Perinatal Intimate Partner Violence Research Articles

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review.

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. We used standard methodological procedures expected by The Campbell Collaboration. In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

Health insurance coverage and experiences of intimate partner violence and postpartum abuse screening among rural US residents who gave birth 2016-2020.

Intimate partner violence (IPV) is elevated among rural residents and contributes to maternal morbidity and mortality. Postpartum health insurance expansion efforts could address multiple causes of maternal morbidity and mortality, including IPV. The objective of this study was to describe the relationship between perinatal health insurance, IPV, and postpartum abuse screening among rural US residents. Using 2016-2020 data on rural residents from the Pregnancy Risk Assessment Monitoring System, we assessed self-report of experiencing physical violence by an intimate partner and rates of abuse screening at postpartum visits. Health insurance at childbirth and postpartum was categorized as private, Medicaid, or uninsured. We also measured insurance transitions from childbirth to postpartum (continuous private, continuous Medicaid, Medicaid to private, and Medicaid to uninsured). IPV rates varied by health insurance status at childbirth, with the highest rates among Medicaid beneficiaries (7.7%), compared to those who were uninsured (1.6%) or privately insured (1.6%). When measured by insurance transitions, the highest IPV rates were reported by those with continuous Medicaid coverage (8.6%), followed by those who transitioned from Medicaid at childbirth to private insurance (5.3%) or no insurance (5.9%) postpartum. Nearly half (48.1%) of rural residents lacked postpartum abuse screening, with the highest proportion among rural residents who were uninsured at childbirth (66.1%) or postpartum (52.1%). Rural residents who are insured by Medicaid before or after childbirth are at elevated risk for IPV. Medicaid policy efforts to improve maternal health should focus on improving detection and screening for IPV among rural residents.

Rural/urban differences in rates and predictors of intimate partner violence and abuse screening among pregnant and postpartum United States residents.

To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. This analysis utilized 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. This is a retrospective, cross-sectional study using multistate survey data. This analysis included 201,413 survey respondents who gave birth in 2016-2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18-35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18-24 years old, or unmarried, compared to urban IPV victims with those same characteristics. IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.

Interventions for intimate partner violence during the perinatal period: a scoping review protocol

IntroductionGlobally, the prevalence and incidence of perinatal intimate partner violence (IPV) are well documented and substantiated; however, there is an urgent need to identify interventions to prevent recurrence or revictimisation,...

Perinatal Intimate Partner Violence: A Qualitative Analysis of Mothers' Perceptions of Early Childhood Exposure

Intimate partner violence (IPV) includes a range of activities inflicted upon a person by a current or former intimate partner. The abuse is often recurrent and patterned, intended at establishing power and control. IPV incidence rates are highest during young adulthood, the dynamics of which are made more complex during and immediately following a pregnancy (the perinatal period). This study focuses on women's perceptions of perinatal IPV. Data come from a qualitative study stemming from a community-based longitudinal project. Participants (n = 301) were screened for lifetime incidence of IPV, and those screening positive (n = 64) were asked to participate in a follow-up interview. Forty women agreed to an interview, and 25 of those described perinatal IPV. Within this subsample, the women were asked to recall the abuse they experienced during and after pregnancy, how it impacted their health and ability to parent, as well as the impacts they believed that the abuse had on their children. Their findings indicate that perinatal IPV is pervasive and consequential. A range of abuse trajectories occurred which left the women feeling demoralized as they entered parenthood. After the birth of their children, the women often shouldered disproportionate caretaking responsibilities in addition to navigating their abusers' ongoing control tactics. While they reported various forms of IPV and recognized that their children had been exposed to it, the women did not often exhibit a clear understanding of how their own victimization impacted their children, prenatally or upon birth. More recognition came in retrospect for those with older children. Understanding the nature of perinatal IPV is critical to identifying early childhood exposure, as well as effectively working with adult survivors to mitigate it.

The influence of maternal reflective functioning and parenting behavior on infant development in the context of perinatal intimate partner violence: a study protocol

