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Associations Between Intimate Partner Abuse and Reproductive Outcomes Among Women of African Descent
African-Caribbean & African- American Women’s Study
Desiree Bertrand, MSN, RNDoris Campbell, PhD, ARNP, FAANAshley Chappell, BS, RN
Jamila Stockman, PhD Phyllis Sharps, PhD, RN, FAAN Jacquelyn Campbell, PhD, RN, FAAN
Mary T. Paterno, PhD(c), MSN, CNM
Acknowledgements
This research supported by a subcontract with the Caribbean Exploratory NIMHD Research Center of Excellence (CERC), University of the Virgin Islands, Grant # P20MD002286, National Institutes of Health
ACAAWS Team MembersUnited StatesJacquelyn Campbell, PhD, RN, FAANPhyllis Sharps PhD, RN, FAANRichelle Bolyard, MHSJamila Stockman, PhD, MPHMarguerite B. Lucea, PhD, MSN, MPH, RNBushra Sabri, PhD, LMSW, ACSWAkosoa McFadgion, MS, MSW, PhD studentKaitlan Gibbons, PsyD(c) Mary Paterno, MSN, CNM, RN, PhD (c)Sharon O’Brien, PhDSachi Mana-ay, BSN studentJessica Draughon, MSN, RN, PhD (c)Charmayne M. Dunlop-Thomas, MSCallie Simkoff, BSN, RNGyasi Moscou-Jackson, MHS, BSN, RNChris KunselmanAyanna Johnson, MPHAshley Chappell, BSN, RNLucine Francis, BSN, RNNaa Ayele Amponsah, MPHHossein Yarandi, PhD
US Virgin IslandsDoris Campbell, PhD, ARNP, FAANGloria Callwood, PhD, RN, FAANDesiree Bertrand, MSN, RNLorna Sutton, MPATyra DeCastroAlexandria Bradley, RNSally Browne, RNEdris Evans, RNYvonne Francis, RNNaomi Joseph, BSN studentJennifer King, RNSuzette Lettsome, MSPHN, RNJulie Matthew, RNKenice Pemberton, ASN studentJ'Nique Smith, BSN studentJaslene Williams, MSW
IntroductionIntimate partner abuse
- increased risk for:Adverse neonatal
outcomesAdverse maternal
outcomesSexually transmitted
infections (STI)
(Coker, 2007; Sarkar, 2008; Seth et al., 2010; Sharps et al., 2007; Shah & Shah, 2010; Silverman et al., 2006; Wu et al., 2003)
African heritage – increased risk for:Adverse neonatal
outcomesAdverse maternal
outcomesSexually transmitted
infections
(CDC, 2010, 2011; Curry et al., 1998; Hogue & Silver, 2011; Martin et al., 2011; McFarlane et al., 1996)
Study Purpose
Examine differences in maternal and neonatal reproductive outcomes comparing women with history of intimate partner abuse (IPA) to never-abused women
MethodsComparative case-control study (randomly
selected controls)Study period 2009-2011
Eligibility criteriaWomen aged 18-55 yearsSelf-identify as Afro Caribbean or African
AmericanReport intimate partner in the past two years
Women recruited from primary care, prenatal or family planning clinics
Questionnaire administered on a touch screen computer with optional headphones
Medical record abstraction for health outcomes
CASES = Intimate Partner Abuse (IPA) Intimate Partner Violence (IPV - physical/sexual abuse) & psychological
abuse (threats/emotional abuse/controlling behavior ) IPV assessed using the Abuse Assessment Screen (AAS, McFarlane & Helton -
www.nnvawi.org) Pushed, slapped, hit, kicked, or physically hurt &/OR Forced sex
Psychological abuse: <19 on WEB (Women’s Experiences of Battering – Hall-Smith) Controlled, in fear of current/former intimate partner
Any of the above by current or former intimate partner
Past 2 Year and Lifetime IPV (Physical/Sexual)—subgroups within cases Exclusive of emotional/controlling abuse Reported as Lifetime and Past-two-year
CONTROLS = Women never abused by anyone in their lifetime
Not eligible (if meeting age, race, and language requirements) Women experiencing abuse only from someone other than an intimate partner or ex-partner. Women reporting no partner within 2 years prior to survey
