical violence, and economic violence. However, there was a significant change in social violence, sexual violence, and overall violence score.

Conclusion: Training the fathers on behavior of domestic violence and its skills leads to reduced social and sexual violence. Therefore, it seems necessary to include education for the fathers in prenatal care.

Effect of intimate partner violence on birth outcomes

Background

Violence by intimate partner during pregnancy has many adverse pregnancy outcomes. Thus, that's why we sought to determine association between intimate partner violence during pregnancy and adverse birth outcomes.

Methods

A facility based cross-sectional study was conducted among 183 recently delivered women from March 31–April 30, 2014 in public health facilities of Hossana Town. The data were collected through structured questionnaire and record review. Women who were not mentally and physically capable of being interviewed and those admitted for abortion were excluded. Ethical clearance was obtained from Jimma University. Logistic regression analysis was employed to determine the association between intimate partner violence and adverse birth outcomes.

Results

About 23 % of women experienced intimate partner violence during pregnancy. The result of this study indicated an association of intimate partner violence with low birth weight of the new born (AOR:14.3,95% CI: (5.03, 40.7). Intimate partner violence was not associated with still birth, pre-term birth and Apgar score less than 7 at 5 minutes.

Conclusion

The findings of this study showed that intimate partner violence during pregnancy was associated with a low birth weight of the new born. Health sectors should train health care providers on how to screen, counsel, treat and follow up abused women.

Disclosure of Spousal Violence: Viewpoints From the Jordanian Society

The objectives of this study were to identify reasons behind not disclosing spousal violence and examine relationships between these reasons and women's demographic profile including the experience of spousal violence. Jordanian women ( N = 709) aged 16 to 66 years ( M = 32.6, SD = 8.7) attending health care centers were recruited. Results indicated that women's intentions to maintain the family unit and use of patience with abuser represented the top two reasons for not disclosing violence. Non-significant relationships were, generally, identified between not disclosing spousal violence and women's demographic profile. Women's justification of spousal violence and witnessing parental violence were the proposed reasons for women's lack of disclosure of violence. Implications for this study include health professionals' use of evidence-based knowledge and skills to deal with victims of violence. Researchers' roles include creating physical and emotional environment that urges disclosure of violence. Furthermore, they can contribute with health professionals in the implementation of health education programs directing victims and perpetrators in the places where they can be located. Proper collaboration between health professionals, researchers, and policy makers may significantly limit suffering of victims of violence.

Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome

AIM

This study determined the influence of prematurity on the manifestation and treatment of neonatal abstinence syndrome (NAS).

METHODS

This was a medical record review of Australian infants exposed to opiates in 2004 and 2007. Finnegan scores were obtained for 215 of 361 (59%) preterm infants under 37-week gestation and 694 of 1178 (59%) term infants.

RESULTS

The mean and standard deviation (SD) gestational ages were 34 (3) and 38 (3) weeks for preterm and term infants, respectively. Maternal daily methadone doses were similar for the preterm and term infants with a mean (SD) of 79 mg (39) versus 72 mg (38) (p = 0.06). Maximum Finnegan scores were significantly lower in preterm infants (10 versus 11, p = 0.01), scores were positively correlated with gestation and fewer preterm infants were medicated for NAS (40% versus 48% p = 0.05). Maximum median daily and interquartile range morphine doses were lower for preterm than term infants (0.5 mg/kg/day (0.3-0.6) versus 0.5 mg/kg/day (0.4-0.7), p = 0.02).

CONCLUSION

Preterm infants were just as likely to be monitored for withdrawal as term infants, but their Finnegan scores were lower and fewer preterm infants were treated for NAS. Whether this indicates decreased NAS severity or physiological immaturity is uncertain. Other means of evaluating NAS in preterm infants are warranted, especially long-term outcomes.

Intimate partner violence during pregnancy: maternal and neonatal outcomes

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

Intimate partner violence and the association with very preterm birth

BACKGROUND

Intimate partner violence is a major public health problem. It occurs commonly in pregnancy, resulting in adverse events for women and their fetus or children. The objective of this study was to examine the association between intimate partner violence and very preterm birth.

