Open Collections

UBC Faculty Research and Publications

Maternal and foetal outcomes among pregnant women hospitalised due to interpersonal violence: A population… Meuleners, Lynn B; Lee, Andy H; Janssen, Patti A; Fraser, Michelle L Oct 12, 2011

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata


52383-12884_2011_Article_426.pdf [ 153.83kB ]
JSON: 52383-1.0220700.json
JSON-LD: 52383-1.0220700-ld.json
RDF/XML (Pretty): 52383-1.0220700-rdf.xml
RDF/JSON: 52383-1.0220700-rdf.json
Turtle: 52383-1.0220700-turtle.txt
N-Triples: 52383-1.0220700-rdf-ntriples.txt
Original Record: 52383-1.0220700-source.json
Full Text

Full Text

RESEARCH ARTICLE Open AccessMaternal and foetal outcomes among pregnantwomen hospitalised due to interpersonalviolence: A population based study in WesternAustralia, 2002-2008Lynn B Meuleners1*, Andy H Lee2, Patti A Janssen3 and Michelle L Fraser1AbstractBackground: Interpersonal violence is responsible for more ill-health and premature death in women under theage of 45 than other preventable health conditions, but findings concerning the effects of violence duringpregnancy on both maternal and foetal health have been inconsistent.Methods: A retrospective population-based cohort study was undertaken using linked data from the HospitalMorbidity Data Collection and the Western Australian Midwives’ Notification System from 2002 to 2008. The aimwas to determine the association between exposure to interpersonal violence during pregnancy and adversematernal and foetal health outcomes at the population level.Results: A total of 468 pregnant women were hospitalised for an incident of interpersonal violence during thestudy period, and 3,744 randomly selected pregnant women were included as the comparison group. The majorityof violent events were perpetrated by the pregnant women’s partner or spouse. Pregnant Indigenous women wereover-represented accounting for 67% of all hospitalisations due to violence and their risk of experiencing adversematernal outcomes was significantly increased compared to non-Indigenous women (adjusted odds ratio 1.53, 95%CI 1.21 to 1.95, p = 0.01). Pregnant women hospitalised for an incident of interpersonal violence sustained almostdouble the risk for adverse maternal complications than the non-exposed group (95% CI 1.34 to 2.18, p < 0.001).The overall risk for adverse foetal complications for pregnant women exposed to violence was increased two-fold(95% CI 1.50 to 2.76, p < 0.001).Conclusions: The risk of adverse health outcomes for both the mother and the baby increases if a pregnantwoman is hospitalised for an incident of interpersonal violence during pregnancy.BackgroundInterpersonal violence is responsible for more ill-healthand premature death in women under the age of 45years than any other preventable health conditions suchas hypertension, obesity and diabetes [1]. When inter-personal violence is experienced during pregnancy, itnot only affects the health and well-being of the motherbut is also associated with adverse health outcomes forthe foetus [2]. This has significant ramifications becausenegative birth outcomes represent a significant cost tosociety. For example, low birth weight and pre-terminfants contribute disproportionately to neonatal mor-bidity and health care costs, as well as leading to a mul-titude of short and long term health problems [3].The term ‘interpersonal violence’ refers to “the inten-tional use of physical force, or power, threatened oractual, against oneself, another person, or against agroup or community, that either results in, or has a like-lihood of resulting in injury, death, psychological harm,mal-development or deprivation“ [4]. This definitionincludes victimisation perpetrated against intimate part-ners, parents, siblings, children, other relatives, friends,* Correspondence: Accident Research Centre (C-MARC), School of Public Health,Curtin University, GPO Box U1987, Perth, Western Australia 6845, AustraliaFull list of author information is available at the end of the articleMeuleners et al. BMC Pregnancy and Childbirth 2011, 11:70© 2011 Meuleners et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (, which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.acquaintances, colleagues and strangers [4-6]. Interper-sonal violence during pregnancy may be perpetrated bycurrent or previous intimate partners, family members,and strangers or may occur as a result of fighting. Pre-vious