Study Definitions
Final Participants
1579 screened from both sites
n=486 n=1059
169controls
159cases
189 controls
n=553
n=461 n=963
384cases
US Virgin IslandsBaltimore City, MD
n=348
34 ineligible race; duplicates
No partner past 2 yrs= 96
No partner past 2 yrs= 25
Didn’t meet case /control criteria = 70
Didn’t meet case /control criteria= 39
Non-selected control =329
Non-selected control = 74
Screened as case; no full survey=11
Lifetime IPA
Total 621/1545=40%B’more 179/488=37%USVI 442/1059=42%
Past 2-year IPV
Total 382/1424= 27%B’more 119/461= 26%USVI 263/963= 26%
1315 fully eligible women
Sub-Sample PopulationBaltimore City, MD US Virgin
Islands
Pregnant at Survey42
cases
64 control
s
98 cases
54 control
sn=258
28 cases
49 control
s
16 cases
8 control
s
Medical Record
Abstractionn=101
Final Participants169
controls159
cases189
controls
n=553
384cases
n=348
VariablesDependent Variables
Pregnancy outcomesMaternal antenatal outcomesMaternal infectionsMaternal behaviorsNeonatal outcomes
Independent VariableLifetime experience of IPA
Analysis
Descriptive analysisChi-square , Fisher’s exact, and t-tests
Regression analysisGeneralized linear modelAIC valuesMediation test
Table 1. Demographic Characteristics of Sub-Sample, n(%)Overall(n=101)
Cases(n=44)
Controls(n=57)
P-value†
Age, years < 20 20-24 25-29 30+
23 (22.8)42 (41.6)21 (20.8)15 (14.8)
10 (22.7)21 (47.7)8 (18.2)5 (11.4)
13 (22.8)21 (36.8)13 (22.8)10 (17.4)
0.66
Education Level < High School High School Some College Completed College
34 (34.4)41 (41.4)13 (13.1)11 (11.1)
12 (27.3)21 (47.7)8 (18.2)3 (6.8)
22 (40)20 (36.4)5 (9.1)8 (14.5)
0.19
Marital Status Single Partnered Married Other
49 (48.5)37 (36.6)12 (11.9)
3 (3)
24 (54.5)12 (27.3)5 (11.4)3 (6.8)
25 (43.9)25 (43.9)7 (12.2)
0
0.10
Income, monthly < $400 $400-$1200 ≥ $1201
42 (43.3)41 (42.3)14 (14.4)
19 (43.2)19 (43.2)6 (13.6)
23 (43.4)22 (41.5)8 (15.1)
0.98
Health Insurance 86 (85) 35 (79.6) 51 (89.5) 0.16
Employed 33 (32.7) 17 (38.6) 16 (28.1) 0.26
† Chi-square or Fisher’s exact test
41 (93.2%)
21
Figure 1. Cases (n=44)
Live BirthMiscarriageFetal Demise
53 (93%)
3 1
Figure 2. Controls (n=57)
Pregnancy Outcomes
Gesta
tiona
l Dia
bete
s
Diabe
tes M
elitu
s
Gesta
tiona
l HTN
Chron
ic H
TN
Pre-
ecla
mps
ia*
PROM
PPRO
M
Plac
enta
l Abr
uptio
n
Pre-
term
Lab
or02468
1012
CasesControls
Figure 3. Maternal Antenatal Outcomes (%)
HTN = hypertensionPROM = premature rupture of membranesPPROM = pre-term premature rupture of membranes
p <0.05
Chyla
mdi
a
Gonor
rhea
HPV
Genita
l Her
pes
Syph
ilis
Tricho
mon
iasis
Any S
TI
Bacte
rial V
agin
osis
Abnor
mal
Pap
Sm
ear
Yeas
tUTI
Smok
ing
Hx
Positiv
e Urin
e To
x05
101520253035
CasesControls
Figure 4. Maternal Infection and Behavioral Outcomes (%)
Table 2. Neonatal Outcomes, n(%)
Overall(n=101)
Cases(n=44)
Controls
(n=57)
P-value†
Gestation at Delivery < 32 32-36 37+
2 (2.1)11 (11.6)82 (86.3)
1 (2.4)5 (12.2)
35 (85.4)
1 (1.9)6 (11.1)
47 (87.0)
1.0
Pre-Term Birth 13 (13.7) 6 (14.6) 7 (13.0) 0.81
Birth Weight in grams (mean, SD)
3075 (610)
3028 (562)
3112 (646)
0.51
Low Birth Weight 12 (13) 5 (12.5) 7 (13.5) 0.74
Very Low Birth Weight
2 (2.2) 1 (2.5) 1 (1.9) 0.72
Small Gestational Age
9 (9.7) 6 (15) 3 (5.7) 0.11
NICU Admission 7 (7.3) 5 (11.9) 3 (3.7) 0.13† Chi-square ,Fisher’s exact test, or t-test; SD=standard deviation
Table 3. Odds Ratio for Select Outcomes, Baltimore cases vs. controls (n=74)
Variable Odds Ratio(95% CI)
Adjusted Odds Rati0*
(95% CI)
Small for Gestational Age
6.3 (1.2-33.8) 7.5 (1.2-46.6)
Smoking 3.4 (1.2-9.6) 3.2 (1.1-9.2)
