Violence From a Partner During Pregnancy, and What It Means for Mothers and Babies

Intimate partner violence (IPV) — emotional, physical or sexual abuse by a partner — during pregnancy is a preventable cause of injury and death. It can cause orthopedic and head injuries, obstetric complications, and injury or death of the fetus; about 40% of homicides of people known to be pregnant or within a year of pregnancy are related to IPV. Black, American Indian or Alaska Native, multiracial and younger women experience it disproportionately.

Much less is known about the effects of emotional and sexual IPV than of physical violence. This study looked at all three.

The study

The Pregnancy Risk Assessment Monitoring System (PRAMS) surveys women by mail or phone 2 to 6 months after a live birth. This analysis used 2016–2022 data from nine jurisdictions that asked about all three types of violence by a husband or partner during pregnancy — 47,796 respondents in Arkansas, the District of Columbia, Indiana, Kansas, Mississippi, Pennsylvania, South Dakota, Washington and Wisconsin. Birth outcomes came from linked birth certificates.

How common

What it was linked to

Compared with women who didn't report each type of violence (adjusted prevalence ratios; 2.0 means twice as common):

— : no significant association. No type of IPV was significantly linked to babies small or large for their gestational age.

• Depression and substance use were roughly twice as common with every type of violence — and they can have cascading effects on the baby and family after birth. Mental health–related deaths, including suicide and overdose, are the leading cause of pregnancy-related deaths.
• Physical violence was linked to pregnancy-related high blood pressure, a risk factor for low birth weight, preterm birth and stroke.
• Physical violence was also linked to less gestational diabetes (0.61) — unlike earlier research, which found no link or more; this needs further study.

Types of intimate partner violence during pregnancy among women with a recent live birth, PRAMS, nine U.S. jurisdictions, 2016–2022. CDC

Preventing it

• Prevention works best at every level — personal, relationship, community and society. Teaching healthy relationship skills and strengthening economic support for families may reduce IPV.
• Screening and referral. The U.S. Preventive Services Task Force recommends that health care providers screen women of reproductive age for IPV and refer those affected to ongoing support. IPV screening is a covered preventive service at no cost to patients.
• Information for everyone, whether or not they disclose violence: prevention education and community resources such as mental health services, crisis hotlines and shelters.
• Beyond the clinic. Because women facing IPV are less likely to get timely prenatal care, programs such as home visiting can bring prevention and help to them.

Limits

• The results apply only to women with live births in these jurisdictions and years (birth outcomes: single births only), and not every jurisdiction asked every question.
• Everything was self-reported after the birth, so violence and substance use may be underreported.
• Only violence by a current husband or partner was counted — not by an ex-partner — so IPV is likely underestimated.
• The measures don't capture how often or how severe the violence was, or combinations of types.
• Each type was compared with women who hadn't experienced that type, so the types can't be compared directly with each other.

Sources

Based on Steele-Baser M, Brown AL, D'Angelo DV, Basile KC, Lee RD, Nguyen AT, Cassell CH, "Intimate Partner Violence and Pregnancy and Infant Health Outcomes — Pregnancy Risk Assessment Monitoring System, Nine U.S. Jurisdictions, 2016–2022," MMWR volume 73, number 48, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's text calls the gestational diabetes finding "0.39 times lower"; its table gives the adjusted prevalence ratio as 0.61, which is the figure used here.