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378: Intimate partner violence and adverse pregnancy outcomes
SMFM Abstracts 375
www.AJOG.org
AGE AT MENARCHE AND THE RISK OF OPERATIVE FIRST DELIVERY GORDON SMITH1, 1 Cambridge University, Obstetrics & Gynecology, Cambridge, United Kingdom OBJECTIVE: The risk of operative delivery at term increases linearly with the age of the mother. We have hypothesized that this is due to a deleterious effect of a prolonged interval between menarche and first birth on uterine function. The objective of this study was to test a prediction arising from that hypothesis, namely, that the risk of operative first delivery would decline with later age at menarche. STUDY DESIGN: We studied the relationship between age at menarche and the risk of operative delivery (a composite of cesarean, forceps or vacuum extraction) using data from ALSPAC, a multi-center prospective cohort study of women attending for prenatal care in South West England. The study group consisted of 3739 primipara in labor at term with a singleton liveborn infant in a cephalic presentation. RESULTS: The rate of operative delivery was highest among women with age at menarche in the bottom quartile (32.4%) and was lower in the second (30.3%), third (29.2%) and top (26.9%) quartiles (test for trend, P⫽0.01). When adjusted for height, body mass index, marital status, smoking status, induction of labor, week of gestation of delivery and birth weight percentile; the odds ratio for operative delivery associated with a 5 year increase in age at menarche (0.71, 95% CI ⫽ 0.54-0.92, P⫽0.01) was very similar to the odds ratio for a 5 year decrease in age at delivery (0.72, 95% CI ⫽ 0.66-0.79, P⬍0.001). There was no association between age at menarche and the risk of operative delivery following adjustment for the interval between menarche and the first birth (adjusted odds ratio 0.99, 95% CI ⫽ 0.78-1.25, P⫽0.91). CONCLUSION: (1) Later age at menarche is associated with a decreased risk of operative first childbirth, consistent with the hypothesis that a prolonged interval between menarche and first birth has a deleterious effect on uterine function. (2) This property of the uterus may explain a significant proportion of recent rises in cesarean section rate, through population trends of earlier menarche and later first childbirth.
DO PERINATAL OUTCOMES DIFFER AMONG THE AFRICAN DIASPORA? AYABA WORJOLOH1, LUCHIN WONG2, ALLISON BRYANT3, YVONNE CHENG4, SHANI DELANEY4, AARON CAUGHEY4, 1University of California San Francisco, South San Francisco, California, 2Santa Clara Valley Medical Center, San Jose, California, 3University of California San Francisco, San Francisco, California, 4University of California, San Francisco, San Francisco, California OBJECTIVE: To determine whether perinatal outcomes differ by country of origin among Black women delivering in the U.S. STUDY DESIGN: This is a retrospective cohort study of all Black women delivering in the U.S. in 2003. We assessed if maternal place of birth, U.S versus non-U.S, was predictive of selected perinatal outcomes. We examined pregnancy-associated hypertension (PAH), diabetes in pregnancy (DM/GDM), preterm delivery (PTD), low birthweight (⬍2500 gms) and term cesarean delivery (CD) as outcomes. We utilized univariate and multivariable analyses to control for potential confounding. RESULTS: Among the 574,437 Black women delivering in the U.S. in 2003, 103,746 were non-U.S. born (18.1%). All of the perinatal outcomes we examined differed between U.S. born and non-U.S. born Black women except for term cesarean delivery (Table 1). All findings of the univariate analyses persisted when we controlled for maternal age, parity, education, prenatal care, and previous preterm delivery. CONCLUSION: There is a higher frequency of many adverse perinatal outcomes among U.S Born black women compared to non-U.S Born. This suggests decreased risk for Black women born outside of the United States which may be hypothetically related to U.S. socioeconomic differences or behavioral or dietary differences. The exceptions were term cesarean delivery and diabetes of pregnancy. Further study is needed to determine what might account for these differences. Table 1 Comparison of perinatal outcomes in U.S. Born vs. Non-U.S. born Black women
PTD PTD⬍32 GH/preE DM/GDM Lbwt Term CD
U.S. Born
