A prospective cohort study of the impact of domestic violence on young teenage pregnancy outcomes

Reproductive and sexual health of Australian adolescents exposed to family and domestic violence

BACKGROUND

There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV.

METHODS

This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes.

RESULTS

Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers.

CONCLUSION

Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.

Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review

The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.

Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches

This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).

Exposure to Interpersonal Violence During Pregnancy and Its Association With Women's Prenatal Care Utilization: A Meta-Analytic Review

Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation (k = 9) and (2) delayed entry into prenatal care (k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care (OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.

Intimate partner violence identified through routine antenatal screening and maternal and perinatal health outcomes

BACKGROUND

This study investigated the association between intimate partner violence (IPV) identified on routine prenatal screening and perinatal outcomes for mother and infant.

METHODS

Routinely collected perinatal data for a cohort of all women and their infants born in public health facilities in Sydney (Australia) over the period 2014-2016 (N = 52,509) were analysed to investigate the risk of adverse maternal and perinatal outcomes associated with a history of IPV. The association between an affirmative response on prenatal IPV screening and low birth weight (LBW) < 2.5 kg, preterm birth < 37 weeks, breastfeeding indicators and postnatal depressive symptoms (PND) was investigated in a series of logistic regression models.

RESULTS

IPV was associated with an increased risk of PND (OR = 2.53, 95% CI 1.76-3.63), not breastfeeding at birth (OR = 1.65, 95% CI 1.30-2.09), non-exclusive breastfeeding at discharge (OR = 1.66, 95% CI 1.33-2.07) and first post-natal visit (OR = 1.54, 95% CI 1.24-1.91). Self-reported fear of a partner was strongly associated with an increased risk of PND (OR = 3.53, 95% CI 2.50-5.00), and also LBW (OR = 1.58, 95% CI 1.12-2.22), preterm birth (OR = 1.38, 95% CI 1.08-1.76), lack of early initiation of breastfeeding (OR = 1.67, 95% CI 1.28-2.17), non-exclusive breastfeeding at discharge from hospital (OR = 1.60, 95% CI 1.24-2.06) and at the first post-natal visit (OR = 1.27, 95% CI 0.99-3.04).

CONCLUSIONS

IPV reported at the time of pregnancy was associated with adverse infant and maternal health outcomes. Although women may be disinclined to report IPV during pregnancy, universal, routine antenatal assessment for IPV is essential for early identification and appropriate management to improve maternal and newborn health.

Trauma in Pregnancy

Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and mortality to pregnant women and fetus. Pathophysiology of trauma is generally time sensitive, and this is still true in pregnant patients, with the additional challenge of rare presentation and balancing the management of two patients concurrently. Successful resuscitation requires understanding the physiologic changes to the woman throughout the course of pregnancy. Ultimately, trauma management is best approached by prioritizing maternal resuscitation.

Domestic Violence in Pregnant Women: A Study Conducted in the Postpartum Period of Adolescents and Adults

The aim of this study was to estimate the prevalence of domestic violence in adolescent and adult mothers who were admitted to obstetrics services centers in Brazil and to identify risk factors of domestic violence and any adverse obstetric and perinatal outcomes. Researchers used standardized interviews, the questionnaire Abuse Assessment Screen, and a review of patients' medical records. Descriptive statistical analyses were also used. The prevalence of domestic violence among all participants totaled 40.1% (38.5% of adolescents, 41.7% of adults). Factors associated with domestic violence during pregnancy were as follows: a history of family violence, a greater number of sexual partners, and being a smoker. No statistically significant association was found for adverse obstetric and perinatal outcomes. Results showed that, in Vitória, Espírito Santo, Brazil, pregnancy did not protect a woman from suffering domestic violence.

A Diagnosis of Denial: How Mental Health Classification Systems Have Struggled to Recognise Family Violence as a Serious Risk Factor in the Development of Mental Health Issues for Infants, Children, Adolescents and Adults

Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child's caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties.

Adolescent Pregnancy Guidelines

OBJECTIVE

To describe the needs and evidence-based practice specific to care of the pregnant adolescent in Canada, including special populations.

OUTCOMES

Healthy pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate care to ensure the best possible outcomes for these young women and their infants and young families, and to reduce repeat pregnancy rates.

EVIDENCE

Published literature was retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g., pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to English or French language materials published in or after 1990. Searches were updated on a regular basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, national and international medical specialty societies, and clinical practice guideline collections.

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS/HARMS/COSTS: These guidelines are designed to help practitioners caring for adolescent women during pregnancy in Canada and allow them to take the best care of these young women in a manner appropriate for their age, cultural backgrounds, and risk profiles.