METHODS

This population-based, case-control study was conducted in Victoria, Australia, from 2002 to 2004. Interviews were conducted with 603 women who had a singleton very preterm birth (20-31 weeks' gestation), 770 women who had a singleton term birth (37 or more completed weeks' gestation), 139 women who had a very preterm twin birth, and 214 women who had a term twin birth. Intimate partner violence was measured using the Composite Abuse Scale, and questions were also asked about fear of partners and violence from others.

RESULTS

Prevalence of intimate partner violence in the past 12 months was 14.9 percent in singleton case women, 11.7 percent in singleton control women, 9.5 percent in twin case women, and 14.7 percent in twin control women. Fear of a previous partner and reporting similar violence experience with someone else were more likely in singleton births (AOR = 1.36; 95% CI 1.03, 1.79) and (AOR = 1.44; 95% CI 1.12, 1.86), respectively. No differences between twin case women and twin control women were observed. When the precipitating cause of very preterm birth was investigated, antepartum hemorrhage was significantly associated with intimate partner violence and all its subscales.

CONCLUSIONS

The heterogeneity of causes of very preterm birth may explain the lack of association found with intimate partner violence in pregnancy. Pregnant women have a significant risk of intimate partner violence, which should be a serious concern for all care providers.

Causes of trauma in pregnant women referred to shabih-khani maternity hospital in kashan

Background

Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus.

Objectives

The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy.

Patients and Methods

This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother’s occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions.

Results

the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases ( 25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively.

Conclusions

Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women.

Impacts of domestic violence on child growth and nutrition: a conceptual review of the pathways of influence

Domestic violence against women is a global problem, and young children are disproportionate witnesses. Children's exposure to domestic violence (CEDV) predicts poorer health and development, but its effects on nutrition and growth are understudied. We propose a conceptual framework for the pathways by which domestic violence against mothers may impair child growth and nutrition, prenatally and during the first 36 months of life. We synthesize literatures from multiple disciplines and critically review the evidence for each pathway. Our review exposes gaps in knowledge and opportunities for research. The framework also identifies interim strategies to mitigate the effects of CEDV on child growth and nutrition. Given the global burden of child malnutrition and its long-term effects on human-capital formation, improving child growth and nutrition may be another reason to prevent domestic violence and its cascading after-effects.

Domestic violence and obesity in Egyptian women

Domestic violence and obesity are global public health problems.This study explores associations of domestic violence and obesity in 5015 ever-married, non-pregnant women aged 15-49 years who took part in the 2005 Egypt Demographic and Health Survey (EDHS). Women's mean body mass index (BMI) was 30.4 kg/m², and 48% were obese. Thirty-seven percent reported any prior psychological, physical or sexual domestic violence.Compared with their counterparts, the adjusted odds of being obese were marginally higher among women who reported any prior sexual (aOR=1.31),physical or sexual (aOR=1.18), or psychological, physical or sexual (aOR=1.17) domestic violence. Women who experienced severe or repeated domestic violence--as measured by reported exposure to three or more acts of physical(aOR=1.25), psychological or physical (aOR=1.18), physical or sexual(aOR=1.36), and psychological, physical or sexual (aOR=1.26) domestic violence--had higher adjusted odds of being obese. Marginally significant adjusted dose-response relationships remained between obesity and the number of specific acts of: (1) physical or sexual violence and (2) psychological, physical or sexual domestic violence. Obesity among women in poorer settings like Egypt may partly have its roots in gender subordination, as manifested in women's exposure to multiple acts of domestic violence.

A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term

BACKGROUND

Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term.

METHODS

A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia.

RESULTS

Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96).

CONCLUSIONS

Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

Demographic risk factors in domestic violence among pregnant women in Uyo, a community in the Niger Delta region, Nigeria

There has been increasing global concern about the level of violence against pregnant women. Anecdotal evidence from general observations shows that there may be higher prevalence in the Niger Delta region of Nigeria. Unfortunately, in spite of the emerging and alarming social indicators for violence against women in the area, little effort has been made to address this dangerous trend. One major concern has been the effects of violence on pregnancy and the difficulty in protecting the pregnant women, since managing violence is often unsuccessful. There is therefore the need to evaluate the magnitude, as well as the risk factors for violence and the sociodemographic characteristics of the women, for purposes of prevention.

