家庭暴力与围产期结局——尼泊尔的一项前瞻性队列研究。
Domestic violence and perinatal outcomes - a prospective cohort study from Nepal.
机构信息
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Kathmandu University School of Medical Sciences, GPO 11008, Kathmandu, Kavre, Dhulikhel, Nepal.
出版信息
BMC Public Health. 2019 May 31;19(1):671. doi: 10.1186/s12889-019-6967-y.
BACKGROUND
Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal.
METHODS
In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations.
RESULTS
Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10-4.73)].
CONCLUSIONS
Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not.
背景
家庭暴力是最常见的针对妇女的暴力形式之一。怀孕期间的家庭暴力与围产期和产妇不良结局有关。我们旨在评估尼泊尔两个地点的家庭暴力是否与分娩方式、低出生体重和早产有关。
方法
在这项前瞻性队列研究中，我们在 2015 年 6 月至 2016 年 9 月期间连续招募了来自两家医院的 2004 名孕妇。使用修改后的虐待评估量表（Abuse Assessment Screen，modified）来评估恐惧和暴力情况。经历过任何恐惧或暴力的情况被定义为任何家庭暴力。从医院记录中获得了 1381 名（69%）妇女的产科结局，仅选择单胎妊娠。分娩方式评估为剖宫产或非剖宫产。出生体重低于 2500 克定义为低出生体重，早产定义为妊娠 37 周前分娩。进行描述性和多逻辑回归分析以评估相关性。
结果
20%的女性报告了任何家庭暴力。在所有 1381 名女性中，37.6%通过剖宫产分娩。在那些行剖宫产的女性中，84.7%的人进行了紧急剖宫产。不到 10%的婴儿早产，13.5%的婴儿出生体重低。我们没有发现怀孕期间任何家庭暴力暴露与低出生体重婴儿或剖宫产风险之间存在显著关联。然而，经历过暴力和恐惧的女性分娩早产儿的风险显著增加[aOR 2.33（95%CI；1.10-4.73）]。
结论
家庭暴力在尼泊尔很常见。这是新生儿严重发病率和死亡率的潜在危险因素。我们发现，经历过恐惧和暴力的孕妇分娩早产儿的风险更高。这一点应该得到卫生部门的重视。在这项研究中，与未经历过任何家庭暴力的女性相比，经历过家庭暴力的女性的剖宫产率和低出生体重率没有显著差异。
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