Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case-control study protocol in a tertiary healthcare facility in Lima, Peru

An Equity, Diversity, and Inclusion glossary for sociodemographic determinants of health within critical care medicine

PURPOSE

Equity, Diversity, and Inclusion (EDI) initiatives within critical care research are limited by a lack of resources and inconsistent and rapidly changing language. The Canadian Critical Care Trials Group (CCCTG) is committed to modelling EDI for the critical care community through its programming, communications, protocols, and policies. The objective of developing the EDI glossary of sociodemographic determinants of health described here was to provide a resource for critical care professionals to support broader equity initiatives and to promote education and awareness about inclusive language.

METHODS

Through literature review, we identified EDI-related sociodemographic determinants of health, defined as sociodemographic factors that are associated with disparities in health care and health outcomes, with a focus on critical care medicine. For each sociodemographic determinant of health, we identified umbrella terms (defined as domains) and subterms/constructs that are related to these domains. We designed the glossary collaboratively with the CCCTG EDI working group, patient and family partnerships committee, and executive committee, which included diverse knowledge users such as researchers, clinicians, and patient and family partners.

RESULTS

We report on 12 sociodemographic determinants of health domains including age, sex, gender, sexuality, race and ethnicity, income, education, employment status, marital status, language, disability, and migration status. Each domain (e.g., sex) contains relevant subterms such as male, female, intersex. For each domain, we provide examples of disparities in health care and health outcomes with a focus on critical care medicine.

CONCLUSIONS

This EDI glossary of sociodemographic determinants of health serves as a nonexhaustive resource that may be referenced by critical care researchers, research coordinators, clinicians, and patient and family partners. The glossary is an essential step to raising awareness about inclusive terminology and to fostering and advancing equity in critical care medicine.

Intimate Partner Violence During Pregnancy and Maternal Morbidity in South Ethiopia: A Cohort Study

Purpose

Intimate partner violence during pregnancy is a universal public health problem. However, its link with maternal morbidity is not well understood in Ethiopia. Thus, the study assessed its effect on maternal morbidity during delivery and postpartum in South Ethiopia.

Methods

A prospective cohort study was conducted among 1535 pregnant women. Pregnant women with intimate partner violence during pregnancy were enrolled as the "exposed group", and pregnant women without intimate partner violence were registered as the "unexposed group". A total of 711 exposed and 774 unexposed women were included in the analysis of this study. Data were collected using an interviewer-administered questionnaire. Data entry and analysis were done in STATA Version 14. A generalized linear model with a log link function using the binreg command was applied to examine the effect of intimate partner violence on maternal morbidity.

Results

The level of maternal morbidity during delivery and postpartum was higher among women with intimate partner violence than women without intimate partner violence (34.0% vs 26.6%). After adjusting for confounders, women with intimate partner violence during pregnancy were more likely to experience maternal morbidity than women without intimate partner violence (aRR=4.45; 95% CI: 3.15, 6.28). Psychological violence was also identified as a risk factor for maternal morbidity (aRR=2.17; 95% CI: 1.76, 2.67). Likewise, women with physical violence were more likely to experience maternal morbidity than those without physical violence (aRR=1.31; 95% CI: 1.12, 1.53).

Conclusion

The current study demonstrated a higher level of maternal morbidity among women with intimate partner violence. Psychological violence, physical violence, and intimate partner violence during pregnancy were found to increase the risk of maternal morbidity. Strengthening the prevention and prompt management of intimate partner violence during pregnancy may significantly reduce the incidence of maternal morbidity.

Intimate partner violence and severe acute maternal morbidity in the intensive care unit: A case-control study in Peru

BACKGROUND

Intimate partner violence is a prevalent public health issue associated with all-cause maternal mortality. This study investigated the relationship between intimate partner violence, severe acute maternal morbidity in the intensive care unit (ICU), and neonatal outcomes.

METHODS

This was a prospective case-control study in a hospital in Lima, Peru, with 109 cases (maternal ICU admissions) and 109 controls (obstetric patients not admitted to the ICU). Data were collected through face-to-face interviews and medical record review. Partner violence was assessed using the World Health Organization instrument. Multivariate logistic regression was used to model the association between intimate partner violence and severe acute maternal morbidity.

RESULTS

There was a significantly higher rate of intimate partner violence both before and during pregnancy among cases (58.7%) than controls (27.5%). In multivariate analysis, intimate partner violence both before and during pregnancy (aOR 3.83 (95% CI: 1.99-7.37)), being married (3.86 (1.27-11.73)), having <8 antenatal care visits (2.78 (1.14-6.80)), and having previous abortions (miscarriage, therapeutic, or unsafe) (1.69 (1.13-2.51)) were significantly associated with severe acute maternal morbidity. The ICU admission rate was 18.8 (per 1000 live births), and ICU maternal mortality was 1.7%. The perinatal mortality rate was higher in cases (9.3%) than in controls (1.8%).

CONCLUSIONS

Intimate partner violence was associated with an increased risk of severe acute maternal morbidity. This suggests a more severe impact of intimate partner violence on pregnancy than has been previously identified. Inquiring about intimate partner violence during prenatal visits may prevent further harm to the mother-baby dyad.