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ABSTRACT: We sought to describe and compare prevalence rates of and risk factors for violence against women during pregnancy and postpartum.
Physical and sexual violence and violence risk factors were assessed during late pregnancy and 6 months postpartum in a prospective study of pregnant women with (n=336) and without (n=298) HIV in 4 US states.
Overall, 10.6% of women reported having experienced violence, 8.9% during pregnancy and 4.9% after delivery. Of these women, 61.7% were abused only during their pregnancy, 21.7% were repeatedly abused, and 16.7% were abused only after their delivery. Sexual violence rarely occurred in the absence of physical violence. The strongest predictor of violence was engaging in bartered sex (adjusted odds ratio [OR]=5.54; 95% confidence interval [CI] =2.0, 15.4). Other predictors included frequent changes in residence (adjusted OR=1.57; 95% CI=1.1, 2.2), financial support from family or partners (adjusted OR=0.42; 95% CI=0.2, 0.8), and HIV diagnosis during current pregnancy (adjusted OR=0.30; 95% CI=0.1, 0.7).
Women more commonly experienced violence during than after their pregnancy, but violence was best predicted by socioeconomic and behavioral indicators whose influence did not vary over time.
American Journal of Public Health 07/2006; 96(6):1052-9. · 3.93 Impact Factor
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ABSTRACT: Adherence to HIV treatment regimens during pregnancy may affect efforts to eliminate vertical transmission and influence the emergence of drug-resistant HIV strains that can affect maternal health and the risk of vertically-transmitted resistant strains. Study objectives were to document patterns of adherence to zidovudine (ZDV) during the perinatal period. Pregnant women with HIV who were seen at public clinics, taking ZDV, and willing to use Medication Event Monitoring Systems (MEMS) caps participated in this adherence substudy. Fifty-three women were included in prenatal analyses; however, 19 women were excluded from postnatal analyses because medical records failed to confirm a postpartum maternal prescription for ZDV. Adherence to ZDV, defined as doses per day taken/prescribed during the last 3 weeks of pregnancy, was extremely low (mean = 50.0%), and declined significantly 3 weeks postpartum (mean = 34.1%) (p =.004). Clinical emphasis must be placed on enhancing adherence during and particularly after pregnancy when ZDV is continued for a mother's own care.
JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2002; 30(3):311-5. · 4.43 Impact Factor
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ABSTRACT: This study estimated the prevalence of violence during pregnancy in relation to HIV infection.
Violence, current partnerships, and HIV risk behaviors were assessed among 336 HIV-seropositive and 298 HIV-seronegative at-risk pregnant women.
Overall, 8.9% of women experienced recent violence; 21.5% currently had abusive partners. Violence was experienced by women in all partnership categories (range = 3.8% with nonabusive partners to 53.6% with physically abusive partners). Neither experiencing violence nor having an abusive partner differed by serostatus. Receiving an HIV diagnosis prenatally did not increase risk. Disclosure-related violence occurred, but was rare.
Many HIV-infected pregnant women experience violence, but it is not typically attributable to their serostatus. Prenatal services should incorporate screening and counseling for all women at risk for violence.
American Journal of Public Health 04/2002; 92(3):367-70. · 3.93 Impact Factor
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ABSTRACT: Develop a clinical risk score to screen for antenatal bacterial vaginosis (BV), irrespective of symptoms.
Cohort study of 913 pregnant women with last menstrual periods between January 30, 1995 and February 22, 1997. BV was evaluated by Nugent-scored vaginal smears (scores of 7 to 10 considered positive) between 24 and 29 weeks' gestation. Forty-four potential risk factors were assessed.
17.8% of women had BV, of whom 22% were screened for BV by the usual care provider. Logistic regression-adjusted analyses found six predictors: vaginal pH>4.5 (OR=11.6, 95% confidence interval [CI] [7.8, 17.2]); black race (OR=1.9, 95% CI [1.3, 2.8]); condom use during pregnancy (OR=1.6, 95% CI [1.0, 2.5]); antenatal BV (OR=1.7, 95% CI [1.0, 2.8]); absence of sperm on smear (OR=1.7, 95% CI [1.0, 2.9]); and no history of sexually transmitted diseases (OR=1.6, 95% CI [1.0, 2.5]). Risk score weights were 5 for an elevated vaginal pH and 1 otherwise. The sensitivity and specificity of screening women with scores > or =4 were both 77%; this would involve screening 33% of patients.
Approximately 80% of our BV cases were asymptomatic, emphasizing the need for objective risk assessment. Using six factors, clinicians can identify pregnant women at risk for BV.
Journal of Perinatology 03/2002; 22(2):125-32. · 1.80 Impact Factor
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ABSTRACT: Objective: To investigate the relationship between fetal fibronectin and bacterial vaginosis, which are associated with an increased risk for preterm delivery.
Methods: Researchers for the Pregnancy, Infection and Nutrition Study, a cohort study of pregnant women at three central North Carolina sites, collected genital tract specimens from all enrolled women between 24 and 29 weeks' gestation. Among women with last menstrual periods between March 10, 1995, and August 15, 1996, 868 pregnancies were eligible for this analysis. Fetal fibronectin was assessed by a dipstick immunoassay kit. Bacterial vaginosis was evaluated by Nugent-scored, Gram-stained vaginal smears (scores of 7-10 considered positive).