RECOMMENDATIONS

1. Health care providers should adapt their prenatal care for adolescents and offer multidisciplinary care that is easily accessible to the adolescent early in the pregnancy, recognizing that adolescents often present to care later than their adult counterparts. A model that provides an opportunity to address all of these needs at one site may be the preferred model of care for pregnant adolescents. (II-1A) 2. Health care providers should be sensitive to the unique developmental needs of adolescents through all stages of pregnancy and during intrapartum and postpartum care. (III-B) 3. Adolescents have high-risk pregnancies and should be managed accordingly within programs that have the capacity to manage their care. The unique physical risks of adolescent pregnancy should be recognized and the care provided must address these. (II-1A) 4. Fathers and partners should be included as much as possible in pregnancy care and prenatal/infant care education. (III-B) 5. A first-trimester ultrasound is recommended not only for the usual reasons for properly dating the pregnancy, but also for assessing the increased risks of preterm birth. (I-A) 6. Counselling about all available pregnancy outcome options (abortion, adoption, and parenting) should be provided to any adolescent with a confirmed intrauterine gestation. (III-A) 7. Testing for sexually transmitted infections (STI) (II-2A) and bacterial vaginosis (III-B) should be performed routinely upon presentation for pregnancy care and again in the third trimester; STI testing should also be performed postpartum and when needed symptomatically. a. Because pregnant adolescents are inherently at increased risk for preterm labour, preterm birth, and preterm pre-labour rupture of membranes, screening and management of bacterial vaginosis is recommended. (III-B) b. After treatment for a positive test, a test of cure is needed 3 to 4 weeks after completion of treatment. Refer partner for screening and treatment. Take the opportunity to discuss condom use. (III-A) 8. Routine and repeated screening for alcohol use, substance abuse, and violence in pregnancy is recommended because of their increased rates in this population. (II-2A) 9. Routine and repeated screening for and treatment of mood disorders in pregnancy is recommended because of their increased rates in this population. The Edinburgh Postnatal Depression Scale administered in each trimester and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).

Domestic violence is a leading risk factor in default from colposcopy services

AIM

Domestic violence is common in women and is associated with poorer health-care outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and loss to follow-up.

MATERIAL AND METHODS

A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a 3-year period. Multivariate analysis was undertaken to determine demographic factors associated with default from care and loss to follow-up.

RESULTS

Of 581 women approached, consent was obtained from 574 women (99%). Domestic violence status was obtained from 566 women, of whom 187 (33%) had a recent history of exposure. Women exposed to violence were more likely to default from colposcopy once (26.2% vs 7.4%; P < 0.0001), twice (11.2% vs 3.2%, P = 0.0001), or thrice (10.7% vs 2.4%, P < 0.0001). They were more likely to be lost to follow-up (8.0% vs 1.1%, P < 0.0001). In multivariate analysis, exposure to domestic violence remained significantly associated with default and loss to follow-up.

CONCLUSION

Domestic violence is a risk factor for default from attendance and loss to follow-up at colposcopy services. This may explain the mechanism behind adverse health-care outcomes seen. Screening and targeted appointment intervention programs may improve clinical compliance.

Prevalence and factors associated with alcohol use among pregnant adolescents

AIM

to identify alcohol use and the associated factors in pregnant adolescents of the municipality of Teresina-PI.

METHOD

this is cross-sectional study with 256 pregnant adolescents whose data were obtained through questionnaires covering socioeconomic, pregnancy and alcohol consumption characteristics and through the application of the Alcohol Use Disorders Identification Test, an instrument developed by the World Health Organization for screening for the excessive use of alcohol. Descriptive statistical analysis was performed using the chi-square test and odds ratio.

RESULTS

the study indicates a prevalence of 32.4% for alcohol use during pregnancy in adolescents. Of these, 36.1% had scores consistent with risky use. The factors associated with an increased risk of alcohol use during pregnancy are: not having a partner, living on less than 1 minimum wage, not being religious, performing up to 3 prenatal consultations, having suffered violence and alcohol use in previous pregnancies.

CONCLUSION

a high prevalence of alcohol consumption by pregnant adolescents and various risk factors involved in this process were identified. These data reflect the need for the use, by nurses, of screening technologies for alcohol consumption during pregnancy and health promotion strategies among groups of adolescents.

Is a randomised controlled trial of a maternity care intervention for pregnant adolescents possible? An Australian feasibility study

Background

The way in which maternity care is provided affects perinatal outcomes for pregnant adolescents; including the likelihood of preterm birth. The study purpose was to assess the feasibility of recruiting pregnant adolescents into a randomised controlled trial, in order to inform the design of an adequately powered trial which could test the effect of caseload midwifery on preterm birth for pregnant adolescents.

Methods

We recruited pregnant adolescents into a feasibility study of a prospective, un-blinded, two-arm, randomised controlled trial of caseload midwifery compared to standard care. We recorded and analysed recruitment data in order to provide estimates to be used in the design of a larger study.

Results

The proportion of women aged 15–17 years who were eligible for the study was 34% (n=10), however the proportion who agreed to be randomised was only 11% (n = 1). Barriers to recruitment were restrictive eligibility criteria, unwillingness of hospital staff to assist with recruitment, and unwillingness of pregnant adolescents to have their choice of maternity carer removed through randomisation.

Conclusions

A randomised controlled trial of caseload midwifery care for pregnant adolescents would not be feasible in this setting without modifications to the research protocol. The recruitment plan should maximise opportunities for participation by increasing the upper age limit and enabling women to be recruited at a later gestation. Strategies to engage the support of hospital-employed staff are essential and would require substantial, and ongoing, work. A Zelen method of post-randomisation consent, monetary incentives and ‘peer recruiters’ could also be considered.

