Pregnancy and childbirth among women previously exposed to sexual violence

• Main Author: Gísladóttir, Agnes
• Other Authors: Unnur Anna Valdimarsdóttir, Læknadeild (HÍ), Faculty of Medicine (HÍ), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2017
• Subjects: Sexual violence; Maternal health; Pregnancy; Obstetrics; Neonatal outcomes; Kynferðislegt ofbeldi; Heilsufar; Mæður; Meðganga; Fæðing; Nýburar; Doktorsritgerðir; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/414

Thesis for a doctoral degree at the University of Iceland. All right reserved. No part of this publication may be reproduced in any form without the prior permission of the copyright holder. Background and aims: Sexual violence is common and, due to the possible impact on the exposed individual, a major public health concern according to the World Health Organization. However, knowledge from large and well conducted studies on the associations between sexual violence and women’s childbirth outcomes later in life is as yet somewhat scarce and inconclusive. Using prospectively collected data, the aim of this thesis was to examine the potential associations between sexual violence exposure in adolescence or adulthood, and the risks of adverse pregnancy, obstetric, or neonatal outcomes in later pregnancies. Material and methods: All three studies were register-based, where information on women who attended a Rape Trauma Service (RTS) were linked with the Icelandic Medical Birth Registry (IMBR). In Study I, 915 pregnancy characteristics of mothers who attended the RTS during 1993–2008 (exposed) were compared to a randomly selected cohort of 1,641 pregnancies of women who had not attended the RTS (non-exposed), using data from the IMBR and maternity records. In Study II, we contrasted obstetric characteristics among 1,068 singleton births of women who attended the RTS 1993-2011, on average six years after the exposure, to 9,126 randomly selected births of non-exposed women, matched by maternal age, parity, and season/year of delivery. In Study III we compared characteristics of live-born singletons of exposed mothers (n=1,067) to those of non-exposed mothers (n=9,104). Poisson regression models were typically used to estimate relative risks (RR) with 95% confidence intervals. Results: Compared to non-exposed women, women previously exposed to sexual violence were younger, more often not employed, not cohabiting, and more often smokers during pregnancy (41.4% vs. 13.5%; aRR 2.59, 95% CI 2.19–3.07). Exposed primiparas ...