The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

A simple clinical assessment screen completed by the health care provider in a private setting and with the male partner absent is as effective as research instruments in identifying abused women. Straightforward, routine clinical assessment is recommended as essential in preventing potential trauma, interrupting existing abuse, and protecting health.

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Context Intimate partner violence against women can have negative mental health consequences for survivors. The effect of interventions designed to improve the survivors' depressive symptoms is unclear.Objective To determine whether an advocacy intervention would improve the depressive symptoms of Chinese women survivors of intimate partner violence' Design, Setting, and Participants Assessor-blind, randomized controlled trial of 200 Chinese women aged 18 years or older with ahistory of intimate partner violence was conducted from February 2007 to June 2009 in a community in Hong Kong, China. Participants were randomly assigned to an intervention or control group.Intervention The intervention group (n:100) received a l2-week advocacy intervention comprising empowerment and telephone social support. The control group (n:100) received usual community services including child care, health care and promotion, and recreational programs.Main Outcome Measures The primary outcome was change in depressive symptoms (Chinese Version of Beck Depression Inventory II) between baseline and 9 months. The minimal clinically important difference was 5 units. Secondary outcomes were changes in intimate partner violence (Chinese Revised Conflict Tactics Scales), health-related qualrty of life (Short Form Health 12 Survey) and perceived social support (Interpersonal Support Evaluation List) between baseline and 9 months. The usefulness of the intervention/usual community services was evaluated at 9 months. Results At 3 months, the mean change of depressive symptoms was 1I.6 (95% confidence interval [CI], 9.5-13.7) in the control group and 14'9 (95yo Cl, in the intervention group. The respective mean changes at 9 months were 19.6 (95o/o CI, 16.6-22.7) and,23.2 (95o CI,20.4-26.0). The intervention effects at 3 and 9 months were not significantly different (P:.86). The intervention significantly reduced depressive symptoms over the control by 2.66 (95Yo,0.26-5.06; P:.03) which was less thanthe minimal clinically important difference. Among the secondary outcomes, statistically significant improvement was found in psychological aggression (-1.87;95% CI: -3.34, -0.40; 3 months: mean change from baseline : 1.5 [95yo CI, -1.0 to 3.9] in the control group and 0.3 l95yo CI, -0.7 to 1.41 in the intervention group; 9 months: mean change from baseline : -6.4195% CI, -7.8 to -5.0] in the control group and -8.9 l95yo CI, -10.6 to -7 .21inthe intervention group) and perceived social support (2.18; 95% CI: 0.48 to 3.89; 3 months: mean change from baseline: 6.4 l95o/o CI, 4.9-7 .8] in the control group and 9 .2 [95yo CI, 7 .7 -10.8] in the intervention group; 9 months: mean change from baseline: 12.4l95yo CI,10.5-14.31 in the control group and I4.4195% CI, l2.l-16.Il in the intervention group) but not in physical assault, sexual coercion, and health-related quality of life. By the end of the study, more women in the intervention group found the intervention to be useful-extremely useful in improving their intimate relationships vs those in the con...

BackgroundIntimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored.ObjectiveOur objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method.MethodsWe used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken.ResultsWe conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances.ConclusionsUsers and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship.ClinicalTrialClinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitatio...

High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

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