201868 Childhood abuse exposures and reproductive outcomes

Sunday, November 8, 2009

Matthew J. Garabedian, MD, MPH , Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY
Corrine Williams, ScD , Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY
Ann L. Coker, PhD , Department of Obstetrics & Gynecology, University of Kentucky College of Medicine, Lexington, KY
Leslie Crofford, MD , Internal Medicine/Rheumatology, University of Kentucky, Lexington, KY
OBJECTIVE

To evaluate the association between childhood abuse exposures (physical and sexual) and adverse pregnancy outcomes (preterm labor, preeclampsia, ectopic pregnancy).

STUDY DESIGN

This is a cross sectional study of parous women in the Kentucky Women's Health Registry (n=3,346). History of childhood violence exposure, preterm labor, preeclampsia, and ectopic pregnancy was identified in a self-report questionnaire. Multivariate analysis controlled for age, education, race/ethnicity, smoking history, and parity.

RESULTS

In multivariate analyses, childhood sexual abuse (9% exposed) was associated with an increased rate of preterm labor (RR 1.50, 95% CI 1.11 2.05) and preeclampsia (RR 1.91, 95% CI 1.39 2.63), yet not ectopic pregnancy (RR 1.42, 95% CI 0.69 2.91). Childhood physical abuse (18% exposed) was associated with an increased rate of preterm labor (RR 1.30, 95% CI 1.01 1.66), but not preeclampsia (RR 1.26, 95% CI 0.96 1.66) or ectopic pregnancy (1.60, 95% CI 0.93 2.75).

CONCLUSIONS

Childhood abuse exposures, but particularly sexual abuse, are associated with some adverse pregnancy outcomes, but not all. The association with preterm labor and preeclampsia may be related to chronic stress and dysregulation of the hypothalamic-pituitary-adrenal axis. The lack of association with ectopic pregnancy may argue for a different causal pathway, and against recall bias being the sole explanation for the observed relationships of violence exposures and adverse reproductive outcomes. These findings highlight the need to screen for history of violence exposures and, when found, provide surveillance for a spectrum of adverse outcomes.

Learning Objectives:
1. Discuss how reproductive outcomes are influenced by a history of childhood abuse exposure; 2. Differentiate the reproductive risks associated with a history of sexual abuse versus physical abuse; 3. Describe a theoretical model explaining the association between childhood abuse exposures and reproductive outcomes

Keywords: Reproductive Health, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I helped conceive this project and have presented on intimate partner violence and adverse pregnancy outcomes at the Society for Maternal Fetal Medicine annual conference this year (Jan, 2009). I am a fellow in Maternal Fetal Medicine and have a background in public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.