Accessible data to investigate for birth outcomes comprised of 87.4 % (n = 1694) of the original cohort (N = 1939). The mean age (at recruitment) was 30 years (mean 30.12, SD 4.8; min 18 - 48 years) and for the majority of women Swedish was their first language. Among those women, almost 4 in 10 women reported a history of violence (n = 656), categories of significant difference were single or living apart, unemployed and experiencing financial distress (Table 1). In this particular cohort 2% (n = 34) women reported experiencing DV during pregnancy (Q-I – Q-II) and all had a history of experiencing violence.
Table 1. Socio-demographic factors at recruitment in early second trimester (N = 1694).
Characteristics
|
Total
|
History of violence 1
|
P
|
Total n (%)
|
n (%)
1687 (100)
|
No
n (%)
1031(61.1)
|
Yes
n (%)
656 (38.9)
|
Age, years
18-25
26-34
≥ 35
Missing =29
|
293 (17.6)
1067 (64.1)
305 (18.3)
|
178 (17.4)
666 (65.2)
178 (17.4)
|
115 (17.9)
401 (62.4)
127 (19.8)
|
0.426
|
Cohabiting status
Single/Living apart
Common law spouse/married
Missing = 56
|
84 (5.1)
1554 (94.9)
|
30 (3.0)
969 (97.0)
|
54 (8.5)
585 (91.5)
|
0.001
|
Language
Swedish
Foreign language
Missing = 11
|
1271 (75.5)
412 (24.5)
|
766 (74.5)
262 (25.5)
|
505 (77.1)
150 (22.9)
|
0.229
|
Educational status
Low educational status
High educational status
Missing = 7
|
555 (32.9)
1132 (67.1)
|
324 (31.4)
707 (68.6)
|
231 (35.2)
425 (64.8)
|
0.107
|
Employment status
Employed
Unemployed
Missing = 8
|
1595 (94.6)
91 (5.4)
|
994 (96.5)
36 (3.5)
|
601 (91.6)
55 (8.4)
|
0.001
|
Financial distress
No
Yes
Missing = 9
|
886 (52.6)
799 (47.4)
|
584 (56.7)
446 (43.3)
|
302 (41.6)
353 (53.9)
|
0.001
|
Pre-specified level of statistical significance < 0.05, two-tailed.
1Reported experience of emotional, physical or sexual abuse during pregnancy irrespective severity.
In the self-reported maternal characteristics and lifestyle questionnaire, more women were multipara, of normal weight or were underweight with less than 4 % reporting fear of birth. Smoking or used wet-tobacco were significantly higher among women with a history of violence. Exposed women also reported a significant lower SOC score and higher EDS scores than women who did not report a history of violence (OR 2.40, 95 % CI (1.90-3.01) respectively (OR 2.41, 95 % CI 1.71-3.40). Alcohol consumption were similar in the two groups, regardless of whether they reported a history of violence or not (Table 2).
Table 2. Descriptive overview of maternal characteristics, in early second trimester of the
pregnancy (N = 1694).
Characteristics
|
Total
|
History of violence1
|
P
|
Total n (%)
|
n (%)
1687 (100)
|
No
n (%)
1031 (61.1)
|
Yes
n (%)
656 (38.9)
|
Parity
Primiparae
Multiparae
Missing = 129
|
708 (45.2)
857 (54.8)
|
419 (44.2)
530 (55.8)
|
289 (46.9)
327 (53.1)
|
0.283
|
BMI
Underweight/ Normal weight
Overweight/ Obese
Missing = 69
|
1199 (73.8)
426 (26.2)
|
742 (74.5)
254 (25.5)
|
457 (72.7)
172 (27.3)
|
0.411
|
Smoking/Wet-tobacco
No
Yes
Missing = 54
|
1338 (81.6)
302 (18.4)
|
860 (85.9)
141 (14.1)
|
478 (74.8)
161 (25.2)
|
0.001
|
Use of Alcohol
No
Yes2
Missing = 63
|
773 (47.4)
858 (52.6)
|
467 (46.8)
531 (53.2)
|
306 (48.3)
327 (51.7)
|
0.542
|
Fear of birth
No
Yes
Missing = 8
|
1625 (96.4)
61 (3.6)
|
998 (96.9)
32 (3.1)
|
627 (95.6)
29 (4.4)
|
0.159
|
SOC
High score
Low score
Missing = 95
|
1194 (74.7)
405 (25.3)
|
782 (81.4)
179 (18.6)
|
412 (64.6)
226 (35.4)
|
0.001
|
EDS
Score < 13
Score ≥ 13
Missing =53
|
1492 (90.9)
149 (9.1)
|
934 (93.9)
61 (6.1)
|
558 (86.4)
88 (13.6)
|
0.001
|
Pre-specified level of statistical significance < 0.05, two-tailed.
1 Reported experience of emotional, physical or sexual abuse during pregnancy irrespective severity.
2 At least once in a month
Maternal birth outcomes were similar in both groups apart from CS, women who had a history of violence had a 33% increased risk of CS (OR 1.33, 95 % CI 1.02 -1.70) (Table 3). In the total 15.3 % (n = 259) of the study population experienced a CS. They were divided between 5.8 % (n = 99) women who chose a planned CS and 9.4 % (n = 160) who had an emergency CS (exclusively presented in the text). Women with history of emotional abuse had significantly increased risk having CS (OR 1.50, 95% CI 1.09-2.06) (Table 4). There was also an increased risk of prematurity for women who were experiencing history of violence 6.6% (n=43) compared to those who were not 4.4. % (n=45) (Table 5).