Trauma in pregnancy: an updated systematic review

We reviewed recent data on the prevalence, risk factors, complications, and management of trauma during pregnancy. Using the terms "trauma" and "pregnancy" along with specified mechanisms of injury, we queried the PubMed database for studies reported from Jan. 1, 1990, through May 1, 2012. Studies with the largest number of patients for a given injury type and that were population-based and/or prospective were included. Case reports and case series were used only when more robust studies were lacking. A total of 1164 abstracts were reviewed and 225 met criteria for inclusion. Domestic violence/intimate partner violence and motor vehicle crashes are the predominant causes of reported trauma during pregnancy. Management of trauma during pregnancy is dictated by its severity and should be initially geared toward maternal stabilization. Minor trauma can often be safely evaluated with simple diagnostic modalities. Pregnancy should not lead to underdiagnosis or undertreatment of trauma due to unfounded fears of fetal effects. More studies are required to elucidate the safest and most cost-effective strategies for the management of trauma in pregnancy.

Prevalence and associations of domestic violence at an Australian colposcopy clinic

OBJECTIVE

Domestic violence is associated with significant mortality and morbidity including gynecological morbidity. We report the prevalence and associations of domestic violence in an Australian colposcopy service.

MATERIALS AND METHODS

A prospective study was performed from consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Key outcomes were the prevalence of intimate partner violence and its key demographic associations.

RESULTS

Consent was obtained from 574 and domestic violence status was ascertained in 566 of 581 women approached. Overall, 33% of responders reported violence within 12 months. In 14.5%, the female reported being sole recipient of violence; in a further 16.6%, violence was bidirectional, and in 1.9% of cases, a woman was the sole perpetrator. Key associations of violence were younger age at presentation (32 vs 35 y; p = .01), higher rates of smoking (51.3% vs 38.2%; p = .0004), higher rates of housing instability (32.2% vs 12.2%; p < .0001), a positive Beck Depression Inventory screen (50.0% vs 24.6%; p < .0001), and higher rates of default to initial attendance (15.5% vs 4.7%, p < .0001).

CONCLUSIONS

Domestic violence is common in women presenting to colposcopy services and may be associated with poor housing stability and higher default rates.

[Giving birth at 16, without violence: a possible reality? Empirical data and critical reflection]

Violence between adolescents during teen pregnancy is relatively new in terms of scientific interest and clinical preoccupations. It is an alarming situation, given that 1) its prevalence ranges from 5 % to 29 % according to the literature; 2) consequences for both the mother's and baby's health are numerous at physical, psychological and sexual levels; 3) scientific and empirical knowledge regarding the phenomenon is limited and diminishes efficacy and relevance of current interventions. It therefore appears of major importance to acquire better knowledge of various ecological factors in order to implement preventative care and services that will allow them as well as their children to thrive in adverse conditions and have access to a safe and supportive environment.

How does violence exposure affect the psychological health and parenting of young African-American mothers?

Urban, minority, adolescent mothers are particularly vulnerable to violence exposure, which may increase their children's developmental risk through maternal depression and negative parenting. The current study tests a conceptual model of the effects of community and contextual violence exposure on the mental health and parenting of young, African-American mothers living in Washington, DC. A path analysis revealed significant direct effects of witnessed and experienced violence on mothers' depressive symptoms and general aggression. Experiences of discrimination were also associated with increased depressive symptoms. Moreover, there were significant indirect effects of mothers' violence exposure on disciplinary practices through depression and aggression. These findings highlight the range of violence young African-American mothers are exposed to and how these experiences affect their mental health, particularly depressive symptoms, and thus disciplinary practices.

Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region

BACKGROUND

Risk factors for pregnancies being complicated by the birth of a small-for-gestational age (SGA) infant were analysed in a socio-economically disadvantaged area, with separate analysis for population-based and customized-based birth weight percentiles.

METHODS

A retrospective case-controlled study of all singleton pregnancies resulting in the birth of an infant with a birth weight < 10 population-based centile, born in the Northern suburbs of metropolitan Adelaide, between 1998 and 2003. Significant risk factors in the univariate analysis were subsequently checked with multivariate analysis.

RESULTS

The analyses confirm marked differences between population-based and customized-birth weight centiles. Patterns of risk factors show clear differences in risk factors for these two different SGA groups. Univariate analyses of all (nulliparous and multiparous women) customized SGA infants shows us the following odds ratio's (OR); unemployment OR 2.06, 95% confidence interval (CI) 1.46-2.92, being a single mother OR 1.90, CI 1.76-2.05, smoking OR 3.24, CI 2.32 - 4.54, recreational drug use OR 2.40, CI 1.55-3.70, mental health problems OR 1.52, CI 1.04-2.23, domestic violence OR 3.42, CI 1.26-9.29, being healthy OR 0.43, CI 0.30-0.61, preeclampsia OR 1.73, CI 1.01-2.97, and BMI < 30 OR 0.63 CI 0.43-0.93. Length of pregnancy interval had no relationship whatsoever with the risk of being delivered of an SGA infant. Multivariate analyses for customized SGA showed five factors with an OR > 2 (95% CI not crossing 1), including unemployment, smoking, maternal age > 34 years, not being healthy and preeclampsia, while different paternity, age 25-34 compared to age < 25 were also found to be significant risk factors. Higher systolic blood pressure was found to convey significant protection.

