Prenatal care in adult women exposed to childhood sexual abuse

Abstract

Aims: Several case reports show a negative impact of childhood sexual abuse (CSA) on prenatal care. The study aimed to systematically investigate this association in a larger study group. Methods: CSA was investigated by face-to-face interviews and by a modified questionnaire developed by Wyatt. All study participants completed a self-administered questionnaire designed to investigate the consequences of CSA on prenatal care during adulthood. Data from 85 women after CSA were compared to those of 170 matched women without such experiences. Results: Women exposed to CSA had fewer than five prenatal consultations more often than unexposed women (26 % /7 % ; P < 0.0001). Of the 85 women with a positive history for CSA, 9.4 % had been asked for such antecedents, 36.5 % had intense memories on original abuse situations during pregnancy, 56.6 % mentioned specific consequences of CSA on prenatal care and 61.2 % were satisfied with obstetrical support. Exposed women (62.4 % ) felt significantly less prepared for labor than unexposed women (75.9 % ) (P < 0.0001). Conclusions: CSA experiences are associated with impaired prenatal care. These results underscore the compelling need to improve prenatal care in women exposed to CSA through better education of obstetricians regarding the effects of CSA and in their ability to provide empathetic professional support.

Factors Related to the Seeking and Contribution of Prenatal Care Among Ethnically Diverse Adolescents

“…Women exposed to childhood maltreatment have been found to report more unhappiness with PNC, fear related to PNC appointments, and lack of confidence in their care providers (Leeners et al 2012). Childbearing women with abuse related PTSD, especially, have been found to skip PNC visits or delay in receiving care to avoid potential traumatic triggers (Seng et al 2011).…”

Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences

“…The method of the study has been previously described [17,18]. Briefly, data on different obstetrical risk factors/behaviors and perinatal outcome (premature delivery, birth weight) from a cohort of 85 women with a history of CSA were compared to those of 170 matched women without CSA experiences.…”

“…CSA experiences were additionally explored using questions modified from a questionnaire developed by Wyatt [33], as described previously [17,18]. In addition to these questions, basic socio-epidemiological data and other ACE (i.e., emotional abuse, substance abuse in family members, mentally handicapped family members, family members at risk for suicide, and family members in prison) were explored.…”

“…Educational level was evaluated with a question on profession offering seven pre-selected categories and a free text answer to enter the precise profession [17,18]. Marital status had to be rated as single, married/cohabiting, divorced, or widowed.…”

“…The fact that at least one out of five women has been exposed to sexual abuse, and 29-78% to physical abuse during childhood support the relevance of such experiences in prenatal care [15,16,18]. In addition to abuse, other adverse childhood experiences (ACE), for example, burdensome life events/family structures, are likely to impair adult women's health [20,26].…”