research, however, has indicated that violence dur-ing pregnancy is more commonly perpetrated by anintimate partner [7-9].The effects of violence during pregnancy on bothmaternal and foetal health have been extensively investi-gated in the literature. However, conflicting results havebeen reported, possibly due to limitations in samplesizes, study methodology and operational definitions[10,11]. Recent studies conducted in the USA usedpopulation-based data to examine the adverse effects ofviolence during pregnancy [12,13]. In Western Australia(WA), a population-based study reported a rising inci-dence of interpersonal violence hospitalisations particu-larly among women of child bearing age, highlightingthis serious public health issue [14]. However, there hasbeen minimal research specifically targeting this vulner-able group in Australia.This population-based, retrospective cohort study uti-lised the Western Australian Data Linkage System todetermine the association between exposure to interper-sonal violence during pregnancy and adverse maternaland foetal health outcomes from 2002 to 2008.MethodsStudy designA retrospective population-based cohort study wasundertaken.Definition and databasesThe study used administrative data from the WesternAustralian Data Linkage System which represents one ofonly a small number of record linkage systems in theworld. It records longitudinal data on the use of healthservices and vital events for the entire Western Austra-lian population of over 2.2 million people. De-identifieddata were obtained through the linkage of the HospitalMorbidity Data Collection (HMDC) and the WesternAustralian Midwives’ Notification System. The HMDCcontains information concerning all inpatient dischargesummary data from all public and private hospitals inWestern Australia from 1970 onwards. The WesternAustralian Midwives’ Notification System contains themother’s demographic information, details of the preg-nancy, labour, delivery, gestational age of baby and birthrecords (both live and death records) from 1980onwards.Cases consisted of all women who were pregnant andadmitted to a WA hospital between January 2002 andDecember 2008 due to involvement in an incident ofinterpersonal violence. A case was identified as a ‘victimof interpersonal violence’ if the principal diagnosis for atleast one hospital separation during pregnancy was an‘injury’, as designated by a diagnosis code between S00.0and T98.3 (Chapter XIX, ICD-10-AM), and a primaryexternal cause indicating that at least one injury in thecase record was inflicted by another person, as desig-nated by external cause codes between X85 and Y09(ICD-10-AM) [15]. Pregnancy was defined by ICD 10-AM codes 000-082, Z33, Z32.1, Z34-Z35, Z37. At leastten months of data before and after the hospital admis-sion for violence were extracted from the hospital mor-bidity records. These records were then linked to theWestern Australian Midwives’ Notification System toidentify maternal birth and foetal outcomes. The com-parison group was randomly selected from women whohad only been admitted to hospital for a pregnancy-related event including the delivery episode and had nodiagnosis of interpersonal violence for that event orprior to or after the pregnancy. A look back period of10 months before and after the delivery date was chosento ensure there was no mis-classification. These recordswere then linked to the Western Australian Midwives’Notification System to identify maternal birth and foetaloutcomes for that group.In this study, adverse maternal birth outcomesincluded threatened abortion (<20 weeks), placentalabruption, placental praevia, preterm labour, prematurerupture of the membranes, and postpartum haemor-rhage. Adverse foetal birth outcomes included foetal dis-tress, low birth weight (less than 2500 g), infant deathand foetal death.The circumstance of the violence event was defined bythe major injury grouping framework devised by theCenter for Disease Control and Prevention. The externalcause codes for injury inflicted by another was dividedinto four sub-groups designating the following methodsof inflicting injury: ‘by bodily force’ (Y04 [ICD-10-AM]),‘by sharp or blunt object’ (Y99, Y00 [ICD-10-AM]), ‘bymaltreatment or rape’ (Y05, Y06.0-9, Y07.0-9 [ICD-10-AM]) and ‘by other methods’ (all other codes betweenX85 to Y09 (ICD-10-AM) [15]. Meanwhile, the relation-ship of the perpetrator to the victim was identified usingthe fifth digit