CONCLUSION

When studying risk factors for pregnancies complicated by the birth of an SGA infant, both population-derived and customized growth centiles should be utilized. This study confirms the importance of smoking as a major risk factor, our data also show major protection being conveyed by having a regular job and being generally healthy. Pregnancy interval did not have any relationship with the birth of SGA infants, while paternity change was identified as a clear risk factor. Although genuine preeclampsia persists as a clear risk factor, higher systolic blood pressure appears to convey protection.

Adolescent pregnancy in a Greek public hospital during a six-year period (2000-2005)--a retrospective study

STUDY OBJECTIVE

Adolescent pregnancy constitutes a multidimensional social problem in modern Greece. The purpose of this study was to investigate the trends of teenage childbearing and to determine the relationship between the incidence of teenage pregnancy and immigrant status of the mother.

DESIGN

This is a retrospective correlational study. The birth registry of the hospital was examined for a 6-year period, from January 2000 to December 2005. Information about the age and nationality of the mothers was collected.

SETTING

The hospital under investigation is Tzaneio Hospital, a public general hospital that provides health services to the residents of Piraeus, a large municipality next to Athens.

RESULTS

During the study period 4628 women gave birth at Tzaneio Hospital, among which 349 (7.54%) were under the age of 19. The study hypothesis, that adolescent childbearing prevails among immigrant population, was confirmed (P < 0.01).

CONCLUSION

Teenage pregnancy rate remains high among some subsamples of the population, such as immigrants. The Greek government, health professionals, and sexuality educators should all work together in order to confront this problem.

Domestic violence and rape

No compilation of women's health care is complete without confronting domestic violence and sexual assault. Long recognized as a health care and physician issue, intimate partner violence continues to be one of the most frequent causes for injury and death to women in the United States and worldwide. According to the Commonwealth Fund survey in 1998, 31% of women reported either physical or sexual abuse from a husband or boyfriend. One in five American women also reported being raped during their lifetime. Careful assessment and universal screening are important tools for the primary care physician.

'Health's a difficult beast': the interrelationships between domestic violence, women's health and the health sector. An Australian case study

This paper reports on the Australian component of a five nation study undertaken in Australia, Canada, Thailand, Bangladesh and Afghanistan examining policy networks that address women's health and domestic violence. It examines the relationship between health and domestic violence in Western Australia and analyses the secondary role assumed by health. The study adopted a qualitative research paradigm and semi-structured interviews. Snowball sampling was used to identify relevant and significant stakeholders and resulted in a final sample of 30 individuals representing three key areas: the 'health policy community', the 'domestic violence prevention community' and 'other interested stakeholders', that is, those who have an interest in, but who are not involved in, domestic violence prevention work. Results suggest that the secondary positioning of health is associated with the historical 'championing' of the issue in the women's movement; limited linkages between the health policy community and the domestic violence prevention community and within the health policy community itself; the 'fit' between domestic violence and the Western Australian Health Department mandate; and the mis-match between domestic violence and the medical model. The conclusion indicates a need for collaboration based on effective links across the domestic violence community and the health policy community.

[Domestic violence and drug abuse in pregnancy]

This study results from a systematic review of scientific publications indexed in Medline between 1993 and 2004, aimed at analyzing scientific knowledge about domestic violence and drugs abuse during pregnancy. Nineteen articles were analyzed. These were published in international periodicals, mainly related to the specialty of child health. Most of these were medical periodicals of American origin and all of them published in English. As to study type, 57.9% were descriptive studies and 42.1% theoretical papers. These deal with subjects related to the woman's psychosocial needs, the importance of paternal responsibility in pregnancy, and the risk factors and implications of domestic violence and drugs use on the health of woman and child. This theoretical foundation allows for interventions in this scenario.

Can screening for domestic violence be introduced successfully in a sexual health clinic?

BACKGROUND

Domestic violence is reported frequently when Australian women are surveyed and is associated with poorer health outcomes on a variety of measures. Routine screening for domestic violence is a strategy designed to both prevent domestic violence and provide an opportunity for early intervention.

METHODS

Following staff consultation and training, a 1-month pilot of routine screening for domestic violence (RSDV) of all female patients was conducted in a large sexual health clinic.

RESULTS

Following the evaluation of this pilot, RSDV was introduced in 2003 for all new female patients. Of the 3244 women eligible for screening, 2893 (89%) were screened. Of these, 254 (8.8%) identified domestic violence.

CONCLUSIONS

Routine screening for domestic violence is feasible in a sexual health clinic population. High screening rates were achieved and high rates of domestic violence were identified, providing an opportunity for intervention.

