Risk factors and health during pregnancy among women previously exposed to sexual violence

Abstract

Objective: To determine whether women exposed to sexual violence in adolescence or adulthood are at increased risk of adverse maternal characteristics during subsequent pregnancies.

Design: Register-based cohort study.

Setting: Iceland.

Population: We identified 586 women who attended a Rape Trauma Service (RTS) between 1993 and 2008 and all subsequent births of these women up to April 2011 (n = 915). These pregnancies were compared with 1641 randomly selected pregnancies of women who had not attended the RTS and who gave birth during the same calendar month.

Methods: Information on maternal smoking, body mass index and illicit drug use was obtained from maternal charts. We used Poisson regression to obtain multivariable adjusted relative risks (aRR) with 95% CI contrasting prevalence of outcomes in the two groups.

Main outcome measures: Characteristics and risk factors during pregnancy, including maternal smoking, body mass index, weight gain during pregnancy, illicit drug use.

Results: Compared with unexposed women, sexually assaulted women were younger and more often primiparous in subsequent pregnancy, more likely not to be employed (7.8% vs. 4.3%; aRR 2.42, 95% CI 1.49-3.94), not cohabiting (45.6% vs. 14.2%; aRR 2.15, 95% CI 1.75-2.65), smokers (45.4% vs. 13.5%; aRR 2.68, 95% CI 2.25-3.20), and more likely to have used illicit drugs during pregnancy (3.4% vs. 0.4%; aRR 6.27, 95% CI 2.13-18.43). Exposed primiparas were more likely to be obese (15.5% vs. 12.3%; aRR 1.56, 95% CI 1.15-2.12).

Conclusions: Women with a history of sexual violence are more likely to have risk factors during pregnancy that may affect maternal health and fetal development.

Keywords: Maternal behavior; maternal health; obesity; pregnancy; sexual violence; smoking; violence against women.