Propensity score analysis of psychological intimate partner violence and preterm birth

Stella Martín-De-Las-Heras,Africa Caño,Juan De Dios Luna,Khalid Saeed Khan,Leticia Rubio,Casilda Velasco

doi:10.1038/s41598-022-06990-2

Abstract

Psychological intimate partner violence (IPV), a global public health problem, affects mothers during pregnancy. We evaluated its relationship with preterm birth. We established a cohort of 779 consecutive mothers receiving antenatal care and giving birth in 15 public hospitals in Spain. Trained midwives collected IPV data using the Index of Spouse Abuse validated in the Spanish language. Preterm was defined as birth before 37 completed weeks of gestation. Gestational age was estimated by early ultrasound. With multivariate logistic regression we estimated the relative association of IPV with preterm birth as adjusted odds ratios (AOR), with 95% confidence intervals (CI). In propensity score analysis, using weighting by inverse probability of exposure to IPV, the whole sample was used for estimating the absolute difference in probability of preterm amongst offspring born to mothers with and without IPV. Socio-demographic and other pregnancy characteristics served as covariates in both analyses. Preterm occurred in 57 (7.3%) pregnancies. Psychological IPV, experienced by 151 (21%) mothers, was associated with preterm birth (11.9% vs 6.5%; AOR = 2.4; 95% CI = 1.1–5.0; p = 0.01). The absolute preterm difference in psychological IPV compared to normal was 0.08 (95% CI = 0.01–0.16; p = 0.04). The probability of preterm birth was 8% higher on average in women with psychological IPV during pregnancy. As our analysis controlled for selection bias, our findings give credence to a causal inference. Screening and management for psychological IPV during pregnancy is an important step in antenatal care to prevent preterm birth.

Highlights

Must act as active screeners, and that this should happen within a system where early detection is followed by proper multidisciplinary input[11]
Considering the public health importance of intimate partner violence (IPV) and preterm birth as important risk factors for maternal and infant morbidity, we examined if the experience of psychological IPV, perpetrated by current or former male partners, and captured with validated tools in pregnancy may be associated with preterm birth in a propensity score analysis to allow for evaluation of a causal inference
The response rate amongst those invited to take part was 92.2% and the data loss was 4.3%: 28 women who refused to participate in the study and 11 who refused to fill out the Index of Spouse Abuse (ISA) questionnaire

Summary

Introduction

Must act as active screeners, and that this should happen within a system where early detection is followed by proper multidisciplinary input[11]. IPV during pregnancy might contribute to preterm birth through an association with obstetric complications, e.g. preeclampsia, gestational diabetes[14–19]. Physical IPV during pregnancy has been most linked to preterm b irth[20–24]. Observational studies[13,14,16,17,21] of the link between psychological IPV and preterm birth are vulnerable to selection bias, a situation where certain characteristics related to the likelihood of exposure, e.g. socioeconomic status, can lead to an inaccurate estimate of the association, making a causal inference impossible. Considering the public health importance of IPV and preterm birth as important risk factors for maternal and infant morbidity, we examined if the experience of psychological IPV, perpetrated by current or former male partners, and captured with validated tools in pregnancy may be associated with preterm birth in a propensity score analysis to allow for evaluation of a causal inference

Methods

Results

Conclusion