Indigenous beliefs and practices that influence the delayed attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa

OBJECTIVE

To explore and describe the indigenous beliefs and practices that influence the attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa

RESEARCH DESIGN AND METHODS

A qualitative design was used to enable participants to share their beliefs and practices in their own words. Purposive sampling was used.

SETTING

Women who were attending antenatal clinics for the first time were targeted. Data were collected via unstructured in-depth interviews. Twelve women were interviewed.

FINDINGS

The findings were grouped into six main categories: pregnancy is a honour; pregnancy needs to be preserved; the unborn infant is protected; the knowledge that clients have; trust in indigenous perinatal practices; and perceptions regarding clinic or hospital services. It became clear that the indigenous beliefs and practices of pregnant women have an influence on their attendance of antenatal clinics. For example, factors such as fear of bewitchment cause delayed attendance of antenatal clinics. Women use herbs to preserve and protect their unborn infants from harm. They also trust the knowledge of traditional birth attendants, and prefer their care and expertise to the harsh treatment that they receive from midwives in hospitals and clinics who look down on their indigenous beliefs and practices.

CONCLUSIONS

It is recommended that indigenous beliefs and practices should be incorporated into the midwifery curriculum, so that the health sector is able to meet the needs of all members of the community.

Partner violence during pregnancy: prevalence, effects, screening, and management

The purpose of this review is to provide an overview of the current state of knowledge regarding the experience of intimate partner violence (IPV) during pregnancy. Pregnancy IPV is a significant problem worldwide, with rates varying significantly by country and maternal risk factors. Pregnancy IPV is associated with adverse newborn outcomes, including low birth weight and preterm birth. Many mechanisms for how IPV may impact birth outcomes have been proposed and include direct health, mental health, and behavioral effects, which all may interact. Screening for IPV during pregnancy is essential, yet due to time constraints and few clear recommendations for assessment, many prenatal providers do not routinely inquire about IPV, or even believe they should. More training is needed to assist health care providers in identifying and managing pregnancy IPV, with additional research needed to inform effective interventions to reduce the rates of pregnancy IPV and resultant outcomes.

Intimate Partner Violence and Posttraumatic Stress Disorder Among High-Risk Women: Does Pregnancy Matter?

Interviews from 655 women participating in the Chicago Women’s Health Risk Study (CWHRS) were used to assess prevalence and factors associated with intimate partner violence (IPV) and posttraumatic stress disorder (PTSD). Black women had the highest rate of IPV overall and among pregnant women, and had decreased odds of PTSD compared to Black nonpregnant women. Hispanic pregnant women, however, had decreased odds of IPV and PTSD compared to Hispanic nonpregnant women. Disparities in IPV by race/ ethnicity and pregnancy status complicate the study of IPV and PTSD and have implications for the public health community.

Short-term outcomes of mothers and newborn infants with comorbid psychiatric disorders and drug dependency

OBJECTIVES

The aim of the present study was to determine the characteristics and short-term outcomes of mother-infant pairs with comorbid drug dependency and psychiatric disorders.

METHODS

A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004.

RESULTS

Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use amphetamines (29% vs 18%, p < 0.05), less likely to use opiates (42% vs 51%, p < 0.05) and to have had no antenatal care (24% vs 8%, p < 0.05). They also had more previous pregnancies (4, range = 2-5 vs 3, range = 2-5, p < 0.05) and domestic violence (29% vs 14%, p < 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p < 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3-8) vs 10 (interquartile range = 7-12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p < 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal.

CONCLUSIONS

Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.

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.

Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation

OBJECTIVES

This study examines alcohol and nonmedical drug use before and during pregnancy and identifies the predictors of use cessation before the first prenatal visit.

METHODS

Data analyses were based on the Prenatal Risk Overview (PRO), a structured interview that screens for psychosocial risk factors associated with poor birth outcomes. The study sample includes 1,492 consecutive prenatal care patients from four urban clinics between November 2005 and June 2007.

