Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

Abstract

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.

Intimate partner violence against pregnant women: the environment according to Levine's nursing theory

“…The events described by them of chronic pain, gastric disorders, high blood pressure, dyspareunia, sleep disorders and dietary patterns; in addition to sadness, fear and insecurity, revealed a negative impact on their physical, mental and sexual health, with risks to pregnancy, thus becoming a pathological process. These findings corroborate other studies (4)(5) . The impairment of mental health can lead them to start prenatal visits after the first quarter (1) , as evidenced in this investigation.…”

“…Instead, they were cyclical and continuous. Therefore, this situation should be considered that violence is perpetrated not only against women, as it can result in possible negative consequences to the fetus and neonate (4,14) . Moreover, it is considered that aggression perceived by the body, which hurt, injure, and often bleed, transcend the physical marks and also affect the mental health of pregnant women, making it a challenge to maintain the biopsychosocial and spiritual balance in a hostile environment in order to maintain and preserve its entirety.…”

“…The impairment of mental health can lead them to start prenatal visits after the first quarter (1) , as evidenced in this investigation. Moreover, it can favor non-attendance to prenatal consultations and the use of legal and/or illegal drugs, among others (4) .…”

“…The implications of such violence are associated with a delay in starting prenatal care, premature labor, bleeding, miscarriage, and depression, among others, with possible fatal outcomes to mother and fetus (2,(4)(5) .…”

A review of research and nursing management of mental health problems in pregnancy and motherhood

“…IPV may result in newborn outcomes, such as prematurity and low birth weight. 10 The US Department of Justice estimates that over a lifetime, 52% of women will experience IPV. 11 Researchers, however, disagree on the prevalence of IPV during pregnancy or if a woman is at increased risk for IPV during the time from conception to delivery.…”