Non-U.S. born
p-value
12.6% 2.0% 4.3% 3.1% 8.2% 14.8%
10.8% 1.6% 2.4% 3.8% 6.7% 14.6%
⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 0.250
EFFECT OF A PREVIOUS CESAREAN DELIVERY ON NEONATAL OUTCOMES HAIM ABENHAIM1, WILLIAM FRASER2, ALICE BENJAMIN3, 1Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 2Ste-Justine, University of Montreal, Montréal, Quebec, Canada, 3McGill University, Montreal, Quebec, Canada OBJECTIVE: For various reasons, cesarean delivery have increased considerably over the last several decades resulting in a greater proportion of new pregnancies being in women with prior cesarean delivery. In our study, we sought to examine the effect of a previous cesarean delivery on neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study on all women with a prior birth who delivered at the Royal Victroia Hospital between 2001 and 2006. We defined our exposure as as having a positive history for cesarean delivery and used unconditional logistic regression analysis to estimate the adjusted effect of a previous cesarean delivery on adverse neonatal outcomes. RESULTS: There were 18,673 births that took place of which 9,708 were in women with a previous birth (77.0% with no previous cesarean delivery and 23.0% with a previous cesarean delivery). As compared to newborns delivered by mothers with no previous cesarean delivery, newborns of mothers with a previous cesarean delivery were more likely to be born ⬍37 week, OR 1.21 (1.04-1.40), p⫽0.01, develop respiratory distress syndrome, OR 1.94 (1.50-2.57), p⬍0.01, and be admitted to the neonatal ICU, OR 1.52 (1.30-1.77), p⬍0.01. CONCLUSION: Having a previous cesarean delivery is associated with an increased risk of adverse neonatal outcomes. When consenting women for cesarean delivery, consideration should be given to the potential effect it may have on neonatal outcomes of subsequent pregnancies. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.405
378
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.403
376
377
INTIMATE PARTNER VIOLENCE AND ADVERSE PREGNANCY OUTCOMES MATTHEW GARABEDIAN1, KRISTINE LAIN1, WENDY HANSEN1, LISANDRA GARCIA1, ANN COKER1, LESLIE CROFFORD1, 1University of Kentucky, Department of OB/GYN, Lexington, Kentucky OBJECTIVE: To evaluate the association between intimate partner violence (IPV) by type experienced (sexual, physical, or stalking) and third trimester bleeding, preeclampsia, and preterm labor (PTL). STUDY DESIGN: This is a cross-sectional study of parous women in the Kentucky Women=s Health Registry who indicated a history of IPV (n⫽3331). Adverse pregnancy outcomes were identified from a self-report questionnaire. Multivariate analysis controlled for age, education, race, and gravidity. RESULTS: A history of any IPV was associated with increased risk of third trimester bleeding (aRR 1.8; 95% CI 1.3 – 2.4), preeclampsia (1.5; 1.2 – 1.8), and PTL (1.5; 1.2 – 1.8). Sexual IPV with or without other types of IPV (stalking or physical) was more strongly associated with third trimester bleeding (2.8; 1.8-4.3), preeclampsia (1.4; 1.1-1.9), and PTL (1.7; 1.3-2.2) than were other forms of IPV. Physical IPV yet no sexual IPV was associated with bleeding (1.8; 1.2-2.8) and PTL (1.4; 1.1-1.8) but not preeclampsia (1.2; 0.9-1.6). Stalking by an intimate partner without sexual or physical IPV was associated with preeclampsia (1.4; 1.1-2.0) but not bleeding (1.3; 0.7-2.5) or PTL (1.2; 0.9-1.8). CONCLUSION: These data suggest different mechanisms by which varying types of IPV influence maternal complications. The trauma and psychological stress from physical or sexual IPV may differentially affect risk of bleeding and PTL. Partner stalking may affect preeclampsia risk through psychosocial stress levels. IPV is known to be associated with adverse pregnancy outcomes such as perinatal death and low birth weight neonates. This cross-sectional study shows significant associations between a history of intimate partner violence with preeclampsia, PTL, and third trimester bleeding, yet we cannot comment on whether the abuse was antecedent to the pregnancy outcomes. Our data highlight the need to screen for IPV among pregnant women and, when found, provide surveillance for a spectrum of adverse outcomes. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.406
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.404