BackgroundIntimate partner violence (IPV) affects 25% of children under the age of five worldwide, yet the impact of perinatal IPV and its underlying mechanisms on infant development remains poorly understood. IPV indirectly affects infant development through the mother’s parenting behavior, but research on maternal neuro and cognitive processes, such as parental reflective functioning (PRF), is scarce, despite its potential as an unfolding mechanism. The objective of our study, Peri_IPV, is to examine the direct and indirect pathways linking perinatal IPV and infant development. We will analyze the direct impact of perinatal IPV on mothers’ neuro and cognitive parental reflective functioning (PRF) and parenting behavior during the postpartum period, the direct impact of perinatal IPV on infant development, and whether maternal PRF mediates the link between perinatal IPV and parenting behavior. We will also explore the mediation role of parenting behavior in the association between perinatal IPV and infant development and whether the impact of perinatal IPV on infant development occurs through the links between maternal PRF and parenting behavior. Finally, we will examine the moderation role of mother’s adult attachment in the impact of perinatal IPV on maternal neuro and cognitive PRF and parenting behavior during the postpartum period, as well as on infant development.MethodsOur study will use a multi-method, prospective design to capture different levels of PRF, parenting behavior, and infant development. Three-hundred and forty pregnant women will participate in a 4-wave longitudinal study from the 3rd trimester of pregnancy to 12 months postpartum. In the 3rd trimester and 2 months postpartum, women will report on their sociodemographic and obstetric characteristics. In all assessment waves, mothers will complete self-reported measures of IPV, cognitive PRF, and adult attachment. At 2 months postpartum, women’s neuro PRF will be monitored, and at 5 months postpartum, their parenting behavior will be assessed. The infant-mother attachment will be assessed at 12 months postpartum.DiscussionOur study’s innovative focus on maternal neuro and cognitive processes and their impact on infant development will inform evidence-based early intervention and clinical practices for vulnerable infants exposed to IPV.

‘It is a hard decision’: a qualitative study of perinatal intimate partner violence disclosure

BackgroundPerinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore barriers and facilitators of perinatal intimate partner violence disclosure.MethodsThis qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 after birth) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman.ResultsThe main themes “barriers to disclosure” and “facilitators of disclosure” were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences and protection of family privacy. Facilitators of disclosure included maternal self-efficacy, threats to security, and formal and informal supportive networks.ConclusionsMost abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthening facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and the facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately.

Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia

Violence around pregnancy is critical in nature and major public health problem worldwide. Thus, the present study aims to determine the extent of perinatal partner violence and to identify its individual and community-level factors among postpartum women in Southern Ethiopia. A total of 1342 postpartum women nested in 38 ‘Kebles’ (clusters) were enumerated using multistage-clustered sampling techniques for multilevel analysis. Different parameters were computed for model comparison and model fitness. The overall prevalence of intimate partner violence before, during, and/or after pregnancy was estimated to be 39.9% [95% CI 36.9–44.5]. About 18% of women reported continuous abuse over the perinatal period. Postpartum women who live in rural areas [adjusted odds ratio (AOR) = 2.46; 95% CI 1.21–5.01], or in neighborhoods with high IPV favoring norms [AOR = 1.49; 95%CI 1.01–2.20], high female literacy [AOR = 2.84; 95%CI 1.62–5.01], high female autonomy [AOR = 2.06; 95%CI 1.36–3.12], or in neighborhoods with lower wealth status [AOR = 1.74; 95%CI 1.14–2.66] were more likely to encounter PIPV. The complex patterns of interplaying factors operating at different levels could put pregnant or postpartum women at higher risk of IPV victimization. Therefore, policies that prioritize the improvement of contextual factors, particularly norms toward IPV and women’s empowerment are likely to be the most effective interventions.

Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling.

Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia. A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models. Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78). Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.

Intimate partner violence during the perinatal period by disability status: Findings from a United States population-based analysis.

The aim of the current study was to compare the prevalence of intimate partner violence (IPV) during the perinatal period among respondents with self-reported disability compared with those without a disability. We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The exposure was perinatal IPV, defined as experiencing abuse by a current or ex-partner in the year before or during pregnancy. Regression models were used to calculated odds of IPV by disability status while accounting for relevant sociodemographic characteristics. Respondents who self-reported disabilities experienced IPV at a higher rate than those without disabilities, both before and during pregnancy. In fully adjusted models, respondents with disabilities had about 2.6 times the odds of experiencing IPV before pregnancy, and about 2.5 times the odds of experiencing IPV during pregnancy, compared with those without disabilities. Respondents with disabilities experienced IPV at higher rates than the general population, and thus are at increased risk for adverse maternal, neonatal and infant health outcomes. Perinatal IPV is a significant issue globally, and our findings suggest perinatal IPV is particularly salient for persons with disability. Findings highlight the need to screen women with disabilities for IPV during the perinatal period as well as the importance of providing them appropriate, accessible information, resources and referrals.

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

BackgroundUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda.MethodsWe conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis.ResultsParticipants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse.ConclusionsOur findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.

Perinatal intimate partner violence during COVID-19 and its associated factors among postpartum mothers attending newborn immunization in southern Ethiopia, 2021: A cross-sectional study.