Substance use among women in shelters for abused women and children. Programming opportunities

OBJECTIVE

This study explores changes in the use of alcohol and other substances by women in British Columbia as they moved into shelters for abused women and again three months later. We see this time as a key life transition, and potentially a rich opportunity for influencing women's substance use behaviour. The purpose of this study was to document changes in the level of use of alcohol and other substances and the levels of stress among women as they moved through shelters for abused women.

METHODS

Standardized questionnaires augmented by qualitative interviews were employed to measure alcohol and substance use, experiences of abuse, and levels and types of stressors facing women in this situation.

FINDINGS

Significant reductions in women's use of alcohol and stimulants were observed from Interview I to Interview II, but there was no significant reduction in use of other depressants or tobacco use. Levels of stress decreased and sources of stress changed for the women after the shelter experience. Stress connected to relationship with partners had the most significant decrease, followed by mental health, housing, and legal issues. Women reported barriers to accessing financial aid and services for substance use outside of the shelter.

CONCLUSIONS

Women's experiences of violence and substance use were found to be interconnected in complex ways and changes in substance use were affected by a range of influences, such as financial concerns, mothering, relationships, levels of social support, and physical and mental health issues. Substance-using women who have experienced violence are an underserved population and a multi-sectoral response designed to address psychosocial, relational, and structural issues could better help them improve their overall health.

Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda

OBJECTIVES

To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery.

METHODS

A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis.

RESULTS

The 169 women [27.7% 95% CI (24.3-31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P < 0.05) regarding domicile variables (had less household decision-making power, more resided in extended families and more had unplanned pregnancy). They delivered babies with a mean birthweight 2647.5 +/- 604 g, on average 186 g [(95% CI 76-296); P = 0.001] lower than those unexposed. After adjusting for age, parity, number of living children, pregnancy planning, domicile and number of years in marriage, the relative risk (RR) of LBW delivery among women exposed to domestic violence was 3.78 (95% CI 2.86-5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01-1.84)].

CONCLUSION

In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization.

Association of violence victimization with inconsistent condom use in HIV-infected persons

The association of violence victimization with current condom use in HIV-infected persons was examined in this cross-sectional study. The HIV-Alcohol Longitudinal Cohort (HIV-ALC) recruited HIV-infected participants with a history of alcohol problems. Interviews assessed violence histories and current sexual behaviors. Of the 349 participants (79% men), 38% reported inconsistent condom use and 80% reported a violence history. Lifetime sexual violence was reported by 40% and lifetime physical violence (without sexual violence) by 40%. Participants reporting lifetime sexual violence had greater odds of inconsistent condom use than participants without any history of violence. A history of childhood sexual violence was also associated with greater odds of inconsistent condom use than participants without a history of childhood sexual violence. A history of sexual violence may in part explain HIV-infected persons' greater risk for transmitting HIV through high-risk sexual behaviors.

Prevalence and pattern of domestic violence against pregnant Nigerian women

Five hundred and twenty-two pregnant Nigerians attending the antenatal clinic in two private hospitals in Lagos between January and June 2003 were interviewed using a structured questionnaire about their experiences of domestic violence. One hundred and four women declined to participate; a response rate of 80.1% was obtained. Analysis of the completed questionnaire by 418 respondents showed that 197 (47.1%) women reported a history of abuse. Of the 197 women who reported abuse, 23 (11.7%) experienced abuse for the first time during the current pregnancy, 97 (49.2%) experienced abuse prior to and during the current pregnancy and in the remaining 77 (39.1%) abuse predate the current pregnancy. A total of 120 (28.7%) women experienced some form of abuse during current pregnancy. Although all social and ethnic groups were involved, no association could be established between prevalence and pattern of abuse and sociodemographic characteristics. Verbal abuse was the most common type of abuse reported (52.3%), followed by economic deprivation (30%), physical abuse (25%), threat of violence (10.8%) and forced sex in 14.2%. The perpetrators of the abuse were husband and boyfriend (78.7%), in-laws (31.5%) and other relations (6.1%). The majority of abused women (99.0%) were not ready to report the abuse to the police. In conclusion, domestic violence is common in our environment and health-care providers should be alert to the clues in order to protect the women from further abuse.

Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice

We examined whether the prenatal detection of family violence and initiation of a comprehensive prenatal individualised care program could ameliorate the impact of family violence on maternal attachment to her infant at 6-months of age. An assessment of domestic violence was established for each subject at the 1(st) antenatal visit and women were classified as being exposed to domestic violence in pregnancy (EDV) or as being not exposed to domestic violence. Outcomes were determined 6 months postpartum. Of 173 consecutive women who met the eligibility criteria, consent was obtained from 150 (87% response). Women who had been subjected to domestic violence showed reduced overall attachment scores to their infants. Following multivariate analysis, drug use in pregnancy and domestic violence showed a significant independent effect on maternal attachment. Drug abuse and domestic violence were also associated with an increase in the easy-difficult scale of infant temperament. Thus, despite excellence in prenatal care, drug abuse and domestic violence were associated with poorer maternal attachment and assessment of infant temperament, suggesting that additional interventions are still required.