classification of the external cause ofinjury codes.This study was conducted in accordance to the guide-lines of the Declaration of Helsinki. Ethical approval wasobtained from both the Human Research Ethics Com-mittee at Curtin University and the Data LinkageBranch of the Department of Health WA.Statistical analysisDescriptive statistics were used to summarise the demo-graphic profile of the sample, including circumstances ofthe injury event and perpetrator-victim relationship.Meuleners et al. BMC Pregnancy and Childbirth 2011, 11:70 2 of 7Chi-squared tests were undertaken to compare demo-graphic characteristics and maternal and foetal out-comes between pregnant women hospitalised forviolence and those not hospitalised for violence. Oddsratios and confidence intervals were calculated usingmultivariable logistic regression models after accountingfor potential confounders namely age, maternal smokingand Indigenous status which can affect maternal andfoetal outcomes [10-13]. Two separate logistic regressionmodels were undertaken. For the first model, the out-come of interest was adverse maternal outcomes whichincluded threatened abortion (<20 weeks gestation), pre-term labour (<37 weeks), pre-labour rupture of themembranes, postpartum haemorrhage (≥500 ml), pla-cental previa, placental abruption, and other causes ofantepartum haemorrhage. For the second model, theoutcome of interest was adverse foetal outcomes whichincluded foetal distress, infant death, low birth weightand foetal death. All statistical analyses were performedin the SAS package version 9.1 [16].ResultsA total of 468 women were admitted to hospital afterinvolvement in at least one incident of interpersonal vio-lence while pregnant from 2002 to 2008. A comparisongroup of 3,744 pregnant women hospitalised for a preg-nancy related event including delivery but who did nothave a record for an incident of interpersonal violencethroughout their pregnancy were randomly selected.The sample characteristics of both groups are presentedin Table 1.A large majority of pregnant women exposed to vio-lence tended to be 25 years of age and under (61.6%),Indigenous (66.5%), multiparous (65.2%), smoked duringtheir pregnancy (59.0%), and were not in a married orde-facto relationship (59.1%). The most common type ofviolence was inflicted by bodily force (65.8% of cases),followed by rape (15.4%), assault with a blunt/sharpobject (11.1%) and other types of assault (11.1%). Ofthose cases where a code existed describing the relation-ship between the perpetrator and the victim (72.0%), themajority of pregnant women were assaulted by eithertheir spouse or partner (69.5%), followed by a personwhere the relationship was not specified (20.8%), oranother family member (5.6%) (not shown in the table).Table 2 shows maternal and foetal outcomes by vio-lence exposure status. Threatened abortions (<20 weeks)occurred significantly more often among women in thenon-exposed group than the exposed group. Othermaternal complications occurred significantly moreoften among women exposed to violence than non-exposed women during their pregnancy.The non-exposed group of women reported a signifi-cantly higher percentage of foetal distress compared towomen who had been exposed to violence during theirpregnancy. Adverse foetal outcomes such as low birthweight and foetal deaths, however, occurred significantlymore often among women exposed to violence duringtheir pregnancy, compared to the non-exposed group.Risk of adverse maternal outcomesAs shown in Table 3, exposure to violence during preg-nancy was associated with a 1.7 fold-increase in the riskof maternal complications (95% CI 1.34 to 2.18, p <0.001). These complications included threatened abor-tions, preterm labour, antepartum haemorrhage (due toplacenta praevia, placental abruption or other), pre-labour rupture of membranes and postpartum haemor-rhage. The increase in risk was evident after accountingfor potential confounders. Indigenous women also had a1.5-fold increased risk of experiencing maternal compli-cations relative to non-Indigenous women (95% CI 1.21to 1.95, p = 0.01).Risk of adverse foetal outcomesAs shown in Table 4, the risk of adverse foetal out-comes, which included low birth weight, foetal distress,and foetal/infant death, among women who had beenhospitalised due to violence during their pregnancy, wasdouble that of women who had not been exposed toviolence (95% CI 1.50 to 2.76, p < 