Objective:This study aimed to assess the prevalence of perinatal intimate partner violence during COVID-19 and its associated factors among postpartum mothers attending newborn immunization in southern Ethiopia, 2021.Method:A facility-based cross-sectional study was conducted among 657 postpartum mothers from 1 to 30 March 2021 in southern Ethiopia. All postpartum mothers who visited the selected hospitals or health centers for newborn immunization and met the inclusion criteria were included in this study. Data were cleaned, coded, entered into Epidata manager version 4.2 and then exported into SPSS version 26 for analysis. Binary and multivariate logistic regression analysis was used.Results:The prevalence of perinatal intimate partner violence was 62.4%. In this study, income loss due to COVID-19 (adjusted odds ratio: 12.00, 95% confidence interval: 5.60, 25.71, p < 0.001) was the strongest factor associated with perinatal intimate partner violence. Young age women (adjusted odds ratio: 5.82, 95% confidence interval: 2.72, 12.46, p < 0.001), partner alcohol use (adjusted odds ratio: 2.21, 95% confidence interval: 1.37, 3.56, p = 0.001), partner substance use (adjusted odds ratio: 2.07, 95% confidence interval: 1.12, 3.83, p = 0.021), and partner relationships (cohabited) (adjusted odds ratio: 1.88, 95% confidence interval: 1.06, 3.34, p = 0.032) were also strongly associated with perinatal intimate partner violence.Conclusion:The prevalence of perinatal intimate partner violence was relatively high. The health of the women should be maintained through empowerment of women and provision of health education in order to minimize prevalence of perinatal intimate partner violence associated with low income, young age, substance use, and cohabited marital status. Future qualitative studies are required to identify the underlying multifactorial reasons for intimate partner violence.

Postpartum Women's Lived Experiences of Perinatal Intimate Partner Violence in Wolaita Zone, Southern Ethiopia: A Phenomenological Study Approach.

ObjectivePerinatal intimate partner violence affects the health and safety of postpartum women and their infants. However, it has not been well recognized and addressed in the study setting. Hence, this study aimed to explore postpartum women’s lived experiences of perinatal intimate partner violence and its contributing factors in Wolaita Zone, Southern Ethiopia.MethodsA phenomenological study approach was used to explore postpartum women’s lived experiences of perinatal partner violence from January to March 2020. A total of twenty-two postnatal women and five health extension workers (HEWs) were interviewed. Interviews were audio-recorded, transcribed verbatim in local languages, and then translated into English. Data were analyzed thematically, using deductive and inductive coding. The consolidated criteria for reporting qualitative research (CORE-Q) checklist was followed to report the findings.ResultsResults indicated that postpartum women had experienced recurrent violence before, during, and after pregnancy from their husbands, with 16 out of 22 women being subjected to perinatal intimate partner violence. A majority of the participants delineated their exposure to perinatal physical violence next to perinatal psychological violence. Many of the interviewed women noted that violence during pregnancy was exacerbated and increased during postpartum. Moreover, the interviewees revealed that some partners were not only a serious threat to their wives, but also their infants during the postpartum period. Four of the participants stated that their newborns were hit and thrown by their father and became unconscious. Participants linked husbands’ perinatal violence with suspicion about the newborn, male-child preference, partner infidelity and jealousy, contraceptives usage, alcohol consumptions, indifference to shortages on household necessities, improper parenting, and financial problems.ConclusionThis study highlights that postpartum women are experiencing continuous and severe forms of perinatal IPV in the study setting. Thus, community-level interventions that minimize perinatal partner violence against postnatal women and their infants are needed.

COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic

ObjectiveThe objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the...

Neighborhood disadvantage moderates the effect of perinatal intimate partner violence (IPV) exposure on disorganized attachment behaviors among 12-month-old infants.

Neighborhood disadvantage moderates the effect of perinatal intimate partner violence (IPV) exposure on disorganized attachment behaviors among 12-month-old infants.

Intimate partner violence and perinatal depression and anxiety: Social support as moderator among Mexican women

AimsTo assess the frequency of perinatal Intimate Partner Violence (IPV), the association between IPV and depressive and anxiety symptoms, and the role of social support (SS) in the relation between IPV and depressive and anxiety symptoms, controlling for sociodemographic factors. MethodWomen were assessed during pregnancy and at six months postpartum (n = 210). The instruments used were: Stressful Life Events Scale; the Patient Health Questionnaire-9; the Anxiety Subscale of the Symptom Checklist-90 and the Social Support Subscale of the Postpartum Depression Predictors Inventory-Revised. ResultsThe prevalence of IPV was 10.7% in pregnancy and 11% during postpartum. IPV increases the risk of suffering depression in pregnancy (OR = 3.5) and at six months postpartum (OR = 18.3), as well as anxiety (OR = 5.9 and OR = 6.2, respectively). Women with lower educational attainment (OR = 3.8) and income (OR = 3.0) had a higher risk of being victims of IPV during pregnancy. Likewise, lack of SS has a great impact on IPV both during pregnancy (OR = 14.12) and the postpartum period (OR = 5.49). This association decreases the impact and significance of the relationship between perinatal depression and anxiety and IPV. ConclusionsHigh levels of SS may partially offset the effect of IPV on postpartum depressive s and perinatal anxiety symptoms. it is necessary for IPV victims to have multiple protective factors. Lack of access to education, poverty and women’s submissive role in relation to men lead to greater vulnerability, constituting a distinct social disadvantage for women.