S114
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
www.AJOG.org
AGE AT MENARCHE AND THE RISK OF OPERATIVE FIRST DELIVERY GORDON SMITH1, 1 Cambridge University, Obstetrics & Gynecology, Cambridge, United Kingdom OBJECTIVE: The risk of operative delivery at term increases linearly with the age of the mother. We have hypothesized that this is due to a deleterious effect of a prolonged interval between menarche and first birth on uterine function. The objective of this study was to test a prediction arising from that hypothesis, namely, that the risk of operative first delivery would decline with later age at menarche. STUDY DESIGN: We studied the relationship between age at menarche and the risk of operative delivery (a composite of cesarean, forceps or vacuum extraction) using data from ALSPAC, a multi-center prospective cohort study of women attending for prenatal care in South West England. The study group consisted of 3739 primipara in labor at term with a singleton liveborn infant in a cephalic presentation. RESULTS: The rate of operative delivery was highest among women with age at menarche in the bottom quartile (32.4%) and was lower in the second (30.3%), third (29.2%) and top (26.9%) quartiles (test for trend, P⫽0.01). When adjusted for height, body mass index, marital status, smoking status, induction of labor, week of gestation of delivery and birth weight percentile; the odds ratio for operative delivery associated with a 5 year increase in age at menarche (0.71, 95% CI ⫽ 0.54-0.92, P⫽0.01) was very similar to the odds ratio for a 5 year decrease in age at delivery (0.72, 95% CI ⫽ 0.66-0.79, P⬍0.001). There was no association between age at menarche and the risk of operative delivery following adjustment for the interval between menarche and the first birth (adjusted odds ratio 0.99, 95% CI ⫽ 0.78-1.25, P⫽0.91). CONCLUSION: (1) Later age at menarche is associated with a decreased risk of operative first childbirth, consistent with the hypothesis that a prolonged interval between menarche and first birth has a deleterious effect on uterine function. (2) This property of the uterus may explain a significant proportion of recent rises in cesarean section rate, through population trends of earlier menarche and later first childbirth.
DO PERINATAL OUTCOMES DIFFER AMONG THE AFRICAN DIASPORA? AYABA WORJOLOH1, LUCHIN WONG2, ALLISON BRYANT3, YVONNE CHENG4, SHANI DELANEY4, AARON CAUGHEY4, 1University of California San Francisco, South San Francisco, California, 2Santa Clara Valley Medical Center, San Jose, California, 3University of California San Francisco, San Francisco, California, 4University of California, San Francisco, San Francisco, California OBJECTIVE: To determine whether perinatal outcomes differ by country of origin among Black women delivering in the U.S. STUDY DESIGN: This is a retrospective cohort study of all Black women delivering in the U.S. in 2003. We assessed if maternal place of birth, U.S versus non-U.S, was predictive of selected perinatal outcomes. We examined pregnancy-associated hypertension (PAH), diabetes in pregnancy (DM/GDM), preterm delivery (PTD), low birthweight (⬍2500 gms) and term cesarean delivery (CD) as outcomes. We utilized univariate and multivariable analyses to control for potential confounding. RESULTS: Among the 574,437 Black women delivering in the U.S. in 2003, 103,746 were non-U.S. born (18.1%). All of the perinatal outcomes we examined differed between U.S. born and non-U.S. born Black women except for term cesarean delivery (Table 1). All findings of the univariate analyses persisted when we controlled for maternal age, parity, education, prenatal care, and previous preterm delivery. CONCLUSION: There is a higher frequency of many adverse perinatal outcomes among U.S Born black women compared to non-U.S Born. This suggests decreased risk for Black women born outside of the United States which may be hypothetically related to U.S. socioeconomic differences or behavioral or dietary differences. The exceptions were term cesarean delivery and diabetes of pregnancy. Further study is needed to determine what might account for these differences. Table 1 Comparison of perinatal outcomes in U.S. Born vs. Non-U.S. born Black women
PTD PTD⬍32 GH/preE DM/GDM Lbwt Term CD
U.S. Born
Non-U.S. born
p-value
12.6% 2.0% 4.3% 3.1% 8.2% 14.8%
10.8% 1.6% 2.4% 3.8% 6.7% 14.6%
⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 0.250
EFFECT OF A PREVIOUS CESAREAN DELIVERY ON NEONATAL OUTCOMES HAIM ABENHAIM1, WILLIAM FRASER2, ALICE BENJAMIN3, 1Jewish General Hospital, McGill University, Montreal, Quebec, Canada, 2Ste-Justine, University of Montreal, Montréal, Quebec, Canada, 3McGill University, Montreal, Quebec, Canada OBJECTIVE: For various reasons, cesarean delivery have increased considerably over the last several decades resulting in a greater proportion of new pregnancies being in women with prior cesarean delivery. In our study, we sought to examine the effect of a previous cesarean delivery on neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study on all women with a prior birth who delivered at the Royal Victroia Hospital between 2001 and 2006. We defined our exposure as as having a positive history for cesarean delivery and used unconditional logistic regression analysis to estimate the adjusted effect of a previous cesarean delivery on adverse neonatal outcomes. RESULTS: There were 18,673 births that took place of which 9,708 were in women with a previous birth (77.0% with no previous cesarean delivery and 23.0% with a previous cesarean delivery). As compared to newborns delivered by mothers with no previous cesarean delivery, newborns of mothers with a previous cesarean delivery were more likely to be born ⬍37 week, OR 1.21 (1.04-1.40), p⫽0.01, develop respiratory distress syndrome, OR 1.94 (1.50-2.57), p⬍0.01, and be admitted to the neonatal ICU, OR 1.52 (1.30-1.77), p⬍0.01. CONCLUSION: Having a previous cesarean delivery is associated with an increased risk of adverse neonatal outcomes. When consenting women for cesarean delivery, consideration should be given to the potential effect it may have on neonatal outcomes of subsequent pregnancies. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.405
378
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.403
376
377
INTIMATE PARTNER VIOLENCE AND ADVERSE PREGNANCY OUTCOMES MATTHEW GARABEDIAN1, KRISTINE LAIN1, WENDY HANSEN1, LISANDRA GARCIA1, ANN COKER1, LESLIE CROFFORD1, 1University of Kentucky, Department of OB/GYN, Lexington, Kentucky OBJECTIVE: To evaluate the association between intimate partner violence (IPV) by type experienced (sexual, physical, or stalking) and third trimester bleeding, preeclampsia, and preterm labor (PTL). STUDY DESIGN: This is a cross-sectional study of parous women in the Kentucky Women=s Health Registry who indicated a history of IPV (n⫽3331). Adverse pregnancy outcomes were identified from a self-report questionnaire. Multivariate analysis controlled for age, education, race, and gravidity. RESULTS: A history of any IPV was associated with increased risk of third trimester bleeding (aRR 1.8; 95% CI 1.3 – 2.4), preeclampsia (1.5; 1.2 – 1.8), and PTL (1.5; 1.2 – 1.8). Sexual IPV with or without other types of IPV (stalking or physical) was more strongly associated with third trimester bleeding (2.8; 1.8-4.3), preeclampsia (1.4; 1.1-1.9), and PTL (1.7; 1.3-2.2) than were other forms of IPV. Physical IPV yet no sexual IPV was associated with bleeding (1.8; 1.2-2.8) and PTL (1.4; 1.1-1.8) but not preeclampsia (1.2; 0.9-1.6). Stalking by an intimate partner without sexual or physical IPV was associated with preeclampsia (1.4; 1.1-2.0) but not bleeding (1.3; 0.7-2.5) or PTL (1.2; 0.9-1.8). CONCLUSION: These data suggest different mechanisms by which varying types of IPV influence maternal complications. The trauma and psychological stress from physical or sexual IPV may differentially affect risk of bleeding and PTL. Partner stalking may affect preeclampsia risk through psychosocial stress levels. IPV is known to be associated with adverse pregnancy outcomes such as perinatal death and low birth weight neonates. This cross-sectional study shows significant associations between a history of intimate partner violence with preeclampsia, PTL, and third trimester bleeding, yet we cannot comment on whether the abuse was antecedent to the pregnancy outcomes. Our data highlight the need to screen for IPV among pregnant women and, when found, provide surveillance for a spectrum of adverse outcomes. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.406
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.404
S114
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008