Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba

OBJECTIVE: To describe the prevalence and correlates of physical abuse during the year of pregnancy and to explore the association between physical abuse and other risk factors for preterm birth. DESIGN: Secondary analysis of data from a case-control study of risk factors for preterm birth. SETTING: Two tertiary care hospitals in the Canadian province of Manitoba. PARTICIPANTS: Six hundred eighty postpartum women who delivered a live singleton newborn after spontaneous onset of labor. MAIN OUTCOME MEASURES: Instruments included the Abuse Assessment Screen, Prenatal Psychosocial Profile, Perceived Stress Scale, and a questionnaire to collect data on demographic characteristics, complications during pregnancy, and lifestyle behaviors. RESULTS: Sixty-four women (9.4%) reported being physically abused during the year of pregnancy. Abused women were significantly more likely to be younger, single, of lower income, and less educated than nonabused women. Significant correlates of abuse, after adjusting for other factors in a logistic regression, included the following: illicit drug use, low support from partner, moving two or more times in the past year, high life event stress, bladder infection during pregnancy, Aboriginal race/ethnicity, and single marital status. CONCLUSION: This study suggests that physical abuse during pregnancy is associated with other risk factors for preterm birth, particularly stress and behavioral risk factors such as substance abuse.     

Additional antibiotic use and preterm birth among bacteriuric and nonbacteriuric pregnant women

OBJECTIVES: To determine the magnitude of and factors associated with spousal abuse during pregnancy in women presenting to tertiary care hospitals in Karachi, Pakistan. METHODS: Five hundred women who delivered a live singleton baby were interviewed. Physical and/or emotional abuse during pregnancy (PEAP) was the primary outcome measure as determined by the World Health Organization's domestic violence module. Frequencies of different forms of abuse were measured and the relationship between PEAP and the risk factors was determined using multiple logistic regression. RESULTS: Of the women interviewed, 44% reported abuse during the index pregnancy; and of these, 43% experienced emotional abuse and 12.6% reported physical abuse. Factors independently associated with PEAP were number of living children (adjusted odds ratio [AOR] 1.34; CI, 1.08-1.65), interfamilial conflicts (AOR 3.03; CI, 1.85-4.96), husband's exposure to maternal abuse (AOR, 2.38; CI, 1.41-4.02), and husband's use of tobacco (AOR 1.59; CI, 1.05-2.42). Women who had adequate social support were less likely to be abused by their husbands (AOR 0.65; CI, 0.51-0.82). CONCLUSIONS: Almost half of the pregnant women interviewed were either physically or emotionally abused. Strong social support helps protect against abuse.     

The relationship between psychosocial profile, health practices, and pregnancy outcomes

BACKGROUND: The influence of psychosocial factors such as stress, anxiety, depression, and self-esteem on birth weight is controversial. A prospective study was conducted to evaluate the relationship between pregnancy outcomes, psychosocial profile, and maternal health practices. METHODS: 3,149 low-income, predominantly African-American pregnant women participated in this study. A 28-item psychosocial scale measured the constructs of negative and positive affect, self esteem, mastery, worry, and stress. Maternal health practices were assessed with 11 questions dealing with diet, exercise, and the use of preventive medical and dental services. RESULTS: A low score on either scale indicated "poor" psychosocial or health practices status. Low birth weight, preterm delivery, and intrauterine growth retardation occurred in 10.9, 10.1 and 7.3% of the pregnant women respectively. In women with low psychosocial scores, the risk of both low birth weight and preterm delivery was 40% higher and the mean birth weight of infants was 51 g (p =0.02) lower as compared to women with high scores. Negative affect (a measure of depression) was the only factor significantly associated with both infant birth weight (beta = -71.2, p =0.001) and low birth weight (AOR=1.4, 95% CI = 1.1-1.7). When data were stratified by body mass index, the adverse effect of negative affect scores on birth weight and low birth weight was present only in thin women. Health practice scores were not associated with any of the pregnancy outcomes. CONCLUSION: Thin women with a poor psychosocial profile and who are depressed during pregnancy are at increased risk of giving birth to low birth weight and preterm infants.     

