University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
Institut national de santé publique du Québec, Montreal, Quebec, Canada.
J Interpers Violence. 2022 Jul;37(13-14):NP11135. doi: 10.1177/0886260520985496. Epub 2021 Feb 3.
Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23-1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19-1.71), stillbirth (RR 1.83, 95% CI 1.27-2.63), preterm birth (RR 1.70, 95% CI 1.54-1.87), and low birthweight (RR 1.78, 95% CI 1.58-2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.
暴力导致严重受伤的孕妇的妊娠结局受到的关注有限。我们研究了妊娠前和妊娠期间遭受攻击与分娩时母婴结局的关系。我们对加拿大魁北克省 1989 年至 2016 年间 2193711 例分娩进行了回顾性队列研究。我们确定了因身体攻击、性攻击和有记录的亲密伴侣暴力而在妊娠前和妊娠期间住院的妇女。我们检查了分娩时的不良结局，包括子痫前期、胎盘早剥、产前出血、死产、早产、低出生体重和其他疾病。在对数二项式回归模型中，我们估计了暴力住院与不良分娩结局之间的关联的风险比（RR）和 95%置信区间（CI），并调整了潜在混杂因素。与无暴露相比，妊娠前或妊娠期间的暴力与胎盘早剥（RR 1.49，95%CI 1.23-1.82）、产前出血（RR 1.43，95%CI 1.19-1.71）、死产（RR 1.83，95%CI 1.27-2.63）、早产（RR 1.70，95%CI 1.54-1.87）和低出生体重（RR 1.78，95%CI 1.58-2.00）的风险增加相关。身体攻击、性攻击和有记录的亲密伴侣暴力都与不良结局相关。无论暴力住院的时间和次数如何，不良结局的风险都增加了，尽管对于住院两次或以上的女性，相关性更强。身体攻击、性攻击和亲密伴侣暴力是不良妊娠结局的重要危险因素。对育龄妇女进行暴力筛查，并在妊娠期间进行更密切的随访，可能有助于改善分娩结局。
