VIOLENCE, PREGNANCY AND BIRTH OUTCOME IN APPALACHIA

Few studies have followed pregnant women prospectively to examine the impact of violence on birth outcome. We included such an assessment in a prospective study of pregnancy among low-income women. Nurses and s ocial workers interviewed pregnant women (n = 364) and asked if they h ad been the object of violence since they became pregnant. These prena tal interviews were linked with information from perinatal records and with birth and death information. In total, 15.9% of women in the stu dy indicated they had been abused since they became pregnant. Abused w omen were more likely to be teenagers and to have partners who were te enagers. Abused women were more likely to be primiparous, to smoke dur ing pregnancy and to have physical problems related to stress. Women b attered during pregnancy were more likely to suffer fetal distress or fetal death [Odds Ratio (OR) 3.68; 95% Confidence Interval (CI) 1.36, 9.94], even after adjusting for maternal age and smoking status. Final ly the infants of abused women were more likely to remain in hospital after their mother's discharge (OR:3.75; 95% CI:1.38, 10.23). Our find ings suggest that fetuses may be compromised in utero, as shown by hig her rates of fetal distress and fetal death found among women physical ly abused during pregnancy.