Childhood Abuse and Common Complaints in Pregnancy

Background: Childhood abuse affects adult health. The objective of this study was to examine the prevalence of emotional, physical, and sexual childhood abuse within a large Norwegian cohort of pregnant women and its association with common complaints in pregnancy. Methods: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Regression analyses were used to examine associations of childhood abuse and 16 common complaints in pregnancy. Results: Eighteen percent (10,363/55,776) of the women reported some type of childhood abuse. Of all women, 3,870 (6.9%) reported sexual abuse, 3,075 (5.5%) physical abuse, and 7,619 (13.6%) emotional abuse as a child. Of those reporting childhood abuse, 31 percent reported two or more types of abuse. All 16 common complaints in pregnancy were associated with reported childhood abuse. Women reporting three types of childhood abuse reported 5.4 common complaints in pregnancy (mean) compared with 3.7 for women without childhood abuse (p < 0.001). Women reporting childhood abuse are more likely to report seven or more common complaints in pregnancy: adjusted odds ratio (AOR) 1.7 (95% CI 1.6–1.9) for emotional abuse; AOR 2.5 (95% CI 2.0–3.1) for combined physical and sexual abuse; and AOR 3.5 (95% CI 3.0–4.0) for all three kinds of abuse. Sociodemographic characteristics and other risk factors did not explain this graded association. Conclusions: Abuse in childhood is associated with increased reporting of common complaints of pregnancy. Clinicians should consider the possible role of childhood abuse when treating women with many common complaints in pregnancy.     

The possible preterm birth preventive effect of ampicillin during pregnancy

Objective: To study the possible association between oral ampicillin treatment during pregnancy and pregnancy complications, in addition to birth outcomes, particularly preterm birth. Methods: We evaluated newborn infants without congenital abnormalities born to mothers with or without ampicillin treatment during pregnancy in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Results: Of 38,151 newborn infants, 2,630 (6.9%) had mothers with ampicillin treatment during pregnancy. Some pregnancy complications, particularly preeclampsia, showed a higher prevalence in pregnant women with ampicillin treatment. Mean gestational age was slightly longer (0.2 week) but it resulted in a significant reduction in the prevalence of preterm birth (7.1 vs 9.3%; adjusted POR with 95% CI: 0.8, 0.7–0.9). The preterm birth preventive effect of ampicillin was most obvious after the use of the drug in the first trimester of pregnancy. Similar difference was not seen in the reduction of low birth weight. The rate of preterm birth was lower in newborn infants born to mothers with acute infectious diseases of both the genitourinary and respiratory systems if they were treated by ampicillin. Conclusions: Ampicillin treatment, particularly in the first trimester of gestation, can reduce the proportion of preterm birth in pregnant women with acute infectious diseases of the genitourinary and respiratory system.     

The Interrelationships Between Abuse, Substance Use, and Psychosocial Stress During Pregnancy

Objective: To describe the association between abuse during pregnancy and substance use and psychosocial stress.
Design: Prospective study of pregnant women.
Setting: Urban prenatal clinics.
Participants: 1,937 predominately low-income, ethnically diverse women.
Main Outcome Measures(s): Three questions from the Abuse Assessment Screen were used to measure abuse. For the total sample, 25.7% reported physical abuse in the past year, 10.5% physical abuse since pregnancy, and 4.5% sexual abuse in the past year. Adolescents were significantly more likely to report any abuse (37.6%) than were adults (22.6%) (chi-square = 44.94; df = 1; p < 0.001). White abused women were significantly more likely to report use of tobacco (chi-square = 17.34; df = 1; p < 0.001) and alcohol (chi-square = 5.65; df = 1, p < 0.01). Abused Asian women were more likely to smoke (chi-square = 12.13; df = 1, p < 0.001), as were women ethnically described as "other" (chi-square = 8.39; df = 1, p < 0.001). There was a higher, but not statistically significant, rate of substance use between abused and nonabused African-American, Native-American, and Hispanic women. Abused women of all races reported higher stress, less support from partners, less support from others, and lower self-esteem.
Conclusions: Abuse during pregnancy is associated with an increased incidence of substance use and psychosocial stress. These relationships must be incorporated into the clinical care of abused pregnant women.     

