Department of Obstetrics and Gynecology, Concord Hospital, Concord, the Department of Obstetrics and Gynecology, the Department of Epidemiology, and the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, and the Department of Obstetrics and Gynecology and the Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and the Department of Internal Medicine, University of New Mexico Health System, Albuquerque, New Mexico.
Obstet Gynecol. 2023 Jul 1;142(1):80-89. doi: 10.1097/AOG.0000000000005216. Epub 2023 Jun 7.
To evaluate the association between exposure to intimate partner violence (IPV) and delivery method in a U.S. obstetric cohort.
The study population included U.S. women with a history of recent live birth, drawn from the 2009-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) cohort. The primary exposure was self-reported IPV. The primary outcome of interest was method of delivery (vaginal or cesarean). Secondary outcomes included preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Bivariate associations between the primary exposure (ie, self-report of IPV vs no self-report of IPV) and each covariate of interest were assessed with weighted quasibinomial logistic regression. Weighted multivariable logistic regression was conducted to evaluate the association between IPV and delivery method controlling for confounders.
A total of 130,000 women were included in this secondary analysis of a cross-sectional sample, representing 7,500,000 women nationwide based on PRAMS sampling design. Of these, 0.8% reported abuse in the 12 months before their current pregnancy and 1.3% reported abuse during pregnancy; 1.6% of the study population reported abuse both before and during pregnancy. After adjusting for maternal sociodemographic characteristics, IPV exposure at any time was not significantly associated with cesarean delivery, compared with no IPV exposure (odds ratio [OR] 0.98, 95% CI 0.86-1.11). Of secondary outcomes, 9.4% of women experienced preterm birth and 15.1% had neonates admitted to the NICU. Exposure to IPV was associated with a 21.0% increased risk of preterm birth, compared with women without exposure (OR 1.21, 95% CI 1.05-1.40), and a 33.3% increased risk of NICU admission (OR 1.33, 95% CI 1.17-1.52) after controlling for confounders. There was no difference in the risk of delivering a neonate who was SGA.
Intimate partner violence was not associated with an increased risk of cesarean delivery. Intimate partner violence before or during pregnancy was associated with increased risk of adverse obstetric outcomes, such as preterm birth and NICU admission, corroborating previous research findings.
在美国产科队列中评估亲密伴侣暴力（IPV）暴露与分娩方式之间的关联。
研究人群包括来自 2009 年至 2018 年 PRAMS（妊娠风险评估监测系统）队列的美国近期活产史的女性。主要暴露因素是自我报告的 IPV。主要结局指标为分娩方式（阴道分娩或剖宫产）。次要结局指标包括早产、小于胎龄儿（SGA）和新生儿重症监护病房（NICU）入院。使用加权拟二项式逻辑回归评估主要暴露因素（即报告的 IPV 与未报告的 IPV）与每个感兴趣的协变量之间的双变量关联。使用加权多变量逻辑回归，在控制混杂因素的情况下，评估 IPV 与分娩方式之间的关联。
在对横断面样本的二次分析中，共有 130,000 名女性被纳入研究，基于 PRAMS 抽样设计，代表全国范围内 750 万名女性。其中，0.8%的女性在当前妊娠前 12 个月内报告遭受虐待，1.3%的女性在妊娠期间报告遭受虐待；1.6%的研究人群在妊娠前和妊娠期间均报告遭受虐待。在校正了产妇社会人口统计学特征后，与无 IPV 暴露相比，任何时间的 IPV 暴露与剖宫产均无显著相关性（比值比 [OR] 0.98，95%CI 0.86-1.11）。在次要结局方面，9.4%的女性发生早产，15.1%的新生儿入住 NICU。与未暴露于 IPV 的女性相比，暴露于 IPV 的女性发生早产的风险增加 21.0%（OR 1.21，95%CI 1.05-1.40），入住 NICU 的风险增加 33.3%（OR 1.33，95%CI 1.17-1.52），在控制混杂因素后。新生儿 SGA 的风险无差异。
亲密伴侣暴力与剖宫产风险增加无关。妊娠前或妊娠期间的亲密伴侣暴力与早产和 NICU 入院等不良产科结局的风险增加有关，这与之前的研究结果一致。
