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

对妇女的暴力是#年妇女死亡的主要原因。 育龄，一直与产前护理不足和低 出生体重。在最近的一项研究中，21%的青少年和14%的成年女性 报告在怀孕期间受到虐待(Parker，McFarlane&Soeken， (1994年)。在本研究中，我们将加深对 虐待对妊娠结局的影响。我们将首先考虑 情绪虐待和虐待严重程度对分娩的影响 结果，妇女对虐待的评价对其产前的影响 健康行为，以及虐待严重程度、评价、 和健康行为及其对老年人的直接和间接影响 妊娠结局。如果女性对虐待严重程度的评估影响到 健康行为，或者如果这些行为解释了虐待对 分娩结局，卫生保健提供者可以针对评估和自我护理 进行产前干预。 这项前瞻性描述性研究的目的是：(L)确定 在选定的不同产前护理中，孕期虐待的流行率 网站，并重新检查滥用是否会增加穷人的相对风险 出生结局(出生体重小于2500克，胎龄小于 超过37周，5分钟阿普加得分不到7分)，考虑到 考虑其他产科和社会风险；(2)确定 虐待的严重程度是否影响虐待对分娩结果的影响 当预先存在的风险得到控制时；以及(3)确定是否 孕妇对虐待相关伤害风险的评估解释了 他们的健康和自我护理行为(产前护理、体重增加、 减少药物滥用)，这反过来又可以充当 虐待对分娩结局的影响。 在八个产前护理机构，包括卫生保健组织、公共诊所和 团体实践，为来自不同种族背景的妇女提供服务， 护士们已经同意对所有孕妇进行筛查，使用经过良好测试的5- 物品滥用评估屏幕(Parker&McFarlane，1991)，并参考 报告虐待行为并对这项研究感兴趣的研究团队女性。 临床医生和研究人员将为受虐妇女提供适当的支持 和推荐人。我们将计算所有孕妇的虐待流行率 在研究期间进行了筛选。图表的Logistic回归分析 审查数据将确定低出生体重的相对风险， 有早产和无早产妇女的5分钟阿普加评分低 产前虐待，同时控制先前存在的风险。此外, 我们将采访196名经历过情感障碍的女性 或在怀孕期间遭受身体虐待。经过仔细的知情同意后， 单一结构面试将以英语或西班牙语进行，以 管理暴力侵害妇女行为严重程度量表(马歇尔，1992年) 和对暴力情况的评估(达顿，1992)，并确定 孕期健康行为(体重增加和药物滥用 减少)。其他数据，包括产前护理充分性，将是 从医疗记录中收集的。在被滥用的样本中， 回归将被用来评估在其中滥用的路径模型 建议通过评估和健康行为来调节 虐待的严重程度和出生体重、胎龄、 和阿普加得分。

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.