Intimate Partner Violence, Small for Gestational Age Birth and Cigarette Smoking in the Pregnancy Risk Assessment Monitoring System.

Exposure to intimate partner violence (IPV) in the perinatal period is associated with obstetric complications, poor maternal mental health, neonatal complications, and increased risk of infant mortality and morbidity. Less is known about how IPV may influence small for gestational age (SGA) birth. Data were obtained for 231,081 United States mothers who delivered neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2-9 months after delivery. Weighted descriptive statistics and multivariate logistic regression models were used. IPV in the year before or during pregnancy was related to SGA bivariately (odds ratio 1.39, 95% confidence interval [CI] 1.28, 1.51), and after adjustment for demographic and obstetric factors, this association attenuated after further adjustment for perinatal smoking patterns, (adjusted odds ratio [aOR] 1.06, 95% CI 0.97, 1.15). Compared with nonabused women, women experiencing perinatal IPV were more than twice as likely to smoke before pregnancy (aOR 2.34, 95% CI 2.19, 2.49), and nearly 1.5 times as likely to report sustained smoking into the last 3 months of pregnancy (aOR 1.45, 95% CI 1.32, 1.59). In turn, among prepregnancy smokers, sustained smoking was associated with delivery of a SGA neonate (aOR 1.87, 95% CI 1.72, 2.03), fully attenuating the association of perinatal IPV with SGA. Women who experienced perinatal IPV were significantly more likely to smoke prepregnancy and sustain smoking into the last 3 months of pregnancy. Through behavioral and physiological pathways, smoking cessation may be uniquely challenging for women experiencing IPV, yet critical to address clinically to mitigate risk for SGA.

Current Reports on Perinatal Intimate Partner Violence.

The purpose of this study was to review the literature on perinatal intimate partner violence, focusing on recent knowledge to guide mental health professionals on the best approaches to identify and treat women exposed to perinatal intimate partner violence. Risk factors have been broadened from individual victim and perpetrator factors to include relationship, community, and societal factors which interact together. Better information is now available on how to identify, document, and treat women exposed to violence around the time of conception, pregnancy, and the postpartum period. Recent information helps psychiatrists and other mental health professionals assist women exposed to violence related to the perinatal period; however, further research is needed to provide improved evidence for optimal interventions for better patient outcomes.

Intimate Partner Violence and Gestational Weight Gain in a Population-Based Sample of Perinatal Women

ObjectiveTo examine the effects of intimate partner violence (IPV) at varied time points in the perinatal period on inadequate and excessive gestational weight gain. DesignRetrospective cohort using population-based secondary data. SettingPregnancy Risk Assessment Monitoring System and birth certificate data from New York City and 35 states. ParticipantsData were obtained for 251,342 U.S. mothers who gave birth from 2004 through 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2 to 9 months after birth. MethodsThe exposure was perinatal IPV, defined as experiencing physical abuse by a current or ex-partner in the year before or during pregnancy. Adequacy of gestational weight gain (GWG) was categorized using 2009 Institute of Medicine guidelines. Weighted descriptive statistics and multivariate logistic regression models were used. ResultsApproximately 6% of participants reported perinatal IPV, 2.7% reported IPV in the year before pregnancy, 1.1% reported IPV during pregnancy only, and the remaining 2.5% reported IPV before and during pregnancy. Inadequate GWG was more prevalent among participants who experienced IPV during pregnancy and those who experienced IPV before and during pregnancy (23.3% and 23.5%, respectively) than in participants who reported no IPV (20.2%; p < .001). Participants who experienced IPV before pregnancy only were significantly more likely to have excessive GWG (p < .001). Results were attenuated in the multivariate modeling; only participants who experienced IPV before pregnancy had weakly significant odds of excessive GWG (adjusted odds ratio = 1.14, 95% CI [1.02, 1.26]). ConclusionThe association between perinatal IPV and inadequate GWG was explained by confounding variables; however, women who reported perinatal IPV had greater rates of GWG outside the optimal range. Future studies are needed to determine how relevant confounding variables may affect a woman's GWG.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.