Department of Gynecology and Obstetrics, University Hospital Zurich, Zurich, Switzerland.
J Psychosom Res. 2010 Nov;69(5):503-10. doi: 10.1016/j.jpsychores.2010.04.017. Epub 2010 Jun 11.
Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA.
The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation.
Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59).
Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.
儿童期性虐待（CSA）的估计患病率为 20%，并且对身心健康的长期影响不断增加，这也可能影响到与之相关的产科护理。然而，关于 CSA 与怀孕之间关联的科学数据却很少。因此，本研究调查了遭受 CSA 的女性的妊娠并发症。
本研究设计为队列研究，比较了 85 名遭受 CSA 的女性和 170 名匹配的未暴露女性。通过使用 Wyatt [Child Abuse Negl 9 (1985) 507-519]修改后的问题进行访谈来识别 CSA。通过问卷调查和在小册子（Mutterpass）中收集有关妊娠并发症的数据，小册子中记录了每位在德国接受产前护理的女性每次产前咨询的所有相关妊娠数据。采用卡方检验、Fisher 精确检验和多因素逻辑回归分析来控制 CSA 与妊娠并发症之间的关联，对于单因素分析中具有显著意义的混杂因素，如身体虐待、儿童期其他不良经历、妊娠期间虐待、物质滥用和职业进行控制。
遭受 CSA 的女性在妊娠期间住院的比例明显更高（41.2%/19.4%；OR 2.91，95%CI 1.64-5.17）。她们更常出现早产宫缩（38.8%/20%；OR 2.54，95%CI 1.43-4.51）、宫颈机能不全（25.9%/9.4%；OR 3.36，95%CI 1.65-6.82）和早产（18.8%/8.2%；OR 2.58，95%CI 1.19-5.59）等并发症。
因此，医疗保健提供者应根据遭受 CSA 的女性的特定需求调整产前护理。