Living in Fear of Experiencing Physical and Sexual Abuse Is Associated with Severe Depressive Symptomatology among Young Women

PURPOSE

To analyze the relationship among fear of being abused, direct experience of physical and sexual abuse, and severe depressive symptoms among young women.

METHODS

A cross-sectional survey was conducted in schools and households among 3615 young Hungarian women, ages 15-24 years, of whom 2016 were students. A multistage stratified sampling method was applied. The shortened Beck Depression Inventory (BDI) and the modified Abuse Assessment Screen were used. Odds ratios (ORs) were calculated, and a general linear model was used to test effects of variables on the BDI score.

RESULTS

Severe depressive symptoms were significantly more common among women who were abused physically (OR=3.474, 95% CI 2.170-5.562) or sexually (OR=6.436, 95% CI 3.085-13.429) in the past year or abused by a partner (OR=3.167, 95% CI 1.806-5.554) or important person (OR=2.989, 95% CI 1.922-4.648) during their lifetime. Severe depressive symptoms were also found among those young women who reported feeling fearful of someone in the family (OR=5.027, 95% CI 2.805-9.012) or in their environment (OR=3.779, 95% CI 2.120-6.738). In a linear regression analysis, fear of someone in the environment or family had the strongest effect on BDI scores after controlling for frequent anxiety.

CONCLUSIONS

Not only the direct lifetime experience of abuse but also the presence of fear of abuse is associated with severe depressive symptomatology among young women. Fear of abuse is also an important factor to take into consideration in assessing young women with depressive symptoms.

Police-reported intimate partner violence during pregnancy and the risk of antenatal hospitalization

OBJECTIVES

Intimate partner violence (IPV) is a significant public health problem and the abuse of women during pregnancy is of particular concern. Few studies have addressed the relationship between IPV and antenatal hospitalization. This study utilized a novel approach to examine the impact of IPV during pregnancy on antenatal hospitalization not associated with delivery.

METHODS

This retrospective cohort study included Seattle women residents 16-49 years of age. Exposed subjects were women with a police-reported IPV incident during pregnancy in the years 1995 through 1998 and who subsequently had a singleton live birth or fetal death. The unexposed group was composed of randomly selected residents with a singleton birth or fetal death and without a police-reported IPV incident during the study period. Linked hospital discharge files and birth records were utilized to determine study outcomes. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Women reporting any IPV during pregnancy were twice as likely as unexposed women to experience an antenatal hospitalization not associated with delivery (aAOR 2.39, CI 1.77, 3.24). Women with IPV were more likely to have been hospitalized with a substance abuse-related diagnosis (aOR 2.70, CI 1.52, 4.78) or a mental health-related diagnosis (aOR 1.93, CI 0.96, 3.91). Physical IPV was more strongly associated with antenatal hospitalization than nonphysical IPV or IPV overall.

CONCLUSION

This study suggests that women hospitalized during pregnancy, particularly those with substance abuse and mental health-related conditions, may be at high risk for concurrent IPV.

Teenage mother's predictions of their support levels before and actual support levels after having a child

OBJECTIVES

To evaluate to what extent teenage mothers are able to predict their postnatal support networks in the antenatal period, and the extent to which support correlates with depressive symptomatology and social class.

DESIGN

A prospective cohort study.

SETTING

Teenage antenatal clinic.

PARTICIPANTS

Teenage mothers (n=124) aged less than 18 years.

INTERVENTION

Women were surveyed in the antenatal period and again 6 months postpartum about their anticipated and actual levels of support using the Maternal Social Support Index. The questionnaire covered key issues involved in discharge planning such as the availability of help with household tasks, emergency respite, and communication. Subjects also completed social class data and the Edinburgh Postnatal Depression Scale.

MAIN OUTCOME MEASURE

Ability of pregnant teenagers to predict postnatal support and correlation of support with social class and depressive symptomatology.

RESULTS

The key finding was that teenage mothers significantly overestimated their support networks in the antenatal period compared to the reality experienced 6 months postpartum (P=0.0001). Dissatisfaction was most marked in the communication and daily activity support subscales. The level of support at 6 months postpartum correlated significantly with the Edinburgh Postnatal Depression score (P=0.0001) and with social class (P=0.017).

CONCLUSION

Services for teenage mothers that provide assistance with communication and daily support activities are required to help overcome the discrepancies between idealization and reality. Poor support correlates with depressive symptomatology and social class.

Prevalence of domestic violence when midwives routinely enquire in pregnancy

OBJECTIVE

To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely.

DESIGN

A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period.

SETTING

The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London.

SAMPLE

Women aged 16 and over booking for maternity care between 14th September 1998 and 21st January 1999.

METHODS

Midwives were required to routinely enquire about domestic violence at booking, 34 weeks of gestation and postpartum (within 10 days) using a series of structured questions.

MAIN OUTCOME MEASURES

The lifetime and annual rates of domestic violence. The prevalence of domestic violence in pregnancy.

