Research Article: Maternal outcomes associated to psychological and physical intimate partner violence during pregnancy: A cohort study and multivariate analysis

Date Published: June 13, 2019

Publisher: Public Library of Science

Author(s): Stella Martin-de-las-Heras, Casilda Velasco, Juan de Dios Luna-del-Castillo, Khalid S. Khan, Soraya Seedat.


Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0–100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2–3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2–4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95%CI = 1.1–4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0–7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7–12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects.

Partial Text

Violence against women including intimate partner violence (IPV) is a global public health problem and a fundamental human rights breach [1]. Psychological abuse in a current or past intimate relation is increasingly being recognized, over and above physical violence [2,3]. Pregnancy represents a period of particular vulnerability [4], with reported IPV prevalence higher than many common obstetric conditions [5], varying across countries and cultural contexts [4,6–8].

IPV in pregnancy was reported by 21.3% (n = 153) of the women, including physical and/or psychological IPV, with no duplication of cases. Physical IPV was reported by 3.6% (n = 26) and psychological by 21.0% (n = 151). The prevalence of women experiencing both, physical and psychological IPV, during pregnancy was 3.3% (n = 24). A flow diagram of the participants and the socio-demographic characteristics of the sample were shown in Fig 1 and Table 1, respectively. The response rate was 92.2% and the lost data 4.3%.

In this study, psychological IPV, reported by 1 in 5 mothers, was associated with urinary tract infection, vaginal infection and spontaneous preterm labour, and physical IPV, reported by 1 in 27 mothers, was associated with antenatal hospitalizations. As mothers with IPV have higher odds of complications, clinicians should be vigilant about the risk of IPV in pregnancy.

Experience of IPV during pregnancy affects maternal health, with psychological IPV playing a recognisable role. Mothers with IPV are deeply concerned about the risk of harm to the unborn baby. Their desire to find ways out of this predicament is fraught with difficulties and often goes unsupported [41]. Obstetricians, gynaecologists, midwives and other allied health care professionals must act as active screeners to identify IPV, particularly of the undervalued psychological IPV. Early detection of IPV must be followed by proper multidisciplinary input to protect the victims [42].




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