Childhood abuse exposures and reproductive outcomes

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.