European Journal of Obstetrics & Gynecology and Reproductive Biology
Intimate partner violence (IPV) and preeclampsia among Peruvian 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.
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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.
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