Spontaneous abortion (SAB) is the most common adverse outcome of pregnancy, and violence may be the most prevalent reproductive risk factor among urban, low-income women. However, little is known about the impact of violence on the risk of SAB.
The specific aims of this case-control study are to: 1) characterize the prevalence and type of violence experienced by women early in pregnancy; 2) evaluate whether violence during pregnancy is an important, independent risk factor for SAB; 3) evaluate whether the frequency, nature, or timing of violence affects the risk of SAB; and 4) generate hypotheses regarding prevention and intervention programs for urban, low-income pregnancy women. Women 14-40 years of age from a defined inner-city community who attend the Hospital of the University of Pennsylvania's (HUP) ED will be screened for pregnancy. Cases (N=465) will include women who present with a SAB or who experience a SAB during the follow-up period. Controls (N=759) will include all women with intrauterine singleton pregnancies that continue through 20 weeks gestational age. Standardized baseline data collection will include structured in-person interview, laboratory analyses of hair and urine for continine, alcohol, and drugs of abuse. Chromosomal analyses will be conducted on products of conception for approximately 120 cases who abort at HUP. Follow-up telephone interviews will take place at 16 and 20 weeks gestation. Pregnancy outcome status will also be ascertained through ongoing review of medical records, pathology logs, and birth certificates. Initial analyses will be exploratory and descriptive, characterizing cases and controls by current or past violence, age, substance use, social isolation, etc. The primary analysis will be logistic regression, with odds ratios and 95% confidence intervals. We will explore whether the effect of violence eon spontaneous abortion varies with the chromosomal status of the fetus as well as according to the timing, frequency and nature of violent incidents. Finally, we will characterize the patterns of use of health and social services agencies by abused women early in pregnancy. The significance of this study lies in its capacity to provide basic epidemiological data regarding the nature and circumstance of violence among pregnancy inner-city women, evaluate whether violence is an independent predictor of spontaneous abortion, and ultimately contribute information important to designing effective treatment and prevention intervention in urban settings. NCRR Clarification: research is on miscarriage
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