RESULTS

Reported alcohol and drug use pre-pregnancy was much higher among U.S.-born women than immigrants, and among unmarried women than married women. American Indians had the highest rates among racial/ethnic groups. Since learning of their pregnancy, 5.6% of patients reported alcohol use and 10.7% reported drug use, reflecting cessation rates of 87.0% for alcohol and 55.6% for drugs. In logistic regression analyses, older age, current smoking, and lack of transportation predicted both alcohol and drug use continuation. Alcohol use continuation was also predicted by pre-pregnancy alcohol use frequency, depression, and physical/sexual abuse by someone other than an intimate partner. Drug use continuation was also predicted by race (higher for American Indians and African Americans), and pre-pregnancy drug use frequency.

CONCLUSIONS

Women who continued to use alcohol or drugs after learning they were pregnant were more frequent users than spontaneous quitters, more likely to smoke cigarettes, and had more psychosocial stressors. Achieving higher rates of cessation may require approaches that simultaneously address substance use and impediments to quitting. Higher continuation rates among some cultural groups require further investigation.

Intimate partner violence (IPV) and preeclampsia among Peruvian women

OBJECTIVE

Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women.

STUDY DESIGN

We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models.

RESULTS

The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5).

CONCLUSIONS

IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.

We don't like to think about it: intimate partner violence during pregnancy and postpartum

Violence directed by an intimate partner toward the pregnant woman and her fetus, or during the first year after delivery, is often either not recognized by professionals or suspected but not addressed. There is no typical abused woman; in fact, intimate partner violence occurs across all social, economic, educational, and professional settings. Physical or sexual abuse may be readily observed in some instances or well hidden at other times; the emotional components of verbal, economic, and isolation abuse are often difficult to assess. All types of intimate partner violence require sensitive assessment and intervention by healthcare professionals, as numerous undesirable outcomes for both the mother and her fetus/baby have been identified. Suggestions for assessment and intervention (primary, secondary, and tertiary) are offered.

Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.

Postpartum women's evaluations of an audio/video computer-assisted perinatal violence screen

For universal screening to become a reality, research must first validate the effectiveness and acceptability of violence screening. This study describes postpartum women's perceptions of an anonymous computer-assisted self-interview for perinatal violence screening. A sample of 519 postpartum women completed interviews that included audio and video enhancements. Post-response evaluations were positive with most women, indicating that they preferred computer interviews to face-to-face or written abuse screening. In addition, participants indicated that the computer format and associated anonymity positively influenced their willingness to answer the violence questions truthfully. Computer interviews offer an alternative approach to violence screening that may help women who are hesitant to disclose abuse directly to their healthcare providers.

Intimate partner violence and the childbearing year: maternal and infant health consequences

Intimate partner violence (IPV) against women is a significant public health problem with negative physical and mental health consequences. Pregnant women are not immune to IPV, and as many as 4% to 8% of all pregnant women are victims of partner violence. Among pregnant women, IPV has been associated with poor physical health outcomes such as increased sexually transmitted diseases, preterm labor, and low-birth-weight infants. This article focuses on the physical health consequences of IPV for mothers and their infants. The purpose of this review is therefore to examine timely research ranging from 2001 to 2006 on IPV during pregnancy, the morbidity and mortality risks for mothers and their infants, and the association between IPV and perinatal health disparities. It will also identify gaps in the published empirical literature and make recommendations for practice, policy, and research.

Intimate partner violence during pregnancy: incidence and associated health behaviors in a rural population

OBJECTIVES

The goal of this investigation was to examine the prevalence of different types of intimate partner violence (IPV) during pregnancy, as well as the association between both physical and psychological IPV and negative health behaviors, including smoking, other substance use, inadequate prenatal care utilization, and nutrition, in a rural sample.

METHODS

104 southern Appalachian women, primarily Caucasian and lower SES, completed a pregnancy interview focused on IPV (CTS2) and health behaviors. Medical records were also reviewed.