RESULTS

The prevalence of domestic violence in pregnancy was 1.8% at booking, 5.8% at 34 weeks of gestation and 5.0% at 10 days postpartum. Eight hundred and ninety-two women were asked about domestic violence on at least one occasion, of whom 22 (2.5%) reported domestic violence in pregnancy. Two hundred and sixty-five maternity notes were reviewed for the retrospective case note survey and one (0.37%) case of domestic violence in pregnancy was identified. Routine questioning increased the rate of detection of domestic violence by 2.1% (95% CI = 0.1-3.4%; P= 0.03). The lifetime prevalence of domestic violence was 13%, and 6.4% in the previous 12 months.

CONCLUSIONS

Routine enquiry for domestic violence can increase the rate of detection in maternity settings, thereby providing an opportunity for women to access help early.

Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study

OBJECTIVE

To examine whether teenage antenatal clinics reduce the incidence of preterm birth.

DESIGN

A multicentre prospective study was performed.

SETTING

Three Australian hospitals with maternity services.

POPULATION

Consecutive teenage patients (N= 731) were approached at their first or second antenatal visit.

METHODS

Cases were women attending multidisciplinary teenage antenatal clinics and controls attended general hospital-based antenatal clinics. Teenage antenatal clinics involved multidisciplinary care and included guidelines to screen and treat all patients for infectious and social pathology. General antenatal clinic care was in accordance with Australian standards.

MAIN OUTCOME MEASURES

Preterm birth, newborn biometry adjusted for gestational age, breastfeeding and contraception plans at discharge.

RESULTS

Consent was obtained from 651 (89%) patients. Teenage pregnancy clinic patients were significantly less likely to present with threatened preterm labour (OR 0.45; 95% CI 0.29-0.68), preterm, prelabour, prolonged rupture of membranes (OR 0.34; 95% CI 0.18-0.63) or deliver preterm (OR 0.40; 95% CI 0.25-0.62) compared with those from general clinics. However, there was no independent effect of clinic care upon newborn biometry outcomes. Clinic care did not significantly alter rates of initiation of breastfeeding in hospital. However, significantly more of the teenage antenatal clinic mothers were discharged on contraception (OR 1.58; 95% CI 1.07-2.25).

CONCLUSION

Teenage-specific antenatal clinics may reduce the rate of preterm birth.

Impact of demographic factors, early family relationships and depressive symptomatology in teenage pregnancy

AIM

Teenage pregnancy has been well studied from a demographic risk perspective, but less data examining the early interpersonal family experiences of teenage mothers are available. We aimed to explore the relative impact of demographic, early interpersonal family relationships and depressive symptomatology as associations for teenage, as compared to non-teenage, childbearing.

METHOD

A prospective cross-sectional cohort study was undertaken. Institutional ethics committee approval and informed consent were obtained. Data from consecutive teenage (teenage) and non-teenage (control) subgroups of antenatal women were compared. Subjects were interviewed and completed the following questionnaires: demographic, drug use and lifestyle; early life experiences; Hospital Anxiety and Depression Scale (HADS); and General Health Questionnaire-28.

RESULTS

In multivariate analysis, the following factors had a significant independent association with younger age of motherhood in order of magnitude: a history of parental separation/divorce in early childhood; exposure to family violence in early childhood; illicit drug use (ever or in pregnancy); idealization of the pregnancy; low family income; a positive HADS-A or HADS-D subscale score; and a low level of education.

CONCLUSIONS

Interventions to reduce the rate of teenage births need to be multifocal and should include strategies to address early childhood exposure to parental separation and violence, reduce idealization of pregnancy, diagnose psychological symptomatology and offer alternative career choices to children defaulting in the education system.

Physical and sexual abuse: risk factors for substance use among young Hungarian women

The authors used a multistage stratified sampling method to conduct a cross-sectional survey of a nationally representative sample of 3,615 Hungarian women aged 15 to 24 years to acquire epidemiologic data on physical and sexual abuse and analyze the relationship between abuse and health-risk behaviors. Just over 30% of the young women reported having experienced some type of abuse in their lifetimes. All maladaptive coping strategies, especially sedative use, were more prevalent among those who had experienced physical abuse. The prevalence of smoking, drinking alcohol, and experimenting with drugs was closely related to both physical and sexual abuse. Having experienced abuse is an important factor in young women's development of risky health behaviors. Clinicians should screen for abuse in this age group to prevent behaviors that lead to long-term health problems.

