Intimate Partner Violence During Pregnancy: Arguing As a Risk Factor in a Population-Based Survey Kenneth D. Rosenberg, MD, MPH (a,b), Katherine D. Woods, BA (a,b), Rebecca T. Geller, MPH (a,c), Alfredo P. Sandoval MBA, MS (a) (a) Oregon Department of Human Services, Office of Family Health, Portland, OR (b) Oregon Health & Sciences University, Department of Public Health and Preventive Medicine, Portland, OR (c) University of Alabama at Birmingham, School of Public Health, Birmingham, AL

Background Physical abuse is associated with depression, drug and alcohol use and depression. AAP & ACOG recommend screening all pregnant women for domestic violence. Prenatal care is one time when most pregnant women will have sustained contact with health professionals.

Methods Data from: Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), 2000 Random sample of Oregon resident mothers 2-6 months after a live birth. Asks about attitudes and behaviors before, during and after pregnancy. Run by DHS Office of Family Health.

Methods 2100 respondents; 73.0% unweighted response rate Intimate Partner Violence during Pregnancy (IPVP): “During your most recent pregnancy, did your husband or partner push, hit, slap, kick, choke or physically hurt you in any other way?” Women less than 20 years old at the time of childbirth were not asked about abuse. Analysis: SPSS 11.5 and SUDAAN 9.0

Results In a multivariate analysis, arguing more than usual with husband/partner in the 12 months before delivery was significantly associated with IPVP (adjusted odds ratio: 10.91, 95% confidence interval ).

Table 1. Intimate Partner Violence During Pregnancy by Maternal Characteristics, Oregon, 2000 Characteristic n * IPVP Bivariate OR Multivariate OR (weighted) (95% CI) (95% CI) Argued in 12 months prior to birth More than usual % ( ) ( ) Not more than usual % Referent Referent Marital Status Not married % 4.50 ( ) 2.84 ( ) Married % Referent Referent Family Income § <$15, % 7.52 ( ) >$15, % Referent Maternal Age years % 3.96 ( ) 25+ years % Referent

Table 1. Intimate Partner Violence During Pregnancy by Maternal Characteristics, Oregon, 2000 (continued) Characteristic n * IPVP Bivariate OR Multivariate OR (weighted) (95% CI) (95% CI) Pregnancy Intention Wanted to be pregnant then % Referent Wanted to be pregnant sooner % 0.34 ( ) Wanted to be pregnant later % 3.13 ( ) Never wanted to be pregnant % 3.65 ( ) Maternal Smoking ║ No % Referent Yes % 7.19 ( ) Maternal Alcohol Use Before Pregnancy ¶ <1 drink/week % Referent 1+ drink/week % 4.26 ( ) *Unweighted number of respondents. ║Maternal smoking in the first trimester of pregnancy. ¶ Maternal drinking in the three months prior to pregnancy.

Discussion Feldhaus’ Physical Violence Screen (PVS) proved effective in ER setting: – Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? (If so by whom?) – Do you feel safe in your current relationship? – Is there a partner from a previous relationship who is making you feel unsafe now?

Discussion Women who argued with their husband or partner more than usual in the 12 months before delivery were more likely to have been victims of IPVP than women who had not argued more than usual. Oregon PRAMS data suggest that an additional screening question might be asked of obstetrics patients about arguing: – Have you and your husband (or partner) argued more than usual in the past year?

Limitations 1. Women less than 20 years old were not asked about IPV. 2. Only women with live births were asked about IPVP. 3. IPV has almost certainly been underreported in this survey. 4. Recall bias

Conclusions We believe that prenatal care providers should ask women about arguing at least once per trimester, and at postpartum follow up visits. While arguing itself may not be the cause of abuse in a relationship, it may alert practitioners to patients at higher risk for violence. Additionally, we recommend that information about abuse should be included in infants’ charts to remind the infant’s providers to be alert for signs of the recurrence of abuse

Acknowledgments We thank Tina Kent for her work on Oregon PRAMS, and Bertha Moseson, MD and Nancy Glass, PhD, for their contributions to this work. We also thank the Maternal and Child Health Bureau of the Health Resources and Services Administration and the Centers for Disease Control and Prevention for their support of Oregon PRAMS.