Association of intimate partner violence with late entry into prenatal care, Maryland 2004-2008 births

Background: Although intimate partner violence (IPV) during pregnancy has been well researched, few studies have looked at the relationship between IPV before/during pregnancy and late entry into prenatal care. Objective: To determine the relationship between IPV before/during pregnancy and late entry into prenatal care. Methods: Using stratified random sampling, data were obtained from 8,074 Maryland mothers who delivered infants during the years 2004-2008 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) postpartum survey. Descriptive and multivariate logistic analyses were performed using SAS 9.2. IPV included being physically hurt by a current or ex-partner in the 12 months preceding or during the most recent pregnancy. Late entry into prenatal care referred to women who did not report a prenatal care visit during the first 12 weeks of gestation. Results: In Maryland, 23.3% of women started prenatal care after the 1st trimester. Of the 7.4% who reported IPV the year before/during pregnancy, 36.0% entered prenatal care late. Women with the highest prevalence of IPV were black (10.5%), <25 years of age (13.3%), and uninsured (11.1%). Abused women were twice as likely to report late prenatal care as non-abused women [Odds Ratio (OR):2.00, 95% confidence interval (1.47-2.71)]. After adjusting for race, age, and insurance coverage, the adjusted OR was 1.2 (0.84-1.71). Conclusion: IPV may be associated with delayed entry into prenatal care, but other factors associated with IPV such as lack of insurance coverage also contribute. Further studies are necessary to better elucidate the complex relationship of IPV with prenatal care initiation.