0.001). Similarly, Indi-genous status was significantly associated with a 2-foldincreased risk for adverse foetal outcomes. Non-smokingby the pregnant women significantly reduced the risk ofexperiencing negative foetal outcomes by 37% (95% CI0.50 to 0.79, p < 0.001).DiscussionThe study has highlighted that pregnant women exposedto violence may sustain poor health outcomes for them-selves and their baby. In this whole population study,pregnant women hospitalised for an incident of inter-personal violence were at almost double the risk ofexperiencing one or more adverse maternal complica-tion than the non-exposed group. The findings providefurther evidence of an association between antepartumhemorrhage and exposure to violence [17]. Violence isoften directed towards the pregnant women’s abdomenand the high prevalence of injury due to blunt forcemay explain these results [17] Consistent with previousresearch,[7-9] the majority of violent events were perpe-trated by the pregnant women’s partner or spouse. Theoverall risk of one or more adverse foetal complicationsamong pregnant women exposed to violence was alsoincreased 2-fold.It is important to note the multifactorial relationshipbetween violence and its impact on maternal and foetaloutcomes during pregnancy.[9,12,13,18-27] Similar toMeuleners et al. BMC Pregnancy and Childbirth 2011, 11:70 3 of 7the literature, [12,28-30] certain demographic character-istics were found to be associated with the risk of vio-lence, such as younger age, marital status and parity.Population subgroups should be targeted for violencescreening and counselling during pregnancy.While mixed findings have been reported on the asso-ciation between ethnicity and rates of interpersonal vio-lence in the US and South America,[25,31,32] it isevident that significant differences exist between Indi-genous and non-Indigenous pregnant women. PregnantIndigenous women accounted for 67% of all hospitalisa-tions due to violence despite representing approximately4% of the WA population. This is consistent with pre-vious research which identified that hospital admissionsby Indigenous females due to violence were consistentlyhigher than Indigenous males, non-Indigenous malesand females [14]. High rates of established behaviouralhealth factors such as being disadvantaged economically,broken family ties, smoking, alcohol and substanceabuse increased the risk of experiencing interpersonalviolence among Indigenous families,[33,34] which mayexplain the higher occurrence of interpersonal violencerelated hospitalisations among our cohort of Indigenouswomen. In addition, the risk of experiencing adversematernal and foetal outcomes for this group was signifi-cantly increased. These findings have important implica-tions for the planning of health services and distributionof resources to effectively reduce the burden of interper-sonal violence in the Indigenous community.This study has addressed a number of shortcomings ofpast research. The use of the WA Data Linkage Systemassisted in reducing selection bias, minimised loss to fol-low up and enabled the assessment of the associationbetween pregnant women exposed to violence andadverse maternal and foetal outcomes at the populationlevel. It also had the advantage of detecting smallTable 1 Demographic, clinical and lifestyle characteristics of pregnant women hospitalised for interpersonal violenceand a comparison group: Western Australia, 2002-2008Pregnant women hospitalised for interpersonalviolence (n = 468)Pregnant women not hospitalised for interpersonalviolence (n = 3,744)P****n % n %Women’s age(years)<0.001≤20 140 30.0 419 11.221 - 25 148 31.6 685 18.326 - 30 98 20.9 1,153 30.831 - 35 50 10.7 1,017 27.2≥36 32 6.8 470 12.6Indigenousstatus<0.001Yes 311 66.5 193 5.2No 157 33.5 3,551 94.8Parity* <0.0010 88 18.8 1,637 43.71 75 16.0 963 25.72 82 17.5 558 14.93+ 223 47.7 586 15.7Gestational age(weeks)<0.001≤27 13 2.8 32 0.928 - 32 18 3.9 44 1.233 - 36 65 13.9 212 5.7≥37 372 79.5 3,456 92.3Marital status <0.001Yes** 183 40.9 2,823 76.3No*** 264 59.1 879 23.7Maternalsmoking<0.001Yes 276 59.0 691 18.5No 192 41.0 3,053 81.5* Parity is defined as the number of live-born children a woman has delivered; ** married or de facto relationship; *** widowed, divorced or single; **** P valuesfrom chi-squared testsMeuleners et al. BMC Pregnancy and Childbirth 2011, 11:70 4 of 7differences by inclusion of a large number of cases.Another strength was the use of