Weight gain and spontaneous preterm birth: the role of race or ethnicity and previous preterm birth

OBJECTIVE: To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status. METHODS: This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.27 kg/wk,), normal (0.27-0.52 kg/wk), or high (more than 0.52 kg/wk). Univariable and multivariable analyses were performed on the relationship between weight gain categories and spontaneous preterm birth, stratified by maternal race or ethnicity and history of previous preterm birth. RESULTS: Overall, low weight gain was associated with spontaneous preterm birth (adjusted odds ratio [AOR] 2.5, 95% confidence interval [CI] 2.0-3.1). Although low gain was consistently associated with increased spontaneous preterm birth, some differences were found in subgroup analysis. Among African Americans with a previous preterm birth, both low and high weight gain were associated with increased odds of spontaneous preterm birth (AOR for low weight gain 4.3, 95% CI 1.2-15.5; AOR for high weight gain 6.1, 95% CI 1.8-20.2). For all other groups, high weight gain was not associated with spontaneous preterm birth. Among Asians with a previous preterm birth, low weight gain was not statistically significantly associated with spontaneous preterm birth (AOR 1.9, 95% CI 0.5-7.7). Among Asians there was also a non-statistically significant inverse relationship between high weight gain and spontaneous preterm birth (AOR 0.5, 95% CI 0.3-1.1). CONCLUSION: These results confirm an association between low maternal weight gain and spontaneous preterm birth. The effect modification of maternal race or ethnicity and history of previous preterm birth on this association deserves further study. LEVEL OF EVIDENCE: II-2.     

Lifetime and during pregnancy experience of violence and the risk of low birth weight and preterm birth

In order to assess the relationship between lifetime and during pregnancy experience of violence and low birth weight (LBW) and preterm birth outcomes, we designed a prospective cohort study in which the birth outcomes of women who experienced violence before their pregnancy or who experienced violence during pregnancy were compared to women who reported no lifetime experience of violence. We found that the risk of having a low birth weight or preterm baby was higher for women who did not experience violence. The proportion of women who had LBW babies was 7.1% for women who experienced violence during pregnancy, 7.8% for women who experienced violence before the current pregnancy, and 9.1% for nonexposed women. The proportion of preterm births was 3.5% for women exposed to violence during pregnancy, 8.5% for women exposed before the current pregnancy, and 9.7% for nonexposed women. However, married women who experienced violence had a higher proportion of LBW and preterm infants compared to the reference group of nonvictims of violence. Overall, women who experienced violence during pregnancy and before their current pregnancy did not have a greater proportion of LBW babies or preterm births. The findings suggest that married women in certain populations may experience more frequent or more severe experience of violence than unmarried women.     

Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua

OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.     

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal

BACKGROUND: Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women. METHODS: In a case-control study, 1400 pregnant women attending Patan Hospital, Kathmandu, Nepal for antenatal care and delivery in the period 1994 to 1996 were included. Women with twin pregnancies (n=15) and those delivering infants with congenital malformations (n=13) were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery, Apgar score, mode of delivery, and perinatal death. Linear and logistic regression models were used to analyze data. RESULTS: Severe anemia (hematocrit < or =24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (<37 weeks gestation). High hematocrit values (> or =40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score or operative deliveries was significantly increased in women with severe anemia in the first trimester. Teenagers, women with short height or low body mass index, and those belonging to the ethnic group Brahmins, had significantly higher risks of delivering low birth weight infants. CONCLUSIONS: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvements in the nutritional status of young Nepali women could contribute to improved health among their infants.     

