Intimate partner violence among delivery-related discharges in the United States and its impact on maternal-fetal pregnancy outcomes. HCUP (NIS), 2002-2009

ABSTRACT

 

Background: Intimate partner violence (IPV) is a growing public health concern in the United States. Data from 27 states and the city of New York showed a 3.6% IPV prevalence among women who gave birth from 2004-2007. Method: We used the Nationwide Inpatient Sample (NIS) dataset from HCUP (2002-2009). We diagnosed IPV and an array of maternal-fetal outcomes in maternal delivery hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) codes. The distribution of IPV by selected socio-demographic, behavioral, geographic, and hospital characteristics, was assessed using descriptive statistics. Survey logistic regression was used to examine the association between IPV and each adverse pregnancy outcome. Joinpoint regression was then used to investigate temporal trends in IPV over the 8-year study period. Results: A total of 3,649 cases of IPV were identified among the 32,658,259 delivery-related hospitalizations yielding a prevalence of 11.2 (95% CI=10.0-12.4) per 100,000 deliveries. From 2002-2009, there was no significant increase in the rate of IPV in this study. After adjustment for potential confounders, delivery discharges with an IPV diagnosis were at an increased risk of cesarean delivery [OR=1.29 (95% CI= 1.08, 1.54)], preterm delivery [OR=1.97 (95% CI= 1.59, 2.44)],  prolonged hospital stay (≥ 4days) [OR=2.43 (95% CI= 2.04, 2.91)], anxiety [OR=2.57 (95% CI= 1.40, 4.73)], fetal death [OR=3.34 (95% CI= 1.99, 5.61)], stillbirth [OR=4.12 (95% CI=2.75, 6.17)], and, depression [OR=6.05 (95% CI= 4.51 8.12)], Conclusion: Public health efforts to alleviate adverse birth outcomes should consider IPV as a significant risk factor.