high quality, objectivedata which should be more accurate than informationobtained via participant self-report measures [35,36].Moreover, the results obtained from this population-based study may be generalisable to the rest of Austra-lia, because WA is considered to be representative ofTable 2 Maternal and foetal outcomes among pregnant women hospitalised for interpersonal violence and acomparison group: Western Australia, 2002-2008Pregnant women hospitalised forinterpersonal violence (n = 468)Pregnant women not hospitalised forinterpersonal violence (n = 3,744)P***Outcomes n % n %MaternalThreatened abortions(<20 weeks)12 2.6 218 5.8 <0.001Threatened pretermlabour (<37 weeks)42 9.0 96 2.6 <0.001APH* - placenta praevia 5 1.1 28 0.7 0.46APH - placental abruption 3 0.6 13 0.3 0.41APH - other 16 3.4 110 2.9 0.56Pre-labour rupture ofmembranes43 9.2 210 5.6 <0.001PPH** (≥500 ml) 68 14.5 356 9.5 <0.001FoetalFoetal distress 65 13.9 599 16.0 <0.001Low birth weight 115 24.6 243 6.5 <0.001Foetal death 5 1.1 6 0.2 0.02Infant death 1 0.2 26 0.7 0.35* APH = Antepartum haemorrhage; ** PPH = Postpartum haemorrhage; *** P values from chi-squared testsTable 3 Results of multivariable logistic regression foradverse maternal outcomes among pregnant womenhospitalised due to interpersonal violence: WesternAustralia, 2002-2008Adverse maternaloutcomesAdjusted odds ratio P 95% CIExposed to violenceNo*Yes 1.70 <0.001 1.34-2.18Maternal smokingYes*No 0.92 0.27 0.78-1.07Indigenous statusNo*Yes 1.53 0.01 1.21-1.95Women’s age(years)≤20*21-25 1.06 0.62 0.85-1.3226-30 1.04 0.70 0.84-1.2931-35 1.12 0.32 0.90-1.39≥36 1.26 0.08 0.98-1.62* Reference groupTable 4 Results of multivariable logistic regression foradverse foetal outcomes among pregnant womenhospitalised due to interpersonal violence: WesternAustralia, 2002-2008Adverse foetal outcomesAdjusted odds ratio P 95% CIExposed to violenceNo*Yes 2.03 <0.001 1.50-2.76Maternal smokingYes*No 0.63 <0.001 0.50-0.79Indigenous statusNo*Yes 2.04 <0.001 1.50-2.77Women’s age (years)≤20*21-25 1.02 0.89 0.74-1.4126-30 0.92 0.61 0.67-1.2631-35 1.25 0.17 0.91-1.73≥36 1.25 0.25 0.85-1.82* Reference groupMeuleners et al. BMC Pregnancy and Childbirth 2011, 11:70 5 of 7the broader Australian population in terms of key socio-demographic and health economic indicators [37].Several limitations should be taken into account.Firstly, our findings reflect only the severe cases ofinterpersonal violence, namely those which led to hos-pitalisation. Therefore, findings cannot be generalisedto pregnant women exposed to less severe violence notrequiring hospitalisation. Also, many violent events inAustralia are never reported,[38] particularly amongIndigenous people and particularly incidents involvingdomestic violence. Limited access to hospitals in ruraland remote areas may also result in underreporting[39]. We also acknowledge that women in the compar-ison group might have been exposed to violence dur-ing pregnancy that did not require hospitalisation orwas not reported, consequently underestimating therisk of adverse outcomes associated with violence.Despite this, it is known that pregnant women aremore likely to seek medical attention due to concernfor their unborn baby [40]. This study investigatedmaternal and foetal outcomes for women who werevictims of an acute episode of violence during preg-nancy. Exposure to chronic violence, on the otherhand, may affect pregnancy outcomes differently andwarrant further studies.Finally, a large number of factors other than inter-personal violence are known to contribute to poormaternal and foetal outcomes. These include alcoholand drug usage, living conditions, health conditions,nutrition, level of prenatal care and socioeconomic sta-tus. Adverse outcomes can occur as a result of inter-personal violence, biological, behavioural andsocioeconomic factors [10]. However, information onsuch potential confounding factors was not captured inthe available databases.ConclusionsIn conclusion, pregnant women hospitalised for an inci-dent of interpersonal violence are at significantlyincreased risk of adverse maternal and foetal outcomes.Since poor maternal and foetal outcomes can have longterm health consequences, greater priority needs to begiven to the primary prevention of violence againstpregnant women and the care given to these women fol-lowing an incident of violence. In developing a responseto violence, the findings indicate that prevention pro-grams