Association of physical violence by an intimate partner around the time of pregnancy with inadequate gestational weight gain

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Abstract

Intimate partner violence has been previously examined in relation to a variety of pregnancy, labor and delivery outcomes. We evaluated whether women who experienced physical violence by their intimate partners around the time of pregnancy were less likely to achieve weight gain according to the US Institute of Medicine (IOM) guidelines. A cross-sectional study was conducted using the 2000–2006 Oklahoma Pregnancy Risk Assessment Monitoring Survey (PRAMS) data for post-partum women, 20 years and older. Physical violence perpetrated by an intimate partner before and/or during pregnancy was prevalent in nearly 6.5% of women. Weight gain was adequate in 38.8%, deficient in 28.4% and excessive in 32.8% of these women, respectively. After adjusting for maternal age, marital status, education, pregnancy intention, stressful life events, third-trimester use of tobacco and alcohol and gestational age at delivery, physical violence by an intimate partner around the time of pregnancy was positively but non-significantly associated with excessive (but not deficient) gestational weight gain. After stratifying by age group, positive and significant associations between physical violence by an intimate partner around the time of pregnancy and inadequate gestational weight gain were observed only among women 35 years and older. With the exception of mothers ≥35 years of age, deficient and excessive gestational weight gains were not significantly related to experiences with physical violence by an intimate partner prior to delivery. Prospective cohort studies are needed to establish whether other forms of violence, including emotional and sexual abuse, can affect gestational weight gain and whether gestational weight gain can mediate the effect of physical, sexual and emotional abuse on pregnancy, labor and delivery outcomes.

Highlights

► Secondary analyses were based on the 2000–2006 Oklahoma PRAMS data. ► Gestational weight gain was generally not related to IPV around pregnancy. ► For women ≥35 years, IPV and inadequate weight gain were directly related.

Introduction

Since 1990, the Institute of Medicine (IOM) has established evidence-based guidelines for gestational weight gain aimed at achieving optimal health for women and their offspring (Kaiser and Allen, 2008, Olson, 2008). While it is anticipated that women in the “low” weight-for-height category (BMI: <19.8 kg/m2) will gain a total of 12.5–18.0 kg during their pregnancies, those in the “normal” (BMI: 19.8–26.0 kg/m2) and “high” (BMI: >26.0–29.0 kg/m2) categories are expected to gain 11.5–16.0 kg and 7.0–11.5 kg, respectively. A gestational weight gain of at least 6.8 kg is projected for “obese” women whose BMI exceeds 29.0 kg/m2 (IOM, 1990). However, current research suggests that a large proportion of women do not comply with these guidelines (Abrams, Altman, & Pickett, 2000). A recent review article by Olson (Olson, 2008) estimated that 33–40% of US women gain within recommended ranges and that excessive weight gain was more frequent than deficient weight gain. The role of intimate partner violence (IPV), a worldwide public health concern, has rarely been explored in relation to adequacy of weight gain in the context of pregnancy. For pregnant women, IPV has been examined in relation to antenatal hospitalization (Lipsky, Holt, Easterling, & Critchlow, 2004), low birth weight (Boy and Salihu, 2004, Neggers et al., 2004), preterm delivery (Neggers et al., 2004), fetal growth restriction (Janssen et al., 2003), maternal (Boy & Salihu, 2004), perinatal (Coker et al., 2004, Janssen et al., 2003) and infant (Boy & Salihu, 2004) mortality. Yet, evidence supporting a role of IPV in adverse pregnancy, labor and delivery outcomes remains inconclusive (Janssen et al., 2003), and many studies have not adjusted for relevant confounders (Chambliss, 2008). So far, the few studies that have explicitly assessed the role of IPV in gestational weight gain have yielded inconsistent results (Kearney et al., 2004, Moraes et al., 2006). Most of these studies were conducted within healthcare institutions, limiting extrapolation beyond clinical populations. The CDC Pregnancy Risk Assessment Monitoring System (PRAMS) conducts large population-based surveys at the state level. In the current study, analyses of the 2000–2006 Oklahoma PRAMS were performed to evaluate whether women who had experienced physical violence by an intimate partner around the time of pregnancy were less likely to gain weight within IOM guidelines. Specifically, we hypothesized that exposure to physical violence by an intimate partner around the time of pregnancy would be associated with an increased odds of excessive or deficient gestational weight gain. A previous study analyzed the relationship between history of abuse and gestational weight gain among teens and adults, separately (Johnson, Hellerstedt, & Pirie, 2002). Distinct patterns were noted whereby experiences with abuse affected gestational weight gain among adults but not among teens (Johnson et al., 2002). Furthermore, since age is an established effect modifier of numerous exposure–outcome relationships (Last, 2001), we further hypothesized that the magnitude of the association between IPV before and/or during pregnancy and adequacy of gestational weight gain will vary according to maternal age.

Section snippets

CDC PRAMS

The CDC PRAMS is an ongoing surveillance project that collects state-specific, population-based data on maternal attitudes and experiences before, during and shortly after pregnancy. Standardized data collection procedures have been adopted by participating PRAMS states. Every month, each PRAMS state selects a stratified sample of 100–250 new mothers from eligible birth certificates. A PRAMS state may sample between 1300 and 3400 women per year. Each selected mother receives a letter

Results

A total of 13,442 women were surveyed by Oklahoma PRAMS from 2000 to 2006. Of those 11,561 (86.0%) were 20 years and older and were, therefore, included in the analyses. Mean age (±standard error) was 27.0 ± 0.07 years. Almost 81% were White, 69% were married, 34% were nulliparous and 48% had above high school education. Nearly 86% initiated prenatal care during their first trimester of pregnancy, 55% had one or more pregnancy complication, 9% smoked cigarettes and 1.7% drank alcohol in the

Discussion

The main objective of our study was to identify the net effect of physical violence by an intimate partner around the time of pregnancy on adequacy of gestational weight gain. Whereas deficient weight gain was generally unrelated to physical violence by an intimate partner around the time of pregnancy, we found slightly elevated but statistically non-significant odds of excessive weight gain among women who reported physical violence by an intimate partner around the time of pregnancy. The

Acknowledgments

No funding was provided for this project. However, this research was supported in part by the intramural research program of the NIH, National Institute on Aging. Funding for The Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) is provided in part by the Centers for Disease Control and Prevention (CDC) Grant Number 5UR6DP000483 and by the Oklahoma State Department of Health.

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