A prospective observational study of domestic violence during pregnancy

OBJECTIVE: To assess whether women reporting domestic violence are at increased risk for adverse pregnancy outcomes. METHODS: A screening questionnaire, previously validated for the identification of female victims of domestic violence, was offered to women presenting to our Labor and Delivery Unit. The survey prompted women to indicate whether her partner or family member physically hurt her, insulted or talked down to her, threatened her with harm, or screamed or cursed at her. The primary study outcome was to detect a 3-fold increase in low birth weight infants (< or = 2,500 g) in women reporting physical abuse, compared with those not reporting domestic violence. RESULTS: A total of 16,041 women were approached to be interviewed. Of these, 949 (6%) women responded affirmatively to one or more of the survey questions, and another 94 (0.6%) declined to be interviewed. The incidence of low birth weight infants was significantly increased in women who reported verbal abuse, compared with the no-abuse group (7.6% versus 5.1%, respectively, P = .002). Physical abuse was associated with an increased risk of neonatal death (1.5% versus 0.2%, P = .004). Interestingly, women who declined to be interviewed had significantly increased rates of low birth weight infants (12.8% versus 5.1%, P < .001), preterm birth at 32 weeks of gestation or less (5.3% versus 1.2%, P = .002), placental abruptions (2.1% versus 0.2%, P < .001), and neonatal intensive care admissions (7.4% versus 2.2%, P = .008) when compared with women in the no-abuse group, respectively. CONCLUSION: Women who declined to be surveyed regarding domestic violence were at increased risk for adverse pregnancy outcome. LEVEL OF EVIDENCE: II-2.     

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth.

OBJECTIVE: To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent. METHOD: The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared. RESULTS. Of 38,151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27-0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups. CONCLUSION: Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.     

Clinical evaluation of periodontium in pregnant women with risk of preterm birth

OBJECTIVES: The aim of the study was to evaluate condition of the periodontium in pregnant women with pathological progress of the pregnancy, clinically and to compare it to periodontium in pregnant women in good health. DESIGN: Over the last years, the studies have described that periodontitis caused by dental plaque, could be the risk factor for preterm birth and low birth weight. MATERIALS AND METHODS: This study was performed in 80 pregnant women, 40 with pathologic pregnancy and 40 with normal pregnancy in it. Periodontal Indexes were used to evaluate periodontium. RESULTS: In the searching group gingivitis gravidarum haemorrhagica diffusa and hyperplastica generalisata were dominating. In the control group gingivitis gravidatum simplex and hyperplastica localisata were observed. CONCLUSIONS: More severe manifestation of gingivitis gravidarum was noticed in pregnant women with risk of preterm low birth.We did not prove correlation between amount of bacterial dental plaque in pregnant women and risk of preterm low birth weight.     

Risk of preeclampsia in HIV-positive pregnant women receiving HAART: a matched cohort study

Objective: We sought to determine whether HIV-positive women receiving highly active anti-retroviral therapy (HAART) are at higher risk for preeclampsia than HIV-negative women. Secondary outcomes included comparing the risks of preterm birth, low birth weight, and small for gestational age birth in these women. Methods: In this retrospective matched cohort study, we compared the pregnancy outcomes of HIV-positive women treated with HAART with those of HIV-negative women who gave birth at Mount Sinai Hospital, Toronto, Ontario. Data were ascertained through chart review. Univariate and multivariate logistic regression models were used to compare pregnancy outcomes between the two groups. Results: Ninety-one HIV-positive pregnant women receiving HAART and 273 HIV-negative pregnant women were identified. After adjusting for confounding factors, there was no difference between HIV-positive and HIV-negative women in the odds of preeclampsia (3.3% vs. 5.1%; adjusted odds ratio [aOR] 0.59; 95% CI 0.11 to 3.08), preterm birth (15.6% vs. 11.4%; aOR 1.70, 95% CI 0.79 to 3.66) or small for gestational age infants (20.2% vs. 8.8%; aOR 2.08, 95% CI 0.89 to 5.24). HIV-positive women treated with HAART had increased odds of giving birth to a low birth weight infant compared to HIV-negative women (20.2% vs. 9.9%; aOR 2.91; 95% CI 1.47 to 5.78). Conclusion: In this cohort, HIV-positive women on HAART did not demonstrate a higher risk of preeclampsia, preterm birth, or small for gestational age infants; however, they did have a higher risk of having low birth weight infants.     