Table 3. Maternal labour and birth outcome (N= 1694).
Characteristics
|
Total
|
History of violence1
|
P
|
Total n (%)
|
n (%)
1687 (100)
|
No
n (%)
1031(61.1)
|
Yes
n (%)
656 (38.9)
|
Labour initiation
Spontaneous
Induction
Missing = 67
|
1384 (85.1)
243 (14.9)
|
856 (86.1)
138 (13.9)
|
528 (83.4)
105 (16.6)
|
0.136
|
Augmentation
No
Yes
Missing = 150
|
1058 (68.5)
486 (31.5)
|
649 (68.5)
299 (31.5)
|
409 (68.6)
187 (31.4)
|
0.946
|
Epidural anesthesia
No
Yes
Missing = 80
|
1267 (78.5)
347 (21.5)
|
788 (80.0)
197 (20.0)
|
479 (76.2)
150 (23.8)
|
0.067
|
Labour outcome
Vaginal birth2
Caesarean section
Missing = 7
|
1430 (84.8)
257 (15.2)
|
889 (86.2)
142 (13.8)
|
541 (82.5)
115 (17.5)
|
0.036
|
Post partum hemorrhage
< 1000 ml
≥ 1000 ml
Missing = 7
|
1602 (95.0)
85 (5.0)
|
984 (95.4)
47 (4.6)
|
618 (94.2)
38 (5.8)
|
0.259
|
Pre-specified level of statistical significance < 0.05, two-tailed.
1Has reported experience of emotional, physical or sexual abuse during pregnancy irrespective severity.
2Inclusive vacuum extraction (n = 121) and forceps (n = 10).
Table 4. Caesarean section in relation to history of violence (N = 1694)
Characteristics
|
Total
|
Caesarean sectio
|
P
|
Total n (%)
|
N (%)
1694 (100)
|
No
n (%)
1435 (84.7)
|
Yes
n (%)
259 (15.3)
|
History of violence1
No
Yes
Missing = 5
|
1031 (61.1)
656 (38.9)
|
889 (62.2)
541 (37.8)
|
142 (55.3)
115 (44.7)
|
0.036
|
DV during pregnancy2
No
Yes
Missing = 0
|
1660 (98.0)
34 (2.0)
|
1406 (98.1)
29 (2.0)
|
254 (98.1)
5 (1.9)
|
0.924
|
History of emotional abuse3
No
Yes
Missing = 15
|
1366 (81.4)
313 (18.6)
|
1173 (82.4)
251 (17.6)
|
193 (75.7)
62 (24.3)
|
0.012
|
History of physical abuse3
No
Yes
Missing = 19
|
1193 (71.2)
482 (28.8)
|
1024 (72.1)
396 (27.9)
|
169 (66.3)
86 (33.7)
|
0.058
|
History of sexual abuse3
No
Yes
Missing = 15
|
1424 (84.8)
255 (15.2)
|
1217 (85.5)
207 (14.5)
|
207 (81.2)
48 (18.8)
|
0.079
|
Pre-specified level of statistical significance < 0.05, two-tailed.
1 Reported experience of of emotional, physical or sexual abuse in early and/or late pregnancy irrespective severity.
2 Reported experience of of emotional, physical or sexual abuse during pregnancy irrespective severity.
3 Reported experience of emotional, physical or sexual abuse during early second trimester irrespective severity.
Table 5. Infant characteristics and birth outcome (N= 1694).
Characteristics
|
Total
|
History of violence1
|
P
|
Total n (%)
|
n (%)
1687 (100)
|
No
n (%)
1031 (61.1)
|
Yes
n (%)
656 (38.9)
|
Gestational week
Premature < 37 weeks
Full term ≥ 37 weeks
Missing = 7
|
88 (5.2)
1599 (94.8)
|
45 (4.4)
986 (95.6)
|
43 (6.6)
613 (93.4)
|
0.049
|
Infant biological sex
Female
Male
Missing = 13
|
829 (49.3)
851 (50.7)
|
494 (48.1)
533 (51.9)
|
335 (51.2)
319 (48.8)
|
0.212
|
Apgar at 5 min
< 7
≥ 7
Missing = 7
|
18 (1.1)
1669 (98.9)
|
10 (1.0)
1021 (99.0)
|
8 (1.2)
648 (98.8)
|
0.634
|
Infant weight
< 2500 g
2500-4000
> 4000 g
Missing = 22
|
50 (3.0)
1293 (77.3)
329 (19.7)
|
28 (2.7)
790 (77.4)
203 (19.9)
|
22 (3.4)
503 (77.3)
126 (19.4)
|
0.742
|
Transferred to NICU
Yes
No
Missing = 181
|
89 (5.9)
1424 (94.1)
|
49 (5.3)
879 (94.7)
|
40 (6.8)
545 (93.2)
|
0.210
|
Pre-specified level of statistical significance < 0.05, two-tailed.
1) Reported experience of emotional, physical or sexual abuse during pregnancy irrespective severity.
Confounding effects of the increased incidence of lower socioeconomic status (cohabiting, employment, economy) and tobacco use on the rate of the two adverse pregnancy outcomes i.e. premature birth and CS showed no potential cause and effect or significant association.
Infant characteristics were similar in the two groups. In addition, there were two intra uterine foetal deaths before gestational week 34 (mothers had not reported experience of violence).