Elsevier

Child Abuse & Neglect

Volume 23, Issue 1, January 1999, Pages 81-90
Child Abuse & Neglect

Original Articles
Pregnancy and delivery for women with a history of child sexual abuse

https://doi.org/10.1016/S0145-2134(98)00113-6Get rights and content

Abstract

Objective: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse.

Method: In a case control study, 82 women with birth of a low birth weight infant (< 2500g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse.

Results: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44–2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight.

Conclusions: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.

Résumé

Objectif: Etudier la relation entre une histoire d’abus sexuel au cours de l’enfance et le risque d’accoucher d’un enfant de petit poids à la naissance. Les objectifs secondaires concernaient l’étude des habitudes liées à la consommation de tabac, des complications obstétricales, de l’utilisation des soins de santé et des plaintes liées à l’état de santé au cours de la grossesse chez des femmes présentant une histoire d’abus sexuel au cours de l’enfance.

Méthode: Dans une étude de cas contrôle, 82 femmes ayant accouché d’un bébé de petit poids à la naissance (>2500 g) (cas) et 91 femmes ayant accouché d’un bébé de poids normal à la naissance (contrôles) ont été interrogées concernant l’expérience d’un abus sexuel au cours de l’enfance, impliquant au moins un attouchement génital. La naissance d’un attouchement genital. La naissance d’un enfant de petit poids n’était pas associée à l’histoire d’un abus sexuel au cours de l’enfance (OR 1.03, 95% CI .44.2.40). Plus de femmes présentant ce type d’antécédents fumaient pendant la grossesse (56% vs 31%), comparées aux femmes non abusées. Les femmes abusées mentionnaient un âge plus jeune pour leurs premières règles et débuts sexuels. Une fois contrôlées pour le petit poids à la naissance, les femmes abusées se présentaient plus souvent sans rendez-vous à la consultation prénatale et se plaignaient plus fréquemment d’inconforts, liés à la grossesse.

Conclusion: Les femmes accouchant d’un bébé de petit poids à la naissance n’étaient pas plus à risque d’avoir été abusées sexuellement au cours de l’enfance que celles ayant accouché d’un enfants de poids normal à la naissance. Les femmes abusées étaient plus fréquemment fumeuses et sans emploi que les femmes non-abusées. Certaines femmes abusées se plaignaient plus fréquemment d’inconforts au cours de la grossesse et utilisaient plus souvent les structures prénatales, mais elles ne présentaient pas plus de complications obstétricales pendant la grossesse et à l’accouchement.

Resumen

Objectivo: Estudiar si las mujeres con una historia de abuso sexual infantil tienen un mayor riesgo de dar a luz niños con bajo peso en el nacimiento. Como objetivos secundarios se trataban de conocer los hábitos de consumo de tabaco, las complicaciones obstétricas, la utilización de cuidados sanitarios y las quejas sobre cuestiones de salud durante el embarazo entre mujeres con una historia de abuso sexual infantil.

Método: Se llevó a cabo un estudio con un diseño caso-control en el que se entrevistó acerca de la experiencia de abuso sexual infantil a 82 mujeres que habı́an tenido un niño con bajo peso (< 2500 gr.) Al nacer (casos) y a 91 mujeres que habı́an tenido un niño con peso normal al nacer.

Resultados: El 14% de las mujeres desvelaron una historia de abuso sexual infantil que habı́a implicado como mı́nimo la existencia de contacto con las zonas genitales. El nacimiento de un niño de bajo peso no estuvo asociado con la historia de abuso sexual (OR 1.03, 95% CI .44–2.40). Un mayor porcentaje de mujeres con historia de abuso sexual (56%) fueron fumadoras durante el embarazo en comparación con las mujeres que no fueron vı́ctimas de abuso sexual infantil (31%). Las mujeres abusadas en la infancia informaron de una menarquia y un inicio de las actividades sexuales a una edad más temprana que las mujeres no abusadas. Controlando la variable del peso del niño al nacer, se observó que los contactos no programados con la consulta médica y la presencia de malestar durante el embarazo eran más frecuentes en las mujeres vı́ctimas de abuso sexual en la infancia.

