一项减少孕期亲密伴侣暴力的综合干预措施：一项随机对照试验。
An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial.
机构信息
From the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska; and RTI International, Rockville, Maryland.
出版信息
Obstet Gynecol. 2010 Feb;115(2 Pt 1):273-283. doi: 10.1097/AOG.0b013e3181cbd482.
OBJECTIVE
To estimate the efficacy of a psycho-behavioral intervention in reducing intimate partner violence recurrence during pregnancy and postpartum and in improving birth outcomes in African-American women.
METHODS
We conducted a randomized controlled trial for which 1,044 women were recruited. Women were randomly assigned to receive either intervention (n=521) or usual care (n=523). Individually tailored counseling sessions were adapted from evidence-based interventions for intimate partner violence and other risks. Logistic regression was used to model intimate partner violence victimization recurrence and to predict minor, severe, physical, and sexual intimate partner violence.
RESULTS
Women randomly assigned to the intervention group were less likely to have recurrent episodes of intimate partner violence victimization (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.29-0.80). Women with minor intimate partner violence were significantly less likely to experience further episodes during pregnancy (OR 0.48, 95% CI 0.26-0.86, OR 0.53, 95% CI 0.28-0.99) and postpartum (OR 0.56, 95% CI 0.34-0.93). Numbers needed to treat were 17, 12, and 22, respectively, as compared with the usual care group. Women with severe intimate partner violence showed significantly reduced episodes postpartum (OR 0.39, 95% CI 0.18-0.82); the number needed to treat was 27. Women who experienced physical intimate partner violence showed significant reduction at the first follow-up (OR 0.49, 95% CI 0.27-0.91) and postpartum (OR 0.47, 95% CI 0.27-0.82); the numbers needed to treat were 18 and 20, respectively. Women in the intervention group had significantly fewer very preterm neonates (1.5% intervention group, 6.6% usual care group; P=.03) and an increased mean gestational age (38.2+/-3.3 intervention group, 36.9+/-5.9 usual care group; P=.016).
CONCLUSION
A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes. Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00381823.
LEVEL OF EVIDENCE
I.
目的
评估心理行为干预在减少非裔美国孕妇妊娠和产后期间亲密伴侣暴力复发以及改善分娩结局方面的效果。
方法
我们进行了一项随机对照试验，共招募了 1044 名女性。女性被随机分配接受干预（n=521）或常规护理（n=523）。个体化量身定制的咨询课程改编自针对亲密伴侣暴力和其他风险的循证干预措施。逻辑回归用于对亲密伴侣暴力受害复发进行建模，并预测轻度、重度、身体和性亲密伴侣暴力。
结果
随机分配到干预组的女性发生亲密伴侣暴力受害复发的可能性较低（比值比[OR]0.48，95%置信区间[CI]0.29-0.80）。轻度亲密伴侣暴力的女性在妊娠期间（OR0.48，95%CI0.26-0.86，OR0.53，95%CI0.28-0.99）和产后（OR0.56，95%CI0.34-0.93）进一步发作的可能性显著降低。与常规护理组相比，分别需要治疗 17、12 和 22 名女性。经历重度亲密伴侣暴力的女性在产后发作显著减少（OR0.39，95%CI0.18-0.82）；需要治疗的人数为 27。经历身体亲密伴侣暴力的女性在第一次随访时（OR0.49，95%CI0.27-0.91）和产后（OR0.47，95%CI0.27-0.82）均有显著减少；需要治疗的人数分别为 18 和 20。干预组的极早产儿（1.5%干预组，6.6%常规护理组；P=.03）和平均孕龄（38.2+/-3.3 干预组，36.9+/-5.9 常规护理组；P=.016）显著增加。
结论
妊娠期间相对短暂的干预对亲密伴侣暴力和妊娠结局有明显影响。强烈建议对亲密伴侣暴力以及其他心理社会和行为风险进行筛查，并将类似的干预措施纳入产前护理。
临床试验注册
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00381823。
证据水平
I。
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