Preterm delivery and the severity of violence during pregnancy.

OBJECTIVE: To determine the severity and consequences of physical violence during pregnancy among participants in a health department prenatal care coordination program. STUDY DESIGN: The prospective cohort study included all program participants from 1994 to 1996. Care coordinators screened participants for physical violence during pregnancy using a validated, systematic assessment protocol three times during prenatal care. The protocol was linked with prenatal records, delivery records and infant records to document complications and infant outcomes. Multiple logistic regression was used to assess the relationship between severe physical violence during pregnancy and pregnancy outcome while controlling for confounding factors. RESULTS: Among the 550 participants, 13.5% reported violence during pregnancy; it included 6.7% severe violence (hitting, kicking, injury with a weapon and abdominal injury) and 6.7% moderate violence (threats, slapping, shoving and sexual abuse). Severe physical prenatal violence was significantly associated with spontaneous preterm labor, preterm delivery, very preterm delivery, very low birth weight, preterm/low birth weight, mean birth weight, mean newborn hospital charges, five-minute Apgar < 7, neonatal intensive care unit admission, and fetal or neonatal death. Body site injured, timing of violence and number of violent incidents were significant factors associated with violence during pregnancy and preterm delivery. CONCLUSION: Because severe physical violence during pregnancy was a significant problem in this population, intervention programs are needed to reduce prenatal violence and its consequences.     

Risk of preterm delivery in relation to maternal low birth weight

OBJECTIVE: We examined the relationship between maternal low birth weight and preterm delivery risk. METHODS: Information concerning maternal birth weight was collected during in-person interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Preterm delivery cases were studied in aggregate, in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34-36 weeks], and early preterm delivery [gestational age at delivery<34 weeks]). RESULTS: After adjusting for confounders, women weighing<2,500 g at birth had a 1.54-fold increased risk of preterm delivery versus women weighing=2,500 g (95% CI 0.97-2.44). Maternal low birth weight was associated with a 2-fold increased risk of spontaneous preterm delivery (95% CI 1.03-3.89), but weakly associated with preterm premature rupture of membranes (OR=1.44; 95% CI 0.67-3.09) and medically induced preterm delivery (OR=1.10; 95% CI 0.43-2.82). Maternal low birth weight was more strongly associated with early preterm delivery (OR=1.94) than with moderate preterm delivery (OR=1.46). Women weighing<2,500 g at birth and who became obese (pre-pregnancy body mass index, =30 kg/m2) before pregnancy had a 3.65-fold increased risk of preterm delivery (95% CI 1.33-10.02) versus women weighing=2,500 g at birth and who were not obese prior to pregnancy (<30 kg/m2). CONCLUSIONS: Results confirm earlier findings linking maternal low birth weight with future risk of preterm delivery.     

