Intimate partner violence: associations with low infant birthweight in a South African birth cohort
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Violence against women is a global public health problem. Exposure to intimate partner violence (IPV) during pregnancy has been associated with a number of adverse maternal and fetal outcomes, including delivery of a low birthweight (LBW) infant. However, there is a paucity of data from low-middle income countries (LMIC). We examined the association between antenatal IPV and subsequent LBW in a South African birth cohort. This study reports data from the Drakenstein Child Lung Health Study (DCLHS), a multidisciplinary birth cohort investigation of the influence of a number of antecedent risk factors on maternal and infant health outcomes over time. Pregnant women seeking antenatal care were recruited at two different primary care clinics in a low income, semi-rural area outside Cape Town, South Africa. Antenatal trauma exposure was assessed using the Childhood Trauma Questionnaire (CTQ) and an IPV assessment tool specifically designed for the purposes of this study. Potential confounding variables including maternal sociodemographics, pregnancy intention, partner support, biomedical and mental illness, substance use and psychosocial risk were also assessed. Bivariate and multiple regression analyses were performed to determine the association between IPV during pregnancy and delivery of an infant with LBW and/or low weight-for-age z (WAZ) scores. The final study sample comprised 263 mother-infant dyads. In multiple regression analyses, the model run was significant [r 2 = 0.14 (adjusted r 2 = 0.11, F(8, 212) = 4.16, p = 0.0001]. Exposure to physical IPV occurring during the past year was found to be significantly associated with LBW [t = −2.04, p = 0.0429] when controlling for study site (clinic), maternal height, ethnicity, socioeconomic status, substance use and childhood trauma. A significant association with decreased WAZ scores was not demonstrated. Exposure of pregnant women to IPV may impact newborn health. Further research is needed in this field to assess the relevant underlying mechanisms, to inform public health policies and to develop appropriate trauma IPV interventions for LMIC settings.
KeywordsIntimate partner violence Trauma Pregnancy Low birth weight South Africa
The authors would like to thank colleagues for their helpful comments and contributions:
Colleen Adnams, Whitney Barnett, Leonie Coetzee, Emilee Da Costa, Kirsty Donald, Sheri Koopowitz, Dave le Roux, Crick Lund, Adele Marais, Alina Metje, Bronwyn Myers, Nyasha Nyakutira, Micky Stern, Carlijn Sturm, Mark Tomlinson, Claire van der Westhuizen, Bavanisha Vythilingum.
The entire on-site Drakenstein clinical and research team for its tireless work and commitment.
All the mothers and infants enrolled in the Drakenstein Child Lung Health Study.
Professor Stein is supported by the Medical Research Council of South Africa.
Support for this study was provided by the Bill and Melinda Gates Foundation (grant number OPP1017641), by the UCLA/South African Trauma Training Research (Phodiso) Program, Fogarty International (grant number 1 D43 TW007278) and by the National Institute of Mental Health (NIMH) Brain Disorders in the Developing World: Research Across the Lifespan program (grant number 1R21MH098662-01).
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