Exposure to Interpersonal Violence During Pregnancy and Its Association With Women’s Prenatal Care Utilization: A Meta-Analytic Review

Abstract

Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation ( k = 9) and (2) delayed entry into prenatal care ( k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [ OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care ( OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.

Association of intimate partner violence during pregnancy and birth weight among term births: a cross-sectional study in Kaduna, Northwestern Nigeria

“…6 Prenatal IPV has been related to adverse birth outcomes including low birth weight (LBW). [7][8][9] The mechanisms of how IPV exposure during pregnancy might impact birth outcomes include direct and indirect biological effects on fetal growth. 10 Prenatal IPV is considered a potentially modifiable risk factor for the prevention of LBW.…”

Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives

“…Notably, in Canada, an alcohol-exposed pregnancy was found to be associated with lesser odds of an optimally timed prenatal ultrasound compared to pregnancies that were not alcohol-exposed (OR: 0.69; 95% CI: 0.53-0.90) (Abdullah et al, 2019). Furthermore, women experiencing violence (Cha et al, 2014;Jamieson et al, 2020) or those with mental health (Kim et al, 2005;Krans et al, 2013) or addiction issues (Roberts et al, 2010a) may have a delayed onset of utilization of prenatal care or may have limited access to prenatal care, especially if living in rural or remote communities (Simkhada et al, 2008). As these characteristics are also associated with an increased risk of alcohol use during pregnancy (Skagerstrom et al, 2011), this means that prenatal care providers may miss the opportunity to identify and address alcohol use during pregnancy among women who may be more prone to having alcohol-exposed pregnancies or which patients have a heightened need for access to brief interventions.…”

The Biopsychosocial Model and Perinatal Health Care: Determinants of Perinatal Care in a Community Sample

“…Wolf et al ( 21 ) and Cha and Masho ( 22 ) reported that preconception and/or prenatal IPV was associated with inadequate prenatal care. One meta-analysis ( 23 ) found that women who experienced IPV had a decreased likelihood of attending at least four prenatal care visits during pregnancy; a separate meta-analysis ( 24 ) indicated that women with past-year experiences of IPV had a high likelihood of delaying or never seeking prenatal care. However, meta-analyses expose the variation in effects across study, perhaps related to the nature of how violence and abuse is assessed; several studies did not find reliable associations between IPV and prenatal care utilization ( 25 ).…”