should target younger pregnant women and focuson preventing intimate partner violence. It is imperativethat culturally appropriate intervention programs areimplemented to reduce the high rate of violence againstIndigenous pregnant women and also that they receiveappropriate care and monitoring after exposure toviolence.Acknowledgements and FundingWe would like to thank the Office of Research and Development at CurtinUniversity for funding this project. We would also like to thank the DataLinkage Unit at the Department of Health, Western Australia for extraction ofthe data set.Author details1Curtin-Monash Accident Research Centre (C-MARC), School of Public Health,Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.2School of Public Health, Curtin University, GPO Box U1987, Perth, WesternAustralia 6845, Australia. 3Department of Health Care and Epidemiology,University of British Columbia, 2329 West Mall, Vancouver, British ColumbiaV6T 1Z4, Canada.Authors’ contributionsLBM conceived of the study, participated in its design and co-ordination,acquired the data, analysed and interpreted data and was involved in thedrafting and revising of the manuscript. AHL participated in the design ofthe study, in data analysis and revised the manuscript critically forintellectual content. PAJ participated in the study’s conception and design,interpretation of data and revised the manuscript for intellectual content.MLF contributed to the design of the study, assisted in data acquisition andthe drafting of the manuscript. All authors read and approved the finalmanuscript.Competing interestsThe authors declare that they have no competing interests.Received: 21 February 2011 Accepted: 12 October 2011Published: 12 October 2011References1. VicHealth: The health costs of violence. Measuring the burden of diseasecaused by intimate partner violence. A summary of findings. CarltonSouth, Victoria, Victorian Health Promotion Foundation; 2004.2. Mouzos J, Makkai T: Women’s experiences of male violence: Findingsfrom the Australian component of the International Violence AgainstWomen Survey (IVAWS). Canberra, Australian Institute of Criminology;2004, Report No. 56..3. Eichenwald EC, Stark AR: Management and outcomes of very low birthweight. N Engl J Med 2008, 358:1700-1711.4. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R: World report onviolence and health. Geneva: World Health Organization; 2002.5. World Health Organisation: International Classification of Diseases, NinthRevision. Geneva, World Health Organisation; 1975.6. World Health Organisation: International Classification of Diseases andRelated Health Problems, Tenth Revision. Geneva, World HealthOrganisation; 1992.7. Australian Bureau of Statistics [ABS]: Personal Safety Survey. Canberra,Australian Bureau of Statistics; 2006, Cat. No. 4906.0.8. Covington DL, Hage M, Hall T, Mathis M: Preterm delivery and the severityof violence during pregnancy. J Reprod Med 2001, 46:1031-1039.9. Rachana C, Suraiya K, Hisham AS, Abdulaziz AM, Hai A: Prevalence andcomplications of physical violence during pregnancy. Eur J Obstet GynecolReprod Biol 2002, 103:26-29.10. Murphy CC, Schei B, Myhr TL, Du Mont J: Abuse: a risk factor for low birthweight? A systematic review and meta-analysis. CMAJ 2001,164:1567-1572.11. Sharps PW, Laughon K, Giangrande SK: Intimate partner violence and thechildbearing year: maternal and infant health consequences. TraumaViolence Abus 2007, 8:105-116.12. El Kady D, Gilbert WM, Xing G, Smith LH: Maternal and neonataloutcomes of assaults during pregnancy. Obstet Gynecol 2005, 105:357-363.13. Lipsky S, Holt VL, Easterling TR, Critchlow CW: Impact of police-reportedintimate partner violence during pregnancy on birth outcomes. ObstetGynecol 2003, 102:557-564.14. Meuleners LB, Hendrie D, Lee AH: Hospitalisations due to interpersonalviolence: a population-based study in Western Australia. Med J Aust 2008,188:572-575.15. National Coding Centre: The Official NCC Australian Version of ICD- 10-AM Tabular List (Annotated) and Index of Procedures ICD-10-AM MBS-Meuleners et al. BMC Pregnancy and Childbirth 2011, 11:70 6 of 7Extended. National Coding Centre, Faculty of Health Sciences, University ofSydney;, 5 2006, Sydney.16. SAS Package Version 9.1: Cary, NC: SAS Institute Inc; 2007.17. Stewart D, Cecutte A: Physical abuse in pregnancy. CMAJ 1993,149:1257-63.18. Janssen PA, Holt VL, Sugg NK, Emanuel I, Critchlow CM, Henderson AD:Intimate partner