Pregnancy outcomes and health care use: effects of abuse

Our purpose was to determine whether pregnancy and neonatal outcomes differed between abused and nonabused women.

Women (N=1014) who completed an abuse questionnaire during pregnancy were followed up after delivery. The 242 women reporting past abuse and the 59 women reporting abuse in pregnancy were grouped in terms of recency and severity of domestic abuse, and their pregnancy and birth outcomes were compared with those of nonabused women with the chi-square test, analysis of variance, and multivariate logistic regression techniques.

Abused women smoked more cigarettes (p<0.0001) and took more prescription drugs (p<0.03) and antidepressants (p>0.05) than nonabused women; they were more likely to have epilepsy (p=0.0002) and asthma (p=0.0018), and also they used social work services more often (p>0.0001). Obstetric histories revealed a higher incidence of miscarriage (p=0.0014), two or more pregnancy terminations (p>0.0001), and neonatal death (p=0.0503) among the abused group. Although abused women delivered infants whose mean birth weight was 132 gm lower than that of nonabused women, the difference was not significant after adjustments were made. Mildly and moderately abused women were admitted to the hospital more frequently during pregnancy (p=0.0067).

Domestic abuse adds significantly to the cost of health care during pregnancy and is associated with poor maternal and fetal outcomes.