Conclusión: Las mujeres que han tenido un hijo con bajo peso al nacer no tenı́an una mayor tendencia a haber experimentado abuso sexual en la infancia que las mujeres que no habı́an tenido un niño con bajo peso. Las mujeres vı́ctimas de abuso sexual en la infancia presentaban una mayor tendencia a ser fumadoras diarias y a estar en el desempleo. Algunas de las mujeres abusadas informaron de más quejas de salud y de una utilización más frecuente de los servicios de salud durante el embarazo, pero no sufrieron más complicaciones obstétricas durante el embarazo y el parto.

Introduction

THE EXTENT OF child sexual abuse (CSA) has received considerable public and professional attention in recent years. Estimated prevalence rates for women are reported in the range between 6% and 62% depending on the definitions and methods used Finkelhor 1994, Gibbons 1996, Russell 1986. In Norwegian studies the prevalence of child sexual abuse among women ranges from 8% to 19% Bendixen et al 1994, Schei 1990, Sætre et al 1986.

The long term effects of child sexual abuse comprize a wide range of psychological and social effects, as well as effects on somatic health such as headache, multiple somatic symptoms, pelvic pain, dysmenorrhoea, dyspareunia, vaginal discharge, and gastrointestinal illness Beitchman et al 1992, Drajier 1989, Drossman et al 1995. It has also been shown that women with a history of CSA have high health care utilization, and are objects of more intervention such as surgical procedures than nonabused women Drossman et al 1995, Kirkengen et al 1993. Genital tract infections have been related to preterm birth (McGregor et al., 1995), and abuse has been proposed as a risk factor for pelvic inflammatory disease (Schei, 1991). It is therefore likely that CSA could be reflected in the course of pregnancy, and in complications during pregnancy and delivery, while also affecting the outcome of pregnancy, for example birth weight.

The relationship of pregnancy and childbirth to the long-term effects of CSA has only been studied to a limited degree and mostly in case series. The results have been inconclusive.

The primary aim of this study was to examine whether women who delivered low birth weight infants were more likely to have experienced CSA than women who delivered nonlow birth weight infants. Secondary aims were to explore medical complications, urogenital infections, use of health care services, medical treatment during pregnancy, intervention during delivery, and discomfort during pregnancy among women with or without a history of CSA. This was part of a study of abuse and low birth weight.

Section snippets

Participants

Women were recruited during an 18-month period stretching from 1992 to 1994 at the Department of Obstetrics, the University Hospital of Trondheim. Women who delivered a baby with birth weight below 2500g regardless of the gestational age constituted the case group. Following each identified case the next woman delivering a baby with birth weight 2500g or more was selected as a control subject. One hundred and fourteen cases and controls were sampled. In all, 11 women were lost to followup,

Results

A total of 34 women (19%) disclosed information of unpleasant sexual experiences before 18 years of age, including exhibitionism, verbal sexual advances, and forced nongenital touching. Twenty-five (14%) of the women, 12 cases and 13 controls, reported experiences of CSA involving at least genital touch (Table 1). Two women did not want to give details of the abuse experience. They are categorized as a special group and are included in the abused group in the subsequent analysis. Birth of LBW

Discussion

This study demonstrated that a high proportion (14%) of Norwegian parous women reported experiences of CSA. Women who delivered a LBW infant were not more likely to have a history of CSA, but the analyses suggest that abused women more often were smokers during pregnancy, had menarche and sexual debut at a lower age, and reported more discomfort during pregnancy. Abused women had used more health care services during pregnancy compared to nonabused women when controlled for LBW.

The detection

Acknowledgements

The authors would like to thank the women who took part in this study, and the Department of Obstetrics at the University Hospital of Trondheim for their support.

References (22)

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  • Cited by (0)

    This study was supported by a research fellowship from the Norwegian Research Council.

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