目的:检查身体,性,或生理伤害在妊娠和围产期结局中的一个大,当代出生队列。
方法:这项回顾性队列研究使用了2016年至2020年与加利福尼亚相关的生命统计和出院数据。我们包括单身人士,胎龄为23-42周的非异常出生。怀孕期间的暴力是根据国际疾病分类确定的,第十次修订(ICD-10)代码。使用卡方检验和多变量Poisson回归模型来评估妊娠暴力与围产期结局的关联。
结果:共有1,728,478例妊娠符合纳入标准,其中3,457人(0.2%)报告了怀孕期间的暴力行为。与那些在怀孕期间没有暴力的人相比,经历过暴力的个体罹患非重度高血压疾病的风险增加(aRR=1.36,95%CI1.22,1.51),具有严重特征的先兆子痫(RR=1.34;95%CI1.11,1.61),绒毛膜羊膜炎(aRR=1.68;95%CI1.48,1.91),贫血(ARR=1.59;95%CI1.50,1.68),产前出血(aRR=2.17;95%CI1.19,3.95),和产后出血(aRR=1.65;95%CI1.48,1.85)。孕期暴力也与5分钟Apgar评分<7的风险增加相关(aRR=1.37;95%CI1.11,1.71)和新生儿低血糖(aRR=1.26;95%CI1.07,1.48)。
结论:妊娠期经历的暴力与不良围产期结局的风险增加相关。了解普遍筛查和怀孕期间暴力的早期识别如何减少这一研究不足的人群的孕产妇发病率差异至关重要。
OBJECTIVE: To examine the association between physical, sexual, or physiological harm in pregnancy and perinatal outcomes in a large, contemporary birth cohort.
METHODS: This retrospective cohort study used California-linked vital statistics and hospital discharge data from 2016 to 2020. We included singleton, non-anomalous births with a gestational age of 23-42 weeks. Violence in pregnancy was identified using International Classification of Disease, Tenth Revision (ICD-10) codes. Chi-square tests and multivariable Poisson regression models were used to evaluate associations of violence in pregnancy with perinatal outcomes.
RESULTS: A total of 1,728,478 pregnancies met inclusion criteria, of which 3,457 (0.2%) had reported violence in pregnancy. Compared to those without violence in pregnancy, individuals who experienced violence had an increased risk of non-severe hypertensive disorders (aRR = 1.36, 95% CI 1.22, 1.51), preeclampsia with severe features (aRR = 1.34; 95% CI 1.11, 1.61), chorioamnionitis (aRR = 1.68; 95% CI 1.48, 1.91), anemia (aRR = 1.59; 95% CI 1.50, 1.68), antepartum hemorrhage (aRR = 2.17; 95% CI 1.19, 3.95), and postpartum hemorrhage (aRR = 1.65; 95% CI 1.48, 1.85). Violence in pregnancy was also associated with increased risk of Apgar score < 7 at 5 min (aRR = 1.37; 95% CI 1.11, 1.71) and neonatal hypoglycemia (aRR = 1.26; 95% CI 1.07, 1.48).
CONCLUSIONS: Violence experienced in pregnancy is associated with an increased risk of adverse perinatal outcomes. Understanding how universal screening and early recognition of violence in pregnancy may reduce disparities in maternal morbidity for this understudied population is critical.