Studies have found that one in six pregnant women have been abused by a partner,beaten, stabbed, shot, or even murdered.
Pregnancy when coupled with domestic violence is a form of intimate partner violence (IPV) where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effects for both the mother and fetus.
Effects of domestic assault and abuse have on pregnancy and birth.
Domestic violence during pregnancy is categorized as abusive behavior towards a pregnant woman, where the pattern of abuse can often change in terms of severity and frequency of violence. Abuse may be a long-standing problem in a relationship that continues after a woman becomes pregnant or it may commence in pregnancy.
Although female-to-male partner violence occurs in these settings, the overwhelming form of domestic violence is perpetrated by men against women.Pregnancy provides a unique opportunity for healthcare workers to screen women for domestic violence though a recent review found that the best way in which to do this is unclear.
Reducing domestic violence in pregnancy should improve outcomes for mothers and babies though more good quality studies are needed to work out effective ways of screening pregnant women.
New research shows the risks to these women may be especially profound.Pregnant women are twice as likely to be a victim of an assault-related trauma (including suicide),and die from their injuries,than an accident-related trauma like car accidents or falls, compared to women who are not pregnant, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania.
The findings come from a Pennsylvania statewide analysis of hospital trauma cases occurring over a decade, and will be presented Sunday at the American Congress of Obstetricians & Gynecologists’ (ACOG) Annual Clinical and Scientific Meeting in San Diego.
“Trauma from assaults or accidents complicates 1 in 12 pregnancies and is the leading non-obstetric cause of death among pregnant women. Not only is it associated with complications for the baby, but management of traumatic injuries in pregnant patients has its unique challenges, given the physiologic changes of pregnancy and restrictions doctors may face when treating pregnant patients,” said the study’s lead author Neha Deshpande, MD, a clinical resident of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania.
The team focused on admissions from 2005 through 2015 and included nearly 45,000 cases of trauma among victims, who were defined as women of childbearing age (14-49).
The results indicated that pregnant trauma victims, on average, suffered less severe injuries than their non-pregnant counterparts.
However, despite less severe injuries, pregnant women were nearly twice as likely to be dead when they arrived at the hospital or die in the hospital.In particular, assault-related trauma was about three times deadlier than accident-related trauma.
In addition, after suffering a violent assault, pregnant women were 4.4 times likelier to be transferred to another facility for obstetric services and support.
“Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.”
“Since the typical definition of maternal deaths includes only those directly caused or impacted by pregnancy, it does not include accidental or incidental causes of death, making it difficult to accurately gauge the burden of trauma-related deaths on maternal mortality,” said senior author Corrina M. Oxford, an assistant professor of Clinical Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania.
“However, evidence presented in our study suggests this is a pervasive issue that requires further attention to ensure these women, and their babies, are being properly cared for.”
Results also showed that nearly 1 in 5 pregnant women reported a psychiatric illness or arrived at the hospital following a suicide attempt. Minority and uninsured women were also significantly more likely to experience assault.
The findings are scheduled to be presented at the American Congress of Obstetricians & Gynecologists’ (ACOG) annual clinical and scientific meeting in San Diego on Sunday.
There are many dangerous effects that violence during pregnancy can cause for both the mother and child. A violent pregnancy is considered high risk because verbal, emotional, and physical abuse all lead to adverse health consequences for both the mother and fetus.
Violence during pregnancy has been associated with miscarriage, late parental care, stillbirth,preterm birth,fetal injury ,including bruising, broken and fractured bones, stab wounds and low birth weight.
Violence during pregnancy also leads to additional risks for the mother such as increased mental health problems,suicide attempts, worsening of chronic illness, injury, substance abuse,anxiety, stress, chronic pain, and gynecological problems.
Women battered during pregnancy were more frequently and severely beaten throughout the course of their relationship compared to women who were not abused during pregnancy. Intimate partner violence also accounts for a large portion of maternal mortality.
Homicide is the second leading cause of injury related deaths in pregnant and post-partum women in the United States and a study conducted in hospital in India found that 16% of all deaths during pregnancy were a result of partner violence.
Studies have also found a correlation between domestic violence and increased use of abortion.Pregnant abused women are less likely to report abuse or leave their abuser because of added financial and housing security concerns.
The authors say the findings point to an opportunity for intervention to safeguard pregnant women, and they recommend universal screening of pregnant women at obstetric clinics for assault and mental illness, similar to screenings for postpartum depression.