Teenagers who plan parenthood

It is clear that a variable number of teenage mothers have, to some extent, planned parenthood. From an evolutionary perspective, it could be argued that teenage childbearing may in fact be a positive adaptive mechanism for humans raised in a hostile environment. Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximise the probability of leaving any descendents at all. If some teenagers are planning or hoping for pregnancy, it is possible that some positive behavioural changes may be observed. This has proven to be the case with many teenagers altering their risk taking behaviours in the anticipation and expectation of pregnancy. There is now substantial evidence that teenagers who become pregnant were at higher risk than the general population for using cigarettes, alcohol, and marijuana. However, once pregnant, rates of consumption are usually lower compared with their non-pregnant peers or even their own personal pre-pregnancy rates of consumption. Therefore, for some teenagers, the conscious or unconscious prospect of pregnancy represents a potential space in which to rethink behaviours that may be harmful to themselves as a future mother, and also to their child. Given that teenage motherhood is not going to simply vanish, it is important to remember to focus research and services on validated interventions that may assist teenage mothers fulfill their ambitions of parenthood and simultaneously provide the best outcomes for their offspring. Evidence-based interventions focus on sustained home visitation by nurses, with limited evidence supporting the use of volunteers. In contrast, evidence suggests that home visitation by paraprofessionals may not be effective. Other strategies that may be helpful include the use of multidisciplinary teenage pregnancy clinics that have been noted to be associated with improved pregnancy outcomes. The role of new mothers’ groups, other community based group activities, peer support workers and intensive educational interventions to encourage return to schooling may be useful but have not been subjected to randomised evaluation. Such evaluation needs to occur.

Violence does not influence early pregnancy loss

OBJECTIVE

To examine the relationship between physical violence, controlling behavior, and spontaneous abortion (SAB).

DESIGN

Nested case-control study.

SETTING

Emergency department of a university hospital.

PATIENT(S)

One thousand one hundred ninety-nine pregnant women.

MAIN OUTCOME MEASUREMENT(S)

Physical violence and controlling behavior.

RESULT(S)

Cases experienced a SAB (n = 392) and controls maintained their pregnancy through 22 weeks (n = 807). Fifteen percent of women reported violence during the pregnancy, and 49% had reported one or more past episodes of violence. We found no relationship between any measure of physical violence (past, current, or by perpetrator) and the risk of SAB.

CONCLUSION(S)

Although physical violence was very prevalent in the study population, exposure to violence did not influence the risk of SAB.

Postnatal home visits in teenage mothers: a randomised controlled trial

BACKGROUND

Teenage pregnancies are associated with negative socioeconomic effects. Our aim was to ascertain whether a postnatal home-visiting service for teenage mothers younger than age 18 years could reduce the frequency of adverse neonatal outcomes and improve knowledge of contraception, breastfeeding, and infant vaccination schedules in this parent group.

METHODS

We enrolled 139 adolescents, attending a teenage pregnancy clinic, in a randomised controlled trial. After completing an antenatal questionnaire designed to assess their knowledge of contraception, infant vaccination, and breastfeeding, we assigned participants to either receive five structured postnatal home visits by nurse-midwives (n=65) or not (n=71). Assessment interviews were done 6 months postpartum. Our primary endpoint was unadjusted difference in knowledge between groups, and incidence of predefined adverse neonatal outcomes. Analysis was by intention to treat.

FINDINGS

Three women withdrew before randomisation because of late fetal loss, 11 mothers withdrew because of adverse neonatal outcomes (adverse neonatal outcome was a primary endpoint, but resulted in withdrawal from the study for knowledge outcomes), and one left voluntarily. Follow-up data were, therefore, available for 124 teenagers. Postnatal home visits were associated with a reduction in adverse neonatal outcomes (intervention: 2; control: 9; relative risk 0.24, 95% CI 0.05-1.08), and a significant increase in contraception knowledge (mean difference 0.92, 95% CI 0.32-1.52). However, there was no significant increase in knowledge with respect to breastfeeding or infant vaccination schedules associated with the home visits.

INTERPRETATION

Postnatal home-visiting services by nurse-midwives reduce adverse neonatal events and improve contraception outcomes, but do not affect breastfeeding or infant vaccination knowledge or compliance.

Nursing care for pregnant adolescents

Although the physical care of pregnant adolescents is similar to that required by adult women, adolescents have additional unique needs. Adolescents often need more support and extensive teaching during pregnancy and the postpartum. Moreover, adolescents often have fewer life experiences than do adult women, making them less able to cope with the life changes they are experiencing related to pregnancy and birth. Nonjudgmental and developmentally appropriate interactions are essential to the care of pregnant adolescents. This article explores nursing care for the physical, emotional, and educational needs of adolescents during the prenatal, intrapartum, and postpartum periods.

Severe obstetric morbidity

Obstetric morbidity is an important marker of the quality of obstetric care. This review explores the definition, incidence and significance of obstetric morbidity. Some topical issues related to obstetric morbidity are discussed. In addition, the importance of long-term morbidity and violence against women is highlighted.

Australian adolescents' attitudes and beliefs concerning pregnancy, childbirth and parenthood: the development, psychometric testing and results of a new scale

Recent research suggests that many adolescents hold unrealistic and idealised beliefs about the likely consequences of pregnancy and parenthood. Such attitudes potentially play an important role in the aetiology of adolescent pregnancy. Disillusionment with reality may also contribute to postnatal depression, domestic violence and child abuse. This paper reports on the development of a scale to measure the prevalence of such beliefs. The scale was administered to a sample of 1546 Australian adolescents. Between one-quarter and one-third of the sample exhibited idealised beliefs, with males having higher levels of idealization. On factor analysis, the idealization construct comprised an overestimation of positive aspects and an underestimation of negative ones. Subjects reported that very few of their beliefs derived from formal educational input.