The relationship of police-reported intimate partner violence during pregnancy and maternal and neonatal health outcomes

Thesis (Ph. D.)--University of Washington, 2002Background. Intimate partner violence (IPV) is a significant public health problem of particular concern during pregnancy. Adverse maternal and neonatal health outcomes may be associated with IPV although studies to date have been inconsistent. This study employed a novel approach to identify IPV exposure with the use of police records.Methods. This is a retrospective cohort study of women reporting IPV during pregnancy from 1995 through 1998. Police records and Washington State birth and hospitalization files were linked and police records were abstracted to examine the relationship between IPV and maternal and neonatal outcomes. A new reference for small-for-gestational-age (SGA) infants was also developed. Unconditional logistic regression was used in bivariate and multivariate analyses to calculate odds ratios (OR) and 95% confidence intervals (CI).Results. Women reporting any IPV were significantly more likely than women who did not report IPV to have a low birth weight (LBW) infant (adjusted OR [aOR] 1.70, CI 1.20, 2.40), a very LBW infant (aOR 2.54, CI 1.32, 4.91), a preterm birth (PTB) (aOR 1.61, CI 1.14, 2.28), a very PTB (aOR 2.90, CI 1.38, 6.12), and a neonatal death (aOR 3.18, CI 1.32, 7.63). Women reporting physical IPV also had a significantly greater risk of LBW, very LBW, and very PTB. Neonatal death was associated with both physical and nonphysical IPV. Only very LBW and very PTB were significantly associated with moderate physical IPV. Hospitalization during pregnancy was strongly associated with any IPV (aOR 2.39, CI 1.77, 3.24), particularly with substance abuse and mental health-related diagnoses. Premature rupture of membranes and abruptio placenta were associated with nonphysical IPV and moderate physical IPV.Conclusions. IPV during pregnancy is significantly associated with adverse maternal and neonatal health outcomes. The findings in this study point to the critical need to identify pregnancy and provide health information and referrals to women at the time of an IPV incident and during subsequent contact with community service and domestic violence programs. These findings may also serve to better inform the legal and justice systems of the potential impact of IPV on the health of pregnant women and their offspring