RESULTS

81% of participants reported some type of IPV during the current pregnancy, with 28% reporting physical IPV, and 20% reporting sexual violence. More than half were current smokers. Physical IPV during pregnancy was associated with significantly increased rates of pregnancy smoking (including decreased rates of quitting and reducing), increased rates of alcohol, marijuana, and harder illicit drug use around the time of conception, and later entry into prenatal care. The experience of psychological IPV during pregnancy was associated with a significantly decreased likelihood of quitting or reducing smoking during pregnancy, an increased rate of alcohol use around the time of conception, and an increased rate of pre-pregnancy obesity.

CONCLUSIONS

In this sample, pregnancy IPV and smoking occurred at rates well above national averages. Additionally, while physical IPV during pregnancy was associated with several negative pregnancy health behaviors, the experience of psychological IPV, even in the absence of physical IPV, also placed women at increased risk for negative health behaviors, all of which have been linked to poor pregnancy and newborn outcomes.

Abuse disclosure in privately and medicaid-funded pregnant women

Disclosure of abuse by pregnant women can vary depending on whether the woman is assessed directly by a trained interviewer versus written questionnaires, and if she is asked repeatedly during the course of pregnancy. One thousand pregnant women were enrolled in a randomized clinical trial designed to assess the effects of a nursing case management intervention on the mental and physical well-being of pregnant women experiencing or at risk for abuse. Thirteen percent of the total study participants reported current abuse and/or abuse within the past year, with only 2% of those reporting that the abuse occurred during pregnancy. The incidence of reported abuse was much higher among Medicaid-funded women (28.9%) than privately insured women (8.7%). Regardless of source of payment, women reporting abuse were significantly younger, less educated, nonwhite with lower income, and had significantly higher stress and lower self-esteem than women not reporting abuse. A high incidence of women reporting intimate partner violence described being choked on the Danger Assessment Screen (34%). We strongly urge that choking be added to routine screening questions used during pregnancy and that the Danger Assessment tool is used for further evaluation of women who screen positive. In addition, we believe another barrier to reporting abuse was fear of being reported to child protective services, contributing to the overall low rate of abuse disclosure.

Postpartum mothers' disclosure of abuse, role, and conflict

Experts evaluating evidence of the occurrence and effects of abuse before, during, and after pregnancy have called for research on the context within which violence occurs. This study elicited postpartum mothers' perceptions of roles and conflict in their abusive intimate relationships. Thirty newly delivered African-, Anglo-, and Hispanic-American abused mothers consented to be interviewed. While ethnicity, cultural norms, and economic issues framed their descriptions, more than half (57%) described their relationships as not abusive even though they reported experiencing behaviors defined as abuse on standardized abuse screening instruments. Several women found ways to take care of themselves within the abusive relationship. The concerns that these diverse abused postpartum mothers expressed can serve as a foundation for the development of culturally sensitive interventions.

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.

Nausea and vomiting in late pregnancy

Nausea and vomiting in late pregnancy is a little-studied phenomenon. In this study of 116 midwestern women, 32% of the women had nausea and vomiting after 20 weeks gestation. The purpose of this study was to examine demographic, anthropometric, maternal health factors, and pregnancy outcomes in women who had late nausea and vomiting in pregnancy (NVP) and those that did not. Women who experienced late NVP had significantly higher parity, were older, gained less weight in pregnancy, and slept fewer hours per night than women who did not experience late NVP. By being aware of prenatal factors that may affect nausea and vomiting in late pregnancy, health care providers will be better able to maximize the quality of life for these women.

Reducing the risk for preterm birth: evidence and implications for neonatal nurses

The incidence of preterm birth has been slowly rising despite advances in obstetric health care. Neonatal nurses have ongoing contact with women who have had a preterm birth and, thus, who are at high risk to have another preterm birth. This article discusses current evidence about reducing risk for preterm birth. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimal health before conception. Quality prenatal care, as defined by the Institute of Medicine, consists of continuing risk assessment, health promotion, and interventions to modify medical and psychosocial risk. When these 3 components are consistently applied, they may confer some protection against preterm birth. Women at highest risk for preterm birth need to seek prenatal care from an expert in maternal-fetal medicine. Women also need to learn about the common, subtle signs of preterm labor so they can recognize symptoms and quickly seek treatment. Neonatal nurses can provide critical information and anticipatory guidance to women at risk for preterm birth so they can make sound decisions about future pregnancies.