Perinatal complications and child abuse in a poverty sample☆
Section snippets
Background
RETROSPECTIVE STUDIES HAVE consistently found a high incidence of neonatal medical problems, premature births and low birth weights in abused children Creighton 1985, Famularo et al 1992, Fontana 1973, Goldson et al 1976, Klein and Stern 1971 that led to a common notion that these problems place a child at a higher risk for maltreatment. Several explanations of this association have been proposed. The early separation hypothesis suggests that separation from the parents due to neonatal disease
Method
Two hundred and six medical charts of the children ages 0–3 years who were born at the Lucile Packard Children’s Hospital and have had public medical insurance were reviewed retrospectively. Data regarding prenatal course, birth history, and maltreatment (report to CPS) were collected and analyzed. The reviewers were trained by the first author to gather the information from the medical charts.
Medical nature of the presentation in most child maltreatment cases as well as high sensitivity of the
Results
Analysis of the CPS reports in our sample is summarized in Table 1. There were two or more reasons for the CPS reports in many of the cases. The majority of the CPS reports in the EMI group were due to prenatal drug use and lack of medical care during pregnancy. Four of the women who did not have prenatal care stated that they were not aware of being pregnant; one of them realized that she was pregnant at 5 months of gestational age; the other three did not know until delivery. In one case the
Discussion
The findings demonstrated strong association between neonatal morbidity and CPS reporting of prenatal abuse in our sample. Our data also showed that the children who have been reported to CPS from our Hospital postnatally did not have significant neonatal morbidity compared to the control group. These results suggest that previously reported association between neonatal morbidity and child abuse might be a result of negative prenatal maternal behaviors and understandably high neonatal morbidity
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This research was supported by the NIMH 5 T-32 grant (MH 19908) and Human Service grant M01–RR00070, General Clinical Research Center of Stanford, NIH.