Assessing for Abuse During Pregnancy

OBJECTIVE: To assess the occurrence, frequency, and severity of physical abuse during pregnancy and associated initiation of prenatal care. DESIGN: Stratified, prospective cohort analysis. SETTING: Public prenatal clinics in Houston, Tex, and Baltimore, Md. PARTICIPANTS: Total population-based sample of 691 black, Hispanic, and white pregnant women. All of the women were urban residents and most of the Hispanic women were Mexican American. All participants were invited into the study at the first prenatal visit and were followed up until delivery. MAIN OUTCOME MEASURE: Identification of abuse status. RESULTS: A three-question Abuse Assessment Screen detected a 17% (1/6) prevalence of physical or sexual abuse during pregnancy, which is more than double all previous published reports. When evaluated against nationally tested research instruments, the three-question screen that was asked at the first prenatal visit was sensitive and specific to abuse status. Abuse was recurrent, with 60% of abused women reporting two or more episodes of assault. Location of abuse focused on the head. Frequency and severity of abuse and potential danger of homicide was appreciably worse for white women. Abused women were twice as likely as nonabused women to begin prenatal care during the third trimester. CONCLUSIONS: A simple clinical assessment screen completed by the health care provider in a private setting and with the male partner absent is as effective as research instruments in identifying abused women. Straightforward, routine clinical assessment is recommended as essential in preventing potential trauma, interrupting existing abuse, and protecting health.