violence and adverse pregnancy outcomes: apopulation-based study. Am J Obstet Gynecol 2003, 188:1341-1347.19. Coker AL, Sanderson M, Dong B: Partner violence during pregnancy andrisk of adverse pregnancy outcomes. Paediatr Perinat Epidemiol 2004,18:260-269.20. Cokkinides VE, Coker AL, Sanderson M, Addy C, Bethea L: Physical violenceduring pregnancy: maternal complications and birth outcomes. ObstetGynecol 1999, 93:661-666.21. Fanslow J, Silva M, Robinson E, Whitehead A: Violence during pregnancy:associations with pregnancy intendedness, pregnancy-related care, andalcohol and tobacco use among a representative sample of NewZealand women. Aust N Z J Obstet Gynaecol 2008, 48:398-404.22. Fanslow J, Silva M, Whitehead A, Robinson E: Pregnancy outcomes andintimate partner violence in New Zealand. Aust N Z J Obstet Gynaecol2008, 48:391-397.23. Kim H, Cain R, Viner-Brown S: Intimate partner violence before or duringpregnancy in Rhode Island. Med Health R I 2010, 93:29-31.24. Neggers Y, Goldenberg R, Cliver S, Hauth J: Effects of domestic violenceon preterm birth and low birth weight. Acta Obstet Gynecol Scand 2004,83:455-460.25. Silverman JG, Decker MR, Reed E, Raj A: Intimate partner violencevictimization prior to and during pregnancy among women residing in26 U.S. states: associations with maternal and neonatal health. Am JObstet Gynecol 2006, 195:140-148.26. Valladares E, Ellsberg M, Pena R, Hogberg U, Persson LA: Physical partnerabuse during pregnancy: a risk factor for low birth weight in Nicaragua.Obstet Gynecol 2002, 100:700-705.27. Yang MS, Ho SY, Chou FH, Chang SJ, Ko YC: Physical abuse duringpregnancy and risk of low-birthweight infants among aborigines inTaiwan. Public Health 2006, 120:557-562.28. Li Q, Kirby RS, Sigler RT, Hwang SS, Lagory ME, Goldenberg RL: A multilevelanalysis of individual, household, and neighborhood correlates ofintimate partner violence among low-income pregnant women inJefferson county, Alabama. Am J Public Health 2010, 100:531-539.29. Lipsky S, Holt VL, Easterling TR, Critchlow CW: Police-reported intimatepartner violence during pregnancy: who is at risk? Violence Vict 2005,20:69-86.30. Moraes CL, Reichenheim ME: Domestic violence during pregnancy in Riode Janeiro, Brazil. Int J Gynaecol Obstet 2002, 79:269-277.31. Bohn DK, Tebben JG, Campbell JC: Influences of income, education, age,and ethnicity on physical abuse before and during pregnancy. J ObstetGynecol Neonatal Nurs 2004, 33:561-571.32. Gazmararian JA, Lazorick S, Spitz AM, Ballard TJ, Saltzman LE, Marks JS:Prevalence of violence against pregnant women. JAMA 1996,275:1915-1920.33. Hunter E, Milroy H: Aboriginal and Torres Strait Islander suicide incontext. Arch Suicide Res 2006, 10:141-57.34. Memmott P, Stacy R, Chambers C, Keys C: Violence in IndigenousCommunities: Full Report. Canberra, Crime Prevention Branch, AttorneyGeneral’s Department; 2001.35. McGwin G, Sims RV, Vonne Pulley L, Roseman JM: Relations amongchronic medical conditions, medications, and automobile crashes in theelderly: a population-based case-control study. Am J Epidemiol 2000,152:5.36. Holland CA, Handley S, Fleetam C: Older drivers, illness and medication.London, Department for Transport; 2003.37. Clark A, Preen DB, Ng JQ, Semmens JB, Holman CDJ: Is Western Australiarepresentative of other Austrlalian States and Territories in terms of keysocio-demographic and health economic indicators? Aus Health Rev 2010,34:210-215.38. Wallace C, Burns L, Gilmour S, Hutchinson D: Substance use, psychologicaldistress and violence among pregnant and breastfeeding Australianwomen. Aust N Z J Public Health 2007, 31:51-56.39. Gillam C, Legge M, Stevenson M, Gavin A: Injury in Western Australia: anepidemiology of injury 1989 to 2000. Perth, Department of HealthWestern Australia; 2003.40. Weiss HB, Sauber-Schatz EK, Cook LJ: The epidemiology of pregnancy-associated emergency department injury visits and their impact on birthoutcomes. Accid Anal Prev 2008, 40:1088-1095.Pre-publication historyThe pre-publication history for this paper can be accessed here: this article as: Meuleners et al.: Maternal and foetal outcomesamong pregnant women hospitalised due to interpersonal violence: Apopulation based study in Western Australia, 2002-2008. BMC Pregnancyand Childbirth 2011 11:70.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at et al. BMC Pregnancy and Childbirth 2011, 11:70 7 of 7


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items