Intimate partner violence (IPV) and preeclampsia among Peruvian women

https://doi.org/10.1016/j.ejogrb.2007.05.013Get rights and content

Abstract

Objective

Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women.

Study design

We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models.

Results

The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR = 2.4; 95% CI: 1.7–3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR = 2.7; 95% CI: 1.9–3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1–4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1–3.5).

Conclusions

IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.

Introduction

Intimate partner violence (abuse directed towards women by male partners) is a common and significant global public health problem [1] that has appropriately been receiving increased attention from clinical and public health investigators. Most studies involving US, Scandinavian, and European populations indicate that 1.8–8.3% of pregnant women report experience IPV during pregnancy [2], [3], [4]. In international settings, intimate partner violence directed against pregnant women is reported to be considerably more common with prevalence estimated as 12–57% [1].

Studies of the relationships between IPV and adverse pregnancy outcomes suggest that newborns born to women exposed to IPV are at risk of preterm delivery and suffer from intrauterine growth retardation or even death [4], [5], [6]. Women exposed to IPV during pregnancy are at increased risk of having pregnancies complicated by vaginal bleeding, uterine and placental abruption, urinary tract and kidney infections [4], [7], [8]. Additionally, exposed women are more likely to have vaginal or cervical infections [9], to be sero-positive for human immunodeficiency virus (HIV) infection [10] and to be victims of suicide or homicide [11].

Although scant, the existing literature suggests that IPV before and/or during pregnancy is associated with an increased risk of pregnancy-induced hypertension (PIH) [4], [12]. Silverman et al. [4] analyzed data from 118,579 women giving birth in 26 US states and who participated in the 2000–2003 Pregnancy Risk Assessment Monitoring System (PRAMS). The authors noted that women reporting IPV in the year before pregnancy only (OR = 1.58; 95% CI: 1.38–1.81), during pregnancy only (OR = 1.35; 95% CI: 1.12–1.63), or during both periods (OR = 1.58; 95% CI: 1.41–1.79) were more likely to have pregnancies complicated by PIH than women not exposed to IPV. These observations in general agree with a report by Kearney et al. [12], but are inconsistent with a report from Berenson et al. [13] who found no evidence of an increased risk of PIH among women exposed to physical abuse during pregnancy when comparing 32 indigent women who reported being physically abused with 352 women who reported no such abuse (OR = 1.1; 95% CI: 0.3–5.3). We therefore evaluated the relation between maternal exposure to IPV and preeclampsia risk, using data from a large case-control study of preeclampsia risk factors among Peruvian women. We also examined the specific role of physical violence and emotional violence in relation to risk of preeclampsia.

Section snippets

Materials and methods

This case-control study was conducted at the Materno Perinatal Institute of Lima and the Dos de Mayo Hospital in Lima, Peru, from May 2004 through October 2005. Both institutions are operated by the Peruvian government and are primarily responsible for providing maternity services to low-income women residing in Lima. This study was approved by the Ethical Committees of both hospitals.

Cases were selected from those women with a diagnosis of preeclampsia. Potential preeclampsia cases were

Results

Socio-demographic and reproductive characteristics of cases and controls are presented in Table 1. Compared with controls, cases tended to be older, single, heavier, and multiparous. They were also more likely to be employed during pregnancy.

In keeping with recent reports from Peru [1], [19]; we noted a high prevalence of IPV among women enrolled in our study. Among normotensive control subject the prevalence of IPV was 24.3% (95% CI: 19.9–28.9%); the prevalence was even higher among

Discussion

The prevalence of IPV in our study of Peruvian pregnant women is high (24.3% among controls and 43.1% among preeclampsia cases). These frequencies are generally consistent with those recently reported from a WHO Study on Women's Health and Domestic Violence against Women [1]. In that study, investigators reported that 50% of Peruvian women reported having been victims of IPV during their lifetime. Approximately 20% of women reported experiencing abuse within the year of interview. Important

Acknowledgements

This research was supported in part by awards from the National Institutes of Health (T37 MD001449-09) and the Bill and Melinda Gates Foundation. The authors wish to thank Ms. Elena Sanchez and Mr. Bizu Gelaye for their expert technical assistance.

References (27)

  • S. Ahmed et al.

    Effects of domestic violence on perinatal and early-childhood mortality: evidence from north India

    Am J Public Health

    (2006)
  • D.K. Kaye et al.

    Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda

    Trop Med Int Health

    (2006)
  • N.P. Yost et al.

    A prospective observational study of domestic violence during pregnancy

    Obstet Gynecol

    (2005)
  • Cited by (34)

    • Maternal and fetal outcomes of intimate partner violence associated with pregnancy in the Latin American and Caribbean region

      2014, International Journal of Gynecology and Obstetrics
      Citation Excerpt :

      Four studies in 5 LAC countries [22,26–28] (Table 1) examined unintended pregnancies and IPV, 3 of which found a significant association (level III evidence) [26–28]. Twelve studies in 8 LAC countries [28–39] (Table 2) looked at maternal outcomes such as pre-eclampsia, vaginal bleeding, spontaneous abortion, gestational weight gain, pregnancy-related symptom distress, cortisol level during pregnancy, hypertension, depression, and sexually transmitted infections. All found significant associations with IPV-P (level II-2 or III evidence).

    View all citing articles on Scopus
    View full text