Maltreatment in childhood and intimate partner violence: A latent class growth analysis in a South African pregnancy cohort

Abstract

Intimate partner violence (IPV) is a significant global problem, prevalent in low and middle-income countries (LMICs). IPV is particularly problematic during the perinatal and early postnatal period, where it is linked with negative maternal and child health outcomes. There has been little examination of profiles of IPV and early life adversity in LMIC contexts. We aimed to characterize longitudinal IPV and to investigate maternal maltreatment in childhood as a predictor of IPV exposure during pregnancy and postnatally in a low resource setting. This study was nested in the Drakenstein Child Health Study, a longitudinal birth cohort. Maternal IPV (emotional, physical and sexual) was measured at six timepoints from pregnancy to two years postpartum (n = 832); sociodemographic variables and maternal maltreatment in childhood were measured antenatally at 28-32 weeks' gestation. Associations between maternal maltreatment in childhood and IPV latent class membership (to identify patterns of maternal IPV exposure) were estimated using multinomial and logistic regression. We observed high levels of maternal maltreatment during childhood (34%) and IPV during pregnancy (33%). In latent class analysis separating by IPV sub-type, two latent classes of no/low and moderate sexual IPV and three classes of low, moderate, and high emotional and physical IPV (separately) were detected. In combined latent class analysis, including all IPV sub-types together, a low, moderate and high exposure class emerged as well as a high antenatal/decreasing postnatal class. Moderate and high classes for all IPV sub-types and combined analysis showed stable intensity profiles. Maternal childhood sexual abuse, physical abuse and neglect, and emotional abuse predicted membership in high IPV classes, across all domains of IPV (aORs between 1.99 and 5.86). Maternal maltreatment in childhood was associated with increased probability of experiencing high or moderate intensity IPV during and around pregnancy; emotional neglect was associated with decreasing IPV class for combined model. Intervening early to disrupt this cycle of abuse is critical to two generations.

Association of maternal prenatal psychological stressors and distress with maternal and early infant faecal bacterial profile

“…Exposure to lifetime IPV in particular, was associated with differences in the infant and maternal faecal bacteria. IPV is a traumatic stressor that often occurs over prolonged and repeated episodes (63) and IPV during pregnancy often persists postpartum (64-66). It should be noted that other effects of IPV which were not controlled for in this study may contribute to its association with changes to infant faecal bacterial composition.…”

“…It should be noted that other effects of IPV which were not controlled for in this study may contribute to its association with changes to infant faecal bacterial composition. For example, mothers who have experienced IPV are more likely to have weakened bonding with their infant (66, 67), which may in turn affect the infant faecal bacterial composition. Supporting evidence from animal work showed that male rat pups that were stressed by maternal separation had elevated faecal levels of Enterobacteria and Bacteroides during adulthood (68).…”

“…The effect of IPV on child feeding may also contribute to faecal bacterial changes. Studies have showed that maternal IPV can contribute to infant malnutrition in low to middle income countries (66, 70, 71). Malnutrition has been associated with marked changes in infants’ faecal bacterial composition (72).…”

Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey

“…To narrow the search for this concept analysis, the focus is on personal resilience and more specifically on perinatal resilience. Research about resilience within the perinatal period has mainly focused on the presence of adversity or trauma such as intimate partner violence, teen-pregnancy and postpartum depression (Wilson-Mitchell et al, 2014;SmithBattle and Freed, 2016;Dekel et al, 2017;Barnett et al, 2018). Suspected components of resilience have been associated with improved perinatal outcomes, such as increased birth weight, decreased rates of postpartum depression, emotional stress and sleeping problems (Roos et al, 2013;Waugh and Koster, 2015;Hain et al, 2016;Johnson et al, 2018).…”

“…An increasing body of research focused on the identification of resilience-promoting characteristics and mechanisms, which can be beneficial for mental health outcomes (Schiele and Domschke, 2018). However, only a few studies assess resilience during the perinatal period, with most of them focusing on unusual trajectories with the presence of adversity or trauma such as intimate partner violence or teen pregnancy (Wilson-Mitchell et al, 2014;SmithBattle and Freed, 2016;Dekel et al, 2017;Barnett et al, 2018;Xuemei et al, 2019). Yet a definition of perinatal resilience is absent.…”