ABUSE, WOMEN'S SELF-CARE, AND PREGNANCY OUTCOMES

点击翻译按钮获取中文摘要

Violence against women is the leading cause of death in women of childbearing age and has been linked to inadequate prenatal care and low birth weight. In a recent study, 21% of teens and 14% of adult women reported being abused during pregnancy (Parker, McFarlane & Soeken, 1994). In the present study we will deepen our understanding of the effect of abuse on pregnancy outcomes. We will consider for the first time the effects of emotional abuse and abuse severity on birth outcomes, the influence of women's appraisal of abuse on their prenatal health behaviors, and the relationships among abuse severity, appraisal, and health behaviors and their direct and indirect effects on the outcomes of pregnancy. If women's appraisal of abuse severity affects health behaviors, or if these behaviors explain the effect of abuse on birth outcomes, health care providers can target appraisal and self-care for prenatal intervention. The aims of this prospective descriptive study are: (l) to determine the prevalence of abuse during pregnancy in selected diverse prenatal care sites and re-examine whether abuse increases the relative risk of poor birth outcomes (birth weight less than 2500 gms., gestational age less than 37 weeks, and 5-minute Apgar score less than 7), taking into consideration other obstetrical and social risks; (2) to determine whether severity of abuse affects the impact of abuse on birth outcomes when pre-existing risks are controlled; and (3) to determine whether pregnant women's appraisal of the risk of abuse-related harm explains their health and self-care behaviors (prenatal care, weight gain, substance abuse reduction), which in turn may act as mediators of the effect of abuse on birth outcomes. At eight prenatal care settings including HMOs, public clinics, and group practices, serving women from a variety of ethnic backgrounds, nurses have agreed to screen all pregnant women using the well-tested 5- item Abuse Assessment Screen (Parker & McFarlane, 1991) and refer to the research team women who report abuse and are interested in the study. Clinicians and researchers will offer abused women appropriate support and referrals. We will calculate abuse prevalence in all pregnant women screened over the study period. Logistic regression analysis of chart review data will determine the relative risk of low birth weight, preterm birth, and low 5-minute Apgar score in women with and without prenatal abuse, while controlling for pre-existing risks. In addition, we will interview a sample of 196 women who have experienced emotional or physical abuse during pregnancy. After careful informed consent, a single structured interview will be conducted in English or Spanish to administer the Severity of Violence Against Women Scale (Marshall, 1992) and the Appraisal of Violent Situations (Dutton, 1992) and to determine health behaviors during pregnancy (weight gain and substance abuse reduction). Other data, including prenatal care adequacy, will be gathered from medical records. Within the abused sample, multiple regression will be used to evaluate a path model in which abuse appraisal and health behaviors are proposed to mediate the effects of abuse severity and pre-existing risks on birth weight, gestational age, and Apgar score.