Reports to police of abuse during pregnancy signal risk of adverse outcomes.

Pregnant women who call the police to report that their partner has physically abused them are at increased risk of a number of adverse birth outcomes.(1) In a population-based study of women who gave birth in Washington State in 1995-1998, the odds of having a low-birth-weight or very low birth weight infant, a preterm or very preterm birth, or an infant who died soon after delivery were significantly elevated among those who reported partner violence during pregnancy. Abused women were of lower socioeconomic status and had poorer obstetric histories than their nonabused peers, but the analyses controlled for these disparities and therefore indicate that these factors alone did not explain the differences in outcomes.

Using data from the Seattle Police Department and statewide birth and fetal death registries, the researchers examined the experiences of women aged 16-49 who had a singleton live birth or a fetal death during the study period. The analyses included 389 women who reported at least one incident of partner violence to the police during pregnancy and 3,090 women, matched by age, race and ethnicity to this group, with no such reports. Six birth outcomes were studied: low birth weight (less than 2,500 g), very low birth weight (less than 1,500 g), preterm birth (20-36 weeks' gestation), very preterm birth (20-31 weeks' gestation), fetal death at 20 or more weeks and neonatal death (before hospital discharge or, for infants delivered in a non-hospital setting, before completion of the birth certificate).

Abused and nonabused women had significantly different demographic and risk-related profiles. The proportions of women who had a high school education or less, received public health benefits, and had subsidized or no insurance were higher among those reporting violence than among others; the proportion who were married was lower among women who had been abused. Smoking and drinking during pregnancy were more prevalent among those reporting abuse than among nonabused women, as was receipt of inadequate prenatal care. Four in l0 abused women had never given birth before, compared with hall of nonabused women. One-third of abused women had had an induced abortion, and one-quarter had had a spontaneous abortion; these proportions were all lower among those who were not abused. Likewise, the proportion who had experienced a fetal death, while small in both groups, was lower among nonabused than among abused women.

Findings from unconditional logistic regression analysis controlling for women's background characteristics showed that every study outcome except fetal death was independently associated with partner violence. Compared with women reporting no partner violence, those reporting any had nearly twice the odds of having a low-birth-weight baby or preterm delivery (odds ratios, 1.7 and 1.6, respectively), more than twice the odds of bearing a very low birth weight infant (2.5) and more than three times the odds of having a baby who was very preterm or who died a short time after birth (3.7 and 3.5).

In addition to studying the overall cohort, the researchers looked separately at outcomes among women who experienced physical and nonphysical (i.e., psychological or emotional) partner abuse. Results for the 72% of women who were physically abused were similar to those for the whole cohort; for women reporting other kinds of abuse, however, most associations were not significant at the multivariate level.

Although the researchers acknowledge that the generalizability of police data is limited, they point out that such data are valuable in establishing that partner violence occurred while a woman was pregnant. They conclude that "when pregnant women are identified at the time of a reported incident, they should be provided health information and referrals to social, health, and crisis intervention services ... because partner violence may be a strong marker for high-risk pregnancy." At the same time, the analysts urge health care providers to screen women for partner violence throughout pregnancy and the postpartum period.

REFERENCE

(1.) Lipsky S et al., Impact of police-reported intimate partner violence during pregnancy on birth outcomes, Obstetrics & Gynecology, 2003, 102(3):557-564.