Maternal History of Childhood Abuse Predicts Preterm Delivery and Low Birth Weight in Offspring Open Access

Weiss, Tamara Eileen (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/xp68kg99h?locale=en
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Abstract


Abstract

Maternal History of Childhood Abuse Predicts Preterm Delivery
and Low Birth Weight in Offspring
By
Tamara E. Weiss, M.D.
Background: Maternal depression has been identified as a risk factor for low birth weight and
preterm delivery. However, depression can often be associated with a history of childhood
maltreatment, which itself has been associated with long-term physiological alterations that
could potentially affect the course and outcome of pregnancy. This study examined the
influence of maternal history of childhood abuse on pregnancy outcome while accounting for the
effects of comorbid psychiatric conditions.
Methods: This was a retrospective cohort analysis using existing data on a subset of subjects
(n=268) drawn from a cohort of women followed prospectively while receiving outpatient
perinatal psychiatric care at the Emory Women's Mental Health Program (WMHP).
Results:
Women with a history of two or more types of severe childhood abuse were more likely
than those without such abuse to deliver a low birth weight (LBW) baby (OR 7.88, 95% CI 1.82-
34.03). Women with this severe abuse were also more likely to have a preterm delivery (OR
4.20, 95% CI 1.16 - 15.22). The risk of LBW and preterm delivery (PTD) remained significant
even after controlling for confounding factors including depression, PTSD, substance abuse,
smoking, medication exposures, age, obesity, race, education, and parity.
Discussion: In this clinical sample of patients followed during pregnancy, maternal history of
severe childhood abuse was associated with increased risk of PTD and having a LBW baby. This
study provides preliminary evidence that women with a history of abuse are at risk for LBW and
PTD which in turn puts their developing child at risk for future psychiatric and medical
problems. It also raises the possibility that women with a history of childhood abuse may
represent an at-risk group that might benefit from close monitoring and early preventative
measures. The data also suggest that maternal history of child abuse may in part be responsible
for some of the previously reported effect of depression and/or psychopharmacologic treatment
on LBW and PTD.

Table of Contents


Table of Contents
Section Page

Introduction ……………………………………………………………………………….…………..............................................1


Methods………………………………………………………………….........................................................................4

Results…………………………………………………………………………………………………...............................................11

Discussion……………………………………………..……………………………………………….............................................23

References……………………………………………………………………………………………..............................................37

Figure 1. Model …………...…………………………………………………………………………...........................................45

Figure 2. Sample Flow Chart …………………………………………………………………………......................................46

Table 1. Demographics and Obstetrical Characteristics………………………………………………..........................47

Table 2. Psychiatric Characteristics and Exposures……………...........................................................48

Table 3. Childhood Abuse Exposure…………………………………………………………………....................................49

Table 4. Raw Outcomes by Abuse……………………………………………………………………...................................50

Figure 3. Distribution of Baby Weight by Abuse………………..............................................................51

Figure 4. Distribution of Gestational Age by Abuse………………………………………………….............................52

Table 5. Univariate Results: Low Birth Weight by Exposure ……………………………………….........................53

Figure 5. Bar Graph: Low Birth Weight by Abuse……………………………………………………............................ 54

Table 6. Univariate Results: Preterm Delivery by Exposure ……...................................................... 55

Figure 6. Bar Graph: Preterm Delivery by Abuse………………………….………………………….............................56

Table 7. Logistic Regression Model of Low Birth Weight……………………..............................................57

Table 8. Forced Model of Low Birth Weight (all relevant variables).………………………………......................58

Table 9. Logistic Regression Model of Preterm Delivery……………………………………………...........................59

Table 10. Forced Model of Preterm Delivery (all relevant variables).………………………….…......................60

Table 11. Secondary Analyses: Low Birth Weight by Abuse Type…………………………………......................61

Table 12. Secondary Analyses: Preterm Delivery by Abuse Type……………………………….....................……62

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