Results: Overall, 6.3% of women had positive fetal fibronectin test results, and 18.8% had bacterial vaginosis. The unadjusted relative risk (RR) of fetal fibronectin-positivity comparing women with bacterial vaginosis to those without bacterial vaginosis was 1.6 (95% confidence interval [CI] 1.1, 2.5). Using multiple logistic regression to adjust for race, maternal age, parity, and location of care, women who had bacterial vaginosis and smoked at the time of recruitment were at substantially increased risk of fetal fibronectin-positivity (RR 7.8, 95% CI 2.2, 27.8) compared with smokers without bacterial vaginosis. Among nonsmokers, bacterial vaginosis was not associated with fetal fibronectin-positivity (RR 1.0, 95% CI 0.4, 2.4). These results were essentially unchanged after adding the requirement of vaginal pH exceeding 4.5 to the bacterial vaginosis definition.
Conclusion: Fetal fibronectin was associated positively with bacterial vaginosis, but only among women who smoked. These results might provide clues as to the biologic relationship between smoking, infection, and preterm delivery.
Fibronectins are ubiquitous proteins found in plasma and extracellular matrix. Fetal fibronectin is a specific form produced during fetal life. It is found in high concentrations in amniotic fluid and at the interface between the decidua and the trophoblast, where it might be an adhesive molecule between those two entities. Before 16-20 weeks' gestation, fetal fibronectin normally is found in the cervix and vagina. A detectable level of cervicovaginal fetal fibronectin after 20 weeks' gestation is abnormal,1 unless within a few days of labor,2 at or before term. Detection of cervicovaginal fetal fibronectin early in the third trimester has been associated with a risk of preterm delivery increased 3.8-8.9 times among unselected, prospective cohorts,3-6 and preterm delivery increased 3.6-20.9 times among women with symptoms of preterm labor or preterm premature rupture of the membranes (PROM).7-9
Bacterial vaginosis is an infection caused by an overgrowth of Gardnerella vaginalis, mixed anaerobes, and genital mycoplasms.10 Approximately one half of women with bacterial vaginosis have no symptoms. Research in the past 10 years has discovered a positive association between spontaneous preterm delivery and bacterial vaginosis with relative risks (RRs) in the range of 1.5-4.0.11-14
Only two prior studies have examined the association between bacterial vaginosis and the presence of cervicovaginal fetal fibronectin among singleton pregnancies, both published in 1996 and conducted using populations of healthy pregnant women. In a study of 82 women, Goffeng et al15 found an unadjusted relative risk of 9.7 (95% confidence interval [CI] 2.0, 46.5) between fetal fibronectin (measured three times between the 7th and 38th weeks of pregnancy) and bacterial vaginosis-associated microflora. In a multicenter study with nearly 3000 women, Goldenberg et al16 found that women with bacterial vaginosis had almost twice the odds of fetal fibronectin at 23-24 weeks' gestation (odds ratio [OR] 1.9, 95% CI 1.3, 2.8) compared with women without bacterial vaginosis, after adjusting for race and parity.
Although the biologic mechanism linking bacterial vaginosis and fetal fibronectin is unknown, bacterial vaginosis could be associated with fetal fibronectin by causing inflammation of the fetal membranes, which releases fibronectin into the cervicovaginal area. The release of fetal fibronectin might cause local inflammation or change in environment, making the vagina more susceptible to infection. Bacterial vaginosis and fetal fibronectin also might be connected by an independent, as yet unknown, determinant of both conditions.
Given the individual associations between preterm delivery and fetal fibronectin and bacterial vaginosis, and the importance of preterm delivery on birth outcome and neonatal health, this research was undertaken to examine the association between bacterial vaginosis and fetal fibronectin. Besides confirming or refuting the prior two reports, our aim was to improve on the previous studies by examining potential effect modifiers and a variety of potential confounders.
Obstetrics and Gynecology 12/1998; 93(1):117-123. · 4.73 Impact Factor
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ABSTRACT: OBJECTIVE: The HIV and Pregnancy Study of the Perinatal Guidelines Evaluation Project is a prospective, longitudinal, multisite study established to: (a) assess the implementation of Public Health Service guidelines regarding the prevention of perinatal HIV transmission and (b) evaluate the psychosocial consequences of HIV infection among pregnant women. A distinctive aspect of the study is the use of an HIV-negative comparison group. This article describes the methodology of the study and baseline characteristics of the study sample. Methods and Results. HIV-infected (n = 336) and uninfected (n = 298) pregnant women were enrolled from four geographic areas: Connecticut, North Carolina, Brooklyn, NY, and Miami, FL. The study included three structured face-to-face interviews from late pregnancy to six months postpartum for HIV-infected and uninfected women. Additional self-reports of medication adherence were collected for the HIV-infected participants, and the medical records of infected mothers and their infants were reviewed. Electronic monitoring of medication adherence was conducted for a subset of the infected women. The groups were successfully matched on self-reported characteristics, including HIV-risk behaviors. More than half of the uninfected women reported a high-risk sexual partner. Baseline comparisons indicated that both the HIV-infected and uninfected women had high levels of depressive symptoms, stress, and recent negative life events. CONCLUSIONS: This study provides a unique description of the psychosocial and behavioral characteristics of a population of low-income women. The results of this study suggest that HIV infection is one of many stressors faced by the women in this study.
Public Health Reports 117(2):137-47. · 1.27 Impact Factor
