Centre for Research on Inner City Health, St Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
BMC Pregnancy Childbirth. 2011 Jun 7;11:42. doi: 10.1186/1471-2393-11-42.
Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence against pregnant women were associated with preterm birth, small for gestational age and postpartum depression in a nationally representative sample of Canadian women.
We analysed data of the Maternity Experiences Survey, a nationally representative survey of Canadian women giving birth in 2006. The comprehensive questionnaire included a 19-item section to collect information on different dimensions of abuse and violence, such as type, frequency, timing and perpetrator of violence. The survey design is a stratified simple random sample from the 2006 Canadian Census sampling frame. Participants were 6,421 biological mothers (78% response rate) 15 years and older who gave birth to a singleton live birth and lived with their infant at the time of the survey. Logistic regression was used to compute Odds Ratios. Survey weights were used to obtain point estimates and 95% confidence intervals were obtained with the jacknife method of variance estimation. Covariate control was informed by use of directed acyclic graphs.
No statistically significant associations were found for preterm birth or small for gestational age, after adjustment. Most dimensions of violence were associated with postpartum depression, particularly the combination of threats and physical violence starting before and continuing during pregnancy (Adjusted Odds Ratio = 4.1, 95% confidence interval: 1.9, 8.9) and perpetrated by the partner (4.3: 2.1, 8.7).
Our findings provide weak evidence of an association between experiences of abuse before and during pregnancy and preterm birth and small for gestational age but they indicate that several dimensions of abuse and violence are consistently associated with postpartum depression.
虐待和暴力侵害妇女行为是一个全球性公共卫生问题，尤其在育龄妇女中更为严重。关于暴力侵害孕妇对早产、小于胎龄儿和产后抑郁等不良妊娠结局的影响，文献结论并不一致。大多数研究都是针对高危孕妇的相对较小样本进行的。我们的目的是在加拿大具有全国代表性的孕妇样本中，调查哪些维度的孕妇暴力与早产、小于胎龄儿和产后抑郁相关。
我们分析了 2006 年加拿大全国孕妇生育经历调查的数据。该全面问卷包括 19 个项目，用于收集不同维度的虐待和暴力信息，如暴力的类型、频率、时间和施害者。该调查设计是从 2006 年加拿大人口普查抽样框架中进行分层简单随机抽样。参与者为 6421 名生物学母亲（78%的回复率），年龄在 15 岁及以上，她们生下了一个单胎活产儿，并在调查时与婴儿同住。使用逻辑回归计算优势比。使用调查权重获得点估计，使用方差估计的 Jackknife 方法获得 95%置信区间。协变量控制是通过使用有向无环图来实现的。
调整后，没有发现与早产或小于胎龄儿相关的统计学显著关联。大多数暴力维度与产后抑郁相关，特别是在怀孕前和怀孕期间开始并持续的威胁和身体暴力（调整后的优势比=4.1，95%置信区间：1.9，8.9），并且由伴侣实施（4.3：2.1，8.7）。
我们的研究结果提供了孕妇在怀孕前和怀孕期间经历的虐待与早产和小于胎龄儿之间存在关联的微弱证据，但表明几个维度的虐待和暴力与产后抑郁一致相关。
