CLINICAL STUDIES
Physical Abuse, Smoking, and Substance Use During Pregnancy: Prevalence, Interrelationships, and Effects on Birth Weight

https://doi.org/10.1111/j.1552-6909.1996.tb02577.xGet rights and content

Objective

To establish the singular and combined occurrence of physical abuse, smoking, and substance use (i.e., alcohol and illicit drugs) during pregnancy and its effect on birth weight.

Design: Prospective cohort analysis.

Setting: Urban public prenatal clinics.

Participants: 414 African American, 412 Hispanic, and 377 white pregnant women.

Main Outcome Measure(s): Occurrence of physical abuse was 16%; smoking, 29.5%; and alcohol/illicit drug use, 11.9%. Significant relationships existed between physical abuse and smoking for African American and white women. For African American women, 33 7% of women who were not abused smoked, versus 49.5% of women who were abused (x2 = 8.21; df = 1;p < 0.005). Alcohol/illicit drug use was 20.8% for nonabused women compared with 42.1% for abused women (x2 = 18.18; df = 1;p < 0.001). For white women, 46.6% of women who were not abused smoked, versus 59-6% of those who were abused (x2 = 5.22; df = 1;p < 0.005). As a triad, physical abuse, smoking, and alcohol/ illicit drug use were significantly related to birth weight (F[3, 1040] = 30.19,p > < 0.001).

Conclusions

Physical abuse during pregnancy is common, readily detected with a five-question screen, and associated with significantly higher use of tobacco, alcohol, and illicit drugs. Clinical protocols that integrate assessment and intervention for physical abuse, smoking, and substance use are essential for preventing further abuse and improving smoking and substance cessation rates.

Section snippets

Physical Abuse During Pregnancy

Physical abuse during pregnancy recently has been recognized as a risk to the health of the mother and fetus (American College of Obstetricians and Gynecologists, 1988; Newberger et al., 1992; U.S. Public Health Service, 1986). Retrospective studies of women in shelters document that 40% to 60% of the women were abused during pregnancy (Walker, 1984). Abused women have reported blows to the pregnant abdomen, breasts, and genitals accompanied by sexual assault (Dobash and Dobash, 1979, Martin,

Methods

A prospective cohort design was followed.

Results

The demographic characteristics, abuse, smoking, and alcohol/illicit drug use status appear in Table 1, along with low-birth-weight deliveries. The ethnic composition of the sample was 34.4% African American, 34.2% Hispanic

(primarily Mexican American), and 31.3% white. Most women were ages 20–29 years, but 30% were adolescents. All were urban residents, and most (94%) had incomes below the poverty level, which is defined as eligibility for the Supplemental Food Program for Women, Infants, and

Discussion

Physical abuse during pregnancy is common, readily detected with a five-question screen, and associated with significantly higher use of tobacco, alcohol, and illicit drugs. Ethnic-specific interrelationships exist. White women who were abused had the highest prevalence of tobacco use, which was associated significantly with low infant birth weight. African-American women who were abused had the highest prevalence of alcohol/illicit drug use, with significant lowering effects on infant birth

Acknowledgment

This study was supported by grant R49/CCR603514- 01 from the Division of Injury Epidemiology and Injury Control, Centers for Disease Control, Atlanta, GA.

References (33)

  • M. Bayatpour et al.

    Physical and sexual abuse as predictors of substance use and suicide among pregnant teenagers

    Journal of Adolescent Health

    (1992)
  • A.B. Berenson et al.

    Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black, and Hispanic women

    American Journal of Obstetrics and Gynecology

    (1991)
  • H. Amaro et al.

    Drug use among adolescent mothers: Profile of risk

    Pediatrics

    (1989)
  • H. Amaro et al.

    Violence during pregnancy and substance use

    American Journal of Public Health

    (1990)
  • American College of Obstetricians and Gynecologists

    The abused woman

    (1988)
  • J. Campbell

    Nursing assessment for risk of homicide with battered women

    Advances in Nursing Science

    (1986)
  • J. Campbell et al.

    Correlates of battering during pregnancy

    Research in Nursing and Health

    (1992)
  • J. Campbell et al.

    Nursing care of survivors of family violence

    (1993)
  • L.C. Castro et al.

    Maternal tobacco use and substance abuse: Reported prevalence rates and associations with the delivery of small for gestational age neonates

    Obstetrics & Gynecology

    (1993)
  • R. Dobash et al.

    Violence against wives

    (1979)
  • L.A. Fingerhut et al.

    Smoking before, during and after pregnancy

    American Journal of Public Health

    (1990)
  • A. Helton et al.

    Battered and pregnancy: A prevalence study

    American Journal of Public Health

    (1987)
  • P.J. Hillard

    Physical abuse in pregnancy

    Obstetrics and Gynecology

    (1985)
  • W. Hudson et al.

    The assessment of spouse abuse: Two quantifiable dimensions

    Journal of Marriage and the Family

    (1981)
  • Institute of Medicine

    Preventing low birthweight

    (1985)
  • P.K. Kokotailo et al.

    Cigarette, alcohol and other drug use by school-age pregnant adolescents: Prevalence, detection, and associated risk factors

    Pediatrics

    (1992)
  • Cited by (0)

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