Physical and Nonphysical Partner Abuse and Other Risk Factors for Low Birth Weight Among Full Term and Preterm Babies:
A Multiethnic Case-Control Study

Reviewed by
Priscilla Schulz, LCSW

from an article of the same title by:
Jacquelyn Campbell, Sara Torres, Josephine Ryan, Christine King, Doris W. Campbell, Rebecca Y. Stallings, and Sandra C. Fuchs

Published: American Journal of Epidemiology,
V. 150 (7), 714-726, 1999

What was the purpose of this study?
Prior research has confirmed common sense that spouse abuse during pregnancy is a serious health problem for both mother and baby. Researchers in the current study explored the mechanisms by which spouse abuse affects the birth weight of infants born to abused women. They also tried to understand how demographic characteristics such as socioeconomic and educational levels play a part in placing infants of abused women at risk for low birth weight.

How was the study conducted?
Over the course of 5 years (1991-1996) 1,004 women from hospital maternity settings in both Florida and Massachusetts completed self-report surveys and answered questions about their experiences of intimate partner abuse, relationship history, stress in their daily lives, social support, and alcohol and drug use during pregnancy. Study participation occurred no sooner than 6 hours after delivery and during subjects' post-partum hospital stay.

Researchers exercised care to use equal numbers of Mexican-American, Puerto Rican, Cuban-American, African-American and Anglo women in the study. In the end, Central American women were included because of the lack of low birth weight infants from Cuban American mothers.

In this "case-control study design", mothers with low-birth weight infants (weighing less than 2,500g) were matched with mothers of normal birth weight infants (weighing at least 2,500g - the control group) on hospital, ethnicity, maternal age and gestation age group. Less than 38 weeks gestation was considered preterm; full term babies were those born at 38 weeks or later. Participants' responses from the full term group were analyzed separately from those of the preterm group. Statistical techniques assessed which factors considered in the study contributed to a woman's risk for having a low birth weight baby.

What are the study's findings?
  • In the initial exploratory analysis the risk for low birth weight was significant only among women who scored above the cut-off for severe physical or nonphysical abuse on the Index of Spouse Abuse-Physical and Index of Spouse Abuse-Nonphysical, respectively, and who also delivered full term infants. However, in the models resulting from the final multiple logistic regression analyses where other factors were considered (i.e., poor obstetric history, inadequate weight gain during pregnancy), neither physical nor nonphysical abuse continued to be statistically significant, independent risk factors for low birth weight infants.
  • Domestic violence had a negative effect on maternal health. Abused women were more likely to smoke and to gain less than the recommended 15 pounds during pregnancy.

  • Demographic and socioeconomic characteristics:
  • Women with less than a high school education were more likely to have a low birth weight baby at full term than those who had at least finished high school
  • Cuban-American and Central American women were significantly less likely than Anglo-American women to bear a low birth weight, preterm infant.

  • Paternity:

    Higher risk for low birth weight was present for both preterm and full term infants when the infant's biological father was not the mother's current intimate partner. Abuse was similarly associated with this paternity issue; when fathers of full term infants were not the mothers' current intimate partners, the risk for wife and child abuse was higher.

    Preterm infants:

    For this group, parity (first birth or current birth being a woman's 4th or greater), surgical/genitourinary abnormalities, low maternal weight and low weight gain during pregnancy all independently predicted higher risk for low birth weight infants.

    What are the implications of this study?
    1. Researchers in this study attribute low rates of spouse abuse to the timing of study participation (6-48 hours post-partum). Previous studies that found the highest prevalence of abuse during pregnancy were those that questioned women over the course of the pregnancy during prenatal visits. Therefore researchers suggest that abuse be assessed at prenatal visits as well as at delivery.
    2. The current study's findings support existing research and suggest that abuse during pregnancy affects infants' birth weight primarily through its interaction with other risk factors for low infant birth weight (e.g., poor maternal health and educational level). The effect of abuse alone is suggested to be greatest for middle class women who may experience fewer of the other risk factors for low infant birth weight.
    3. Because researchers found that abuse during pregnancy was related to whether or not the woman's intimate partner was the baby's father, it is recommended that all pregnant women be questioned about this issue, and that appropriate safety planning be considered where indicated.

Reviewed by Priscilla Schulz, November 1999
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