Intimate partner violence and birth outcomes: a systematic review

OBJECTIVE: There is a lack of comprehensive information on the relationship between domestic physical and emotional violence and pregnancy outcomes. Accordingly, we undertook this systematic review of the literature to examine the evidence on the association between physical and emotional abuse and pregnancy outcomes. STUDY DESIGN AND METHOD: A comprehensive literature search was carried out using pertinent key words that would retrieve any research article pertaining to the topic. This was supplemented by cross-referencing of the articles. A total of 296 articles were found; case reports and articles that failed to satisfy the study inclusion criteria were removed and 30 articles were included in the review. RESULTS: Overall, adverse pregnancy outcomes, including low birth weight, maternal mortality and infant mortality are significantly more likely among abused than nonabused mothers. Abused pregnant mothers present more often than nonabused mothers with kidney infections, gain less weight during pregnancy, and are more likely to undergo operative delivery. Fetal morbidity, such as low birth weight, preterm delivery, and small size for gestational age are more frequent among abused than nonabused gravidas. The risk for maternal mortality is three times as high for abused mothers. Black abused mothers are 3-4 times as likely to die as their white counterparts. Unmarried victims are also three times as likely to die as married abused mothers. Intimate partner violence is also responsible for increased fetal deaths in affected pregnancies (about 16.0 per 1000). CONCLUSION: Intimate partner violence is often a life-threatening event to both the mother and the fetus. This, in addition to the heightened level of feto-maternal morbidity and mortality, represents clear-cut justification for routine systematic screening for the presence of abuse during pregnancy.     

Admission for nephrolithiasis in pregnancy and risk of adverse birth outcomes

OBJECTIVE: Nephrolithiasis occurring during pregnancy may be associated with an elevated risk of preterm delivery and other adverse birth outcomes. The goal of this study was to describe the association between these outcomes and admission for nephrolithiasis during pregnancy. METHODS: We performed a retrospective cohort study using birth certificate records linked to Washington State hospital discharge data from 1987-2003 to compare pregnant women admitted for nephrolithiasis and randomly selected pregnant women without nephrolithiasis. The main outcomes of interest were preterm delivery, premature rupture of membranes at term or before 37 weeks of gestation, low birth weight, and infant death. RESULTS: A total of 2,239 women were admitted for nephrolithiasis, yielding a cumulative incidence of 1.7 admissions per 1,000 deliveries. Women admitted for nephrolithiasis during pregnancy had nearly double the risk of preterm delivery compared with women without stones (adjusted odds ratio 1.8, 95% confidence interval 1.5-2.1). However, they were not at higher risk for the other outcomes investigated. A total of 471 (25.9%) women had one or more procedures for kidney stones during prenatal hospitalization. Undergoing a procedure and the trimester of admission did not affect the risk of preterm delivery. CONCLUSION: Although the incidence of nephrolithiasis requiring hospital admission during pregnancy is relatively low, these women have an increased risk of preterm delivery. This has potential implications for counseling of pregnant women with kidney stones requiring hospital admission. Additionally, it may prompt definitive treatment of small, asymptomatic stones in women during reproductive years.     

Prenatal predictors of intimate partner abuse

OBJECTIVE: To determine the prevalence of physical abuse and to identify predictors of abuse in a sample of pregnant women in Alabama. DESIGN: A prospective, correlational design was used. SETTING: Participants were drawn from four unrelated public and private prenatal clinics in Tuscaloosa, Alabama. PARTICIPANTS: The sample consisted of pregnant women between 20 and 34 years of age who had no high-risk health conditions and who initiated prenatal care during the 1st trimester. Four hundred thirty-nine ethnically diverse women completed interviews during the 1st and 3rd trimesters and had available birth outcomes. MAIN OUTCOME MEASURE: Physical abuse during pregnancy was measured by a modified version of the Abuse Assessment Screen. Bivariate and multiple logistic regressions yielded significant associations between individual predictors and physical abuse during pregnancy. RESULTS: The findings showed that 10.9% of the sample experienced physical abuse during the current pregnancy and 62% reported the intimate partner or former intimate partner to be the perpetrator. The best predictive model included stressful life events, depression, lack of faith in God or a higher power, and lack of contraceptive use.