Prenatal Sociodemographic Factors Predicting Maltreatment of Children up to 3 Years Old: A Prospective Cohort Study Using Administrative Data in Japan.

Aya Isumi,Kunihiko Takahashi,Takeo Fujiwara

doi:10.3390/ijerph18052505

Abstract

Identifying risk factors from pregnancy is essential for preventing child maltreatment. However, few studies have explored prenatal risk factors assessed at pregnancy registration. This study aimed to identify prenatal risk factors for child maltreatment during the first three years of life using population-level survey data from pregnancy notification forms. This prospective cohort study targeted all mothers and their infants enrolled for a 3- to 4-month-old health check between October 2013 and February 2014 in five municipalities in Aichi Prefecture, Japan, and followed them until the child turned 3 years old. Administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), which is suggestive of child maltreatment cases, were linked with survey data from pregnancy notification forms registered at municipalities (n = 893). Exact logistic regression was used for analysis. A total of 11 children (1.2%) were registered with RCCRC by 3 years of age. Unmarried marital status, history of artificial abortion, and smoking during pregnancy were significantly associated with child maltreatment. Prenatal risk scores calculated as the sum of these prenatal risk factors, ranging from 0 to 7, showed high predictive power (area under receiver operating characteristic curve 0.805; 95% confidence interval (CI), 0.660–0.950) at a cut-off score of 2 (sensitivity = 72.7%, specificity = 83.2%). These findings suggest that variables from pregnancy notification forms may be predictors of the risk for child maltreatment by the age of three.

Highlights

Child maltreatment is one of the most important social issues that require urgent attention in Japan, considering the steady increase in the number of child maltreatment cases handled at Child Guidance Centers [1] and the long-term detrimental impact on the child’s physical and mental health [2,3,4,5,6]
In these five municipalities, data from pregnancy notification forms were able to link with administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), and this sample served as an examination of the feasibility of linking of data
We found that unmarried status, history of artificial abortion, and smoking during pregnancy significantly predicted child maltreatment

Summary

Introduction

Child maltreatment is one of the most important social issues that require urgent attention in Japan, considering the steady increase in the number of child maltreatment cases handled at Child Guidance Centers [1] and the long-term detrimental impact on the child’s physical and mental health [2,3,4,5,6]. RCCRC hold conferences with stakeholders, such as Child Guidance Centers, schools, medical institutions, or police; collect information about the child and his/her family; assess the degree of emergence and seriousness of the child’s situation; develop a support plan; and monitor the case. A total of 61,117 children were newly registered with RCCRC due to child maltreatment in a fiscal year (FY) 2016 [7], which accounts for approximately 0.3% of children aged 0 to 18 years old in Japan [8]. Children under 1 year old accounted for half of the deaths from child maltreatment (except filicide–suicide) in 2007–2016 in Japan [10].

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