NICU Admission 5.1 (0.9-28.5) 4.0 (0.66-24.4)† Adjusted for education, martial status, and income
DiscussionNo significant difference found for most
variables
IPA associated with higher smoking and SGA infants
SGA may result in serious neonatal complications
Nurses should focus on smoking reduction among women of childbearing age experiencing IPA
Intervention research studies should test approaches to smoking cessation for women with IPA
Limitations
Small sample sizeUnable to differentiate based on type/timing
of abuseHomogenous populationLimited to participants who gave permission
for medical record review
Strengths
ACASI technologyIncluded participants from USVILongitudinal dataIncluded SGA as an outcome
References Centers for Disease Control and Prevention. (2011). HIV
surveillance report, 2009. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/
Centers for Disease Control and Prevention. (2010). Sexually transmitted disease surveillance 2009. Retrieved from http://www.cdc.gov/std/stats
Coker, A. L. (2007). Does physical intimate partner violence affect sexual health?: A systematic literature review. Trauma, Violence, & Abuse, 8, 149-177. doi:10.1177/1524838007301162
Curry, M. A., Perrin, N., & Wall, E. (1998). Effects of abuse on maternal complications and birth weight in adult and adolescent women. Obstetrics & Gynecology, 92, 530-534.
Hogue, C. J. R., & Silver, R. M. (2011). Racial and ethnic disparities in United States: Stillbirth rates: Trends, risk factors, and research needs. Seminars in Perinatology, 35, 221-233. doi:10.1053/j.semperi.2011.02.019
MacFarlane, J., Parker, B., & Soeken, K. (1996). Abuse during pregnancy: Associations with maternal health and infant birth weight. Nursing Research, 45(1), 37-42.
ReferencesMartin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J.
K., Kirmeyer, S., Mathews, T. J., … Wilson, E. C. (2011). Births: Final data for 2009. National Vital Statistics Reports, 60(1), 1-72.
Parker, B., & McFarlane, J. (1991). Identifying and helping battered pregnant women. MCN. The American Journal of Maternal Child Nursing, 16(3), 161-164.
Sarkar, N. N. (2008). The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. Journal of Obstetrics and Gynaecology, 28(3), 266-271.
Seth, P., Raiford, J. L., Robinson, L. S., Wingood, G. M., & DiClemente, R. J. (2010). Intimate partner violence and other partner-related factors: Correlates of sexually transmissible infections and risky sexual behaviors among young adult African American women. Sexual Health, 7, 25-30. doi:10.1071/SH08075
Shah, P. S., & Shah, J. (2010). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analyses. Journal of Women’s Health, 19(11), 2017-2031. doi:10.1089=jwh.2010.2051
ReferencesSharps, P. W., Laughon, K., & Giangrande, S. K. (2007).
Intimate partner violence and the childbearing year. Trauma, Violence & Abuse, 8(2), 105-116. doi:0.1177/1524838007302594
Silverman, J. G., Decker, M. R., Reed, E., & Raj, A. (2006). Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: Associations with maternal and neonatal health. American Journal of Obstetrics & Gynecology, 195, 140-148. doi:10.1016/j.ajog.2005.12.052
Smith, P. H., Earp, J., & DeVellis, R. (1995). Measuring battering: Development of the women’s experience with battering (WEB) scale. Women’s Health: Research on Gender, Behavior, and Policy, 1(4), 273-288.
Wu, E., El-Bassel, N., Witte, S. S., Gilbert, L., & Chang, M. (2003). Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS and Behavior, 7(3), 291-301. doi:1090-7165/03/0900-0291/0