Opportunities for intervention: discussing physical abuse during prenatal care visits.

BACKGROUND: The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that screening for physical abuse during prenatal care visits becomes routine. Although prenatal care visits offer a unique intervention opportunity, screening is not yet standard practice. DATA AND METHODS: We used data from the 1996 and 1997 Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the prevalence of and the factors associated with health care providers' discussion of physical abuse with pregnant women in 14 states. PRAMS is a state-specific, population-based surveillance system that collects information from women on maternal behaviors before and during pregnancy, and at 2 to 6 months postpartum. RESULTS: Between 22% and 39% of the women surveyed reported that health care providers talked with them about physical abuse during prenatal care visits. Health care providers were more likely to discuss physical abuse with women who were black, Hispanic, young (aged <20 and 20 to 29), had a high school education or less, or paid for prenatal care with Medicaid. CONCLUSIONS: Our results indicate that most pregnant women do not report that their prenatal care providers discussed physical abuse with them. Logistic regression analyses identified consistent associations across the 14 states between discussion of abuse and demographic and pregnancy-related factors. A better understanding of the factors associated with whether a health care provider discusses physical abuse with a pregnant woman could increase intervention opportunities.

Prevalence of selected maternal and infant characteristics, Pregnancy Risk Assessment Monitoring System (PRAMS), 1997.

PROBLEM/CONDITION: Certain maternal behaviors and experiences (e.g., unintended pregnancy, late entry into prenatal care, smoking cigarettes during pregnancy, and physical abuse during pregnancy) might be related to adverse reproductive outcomes (e.g., low birthweight, infant morbidity and mortality, and maternal morbidity). Information on the prevalence of these behaviors and experiences is needed to monitor trends over time, to increase understanding of maternal behaviors and experiences and their relation to perinatal and maternal outcomes, and to develop and assess programs and policies designed to reduce these adverse outcomes among pregnant women and their infants. REPORTING PERIOD: From 1993 through 1997. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is a CDC-developed, ongoing, state- and population-based surveillance system designed to collect information on self-reported maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver a live-born infant. A 14-page questionnaire is mailed to a sample of mothers that is randomly selected from state birth certificate records. The questionnaire is followed by two additional mailings and follow-up with nonresponders by telephone. Responses are accumulated during the calendar year, combined with birth certificate data, and then weighted to be representative of all mothers who had a live-born infant in the state. Data for 1997 from 13 states were examined. RESULTS: The prevalence of unintended pregnancy resulting in a live-born infant ranged from 33.9% to 50.0% in the 13 states. From 1993 through 1997, data from Georgia demonstrated a significant decreasing trend (p = .01) in unintended pregnancy, whereas this trend significantly increased in New York (p = .03). In most states, women who were younger (aged <20 years), had less than 12 years of education, were black, and received Medicaid were more likely to report an unintended pregnancy. In 1997, 16.6%-30.7% of women entered prenatal care after the first 3 months of pregnancy. In most states, women who were younger (aged <20 years), black, had lower levels of education, and received Medicaid were more likely to enter prenatal care late or not at all. Georgia and Washington experienced significant decreasing trends in smoking during pregnancy. Across the 13 states, 11.0%-23.9% of women reported smoking during pregnancy. In seven of 13 states, white women were more likely to smoke during pregnancy than black women. In eight of 13 states, smoking was significantly more prevalent among women who delivered a low birthweight infant than women who delivered a normal weight infant. In seven states, the proportion of women who initiated breast-feeding significantly increased from 1993 through 1997; the prevalence in 1997 ranged from 48.1% to 86.8%. Women who were most likely to breast-feed were older, more educated, white, and did not receive Medicaid. The state-specific prevalence of physical abuse during pregnancy by a husband or partner ranged from 2.4% to 5.6%. In most of these states, women who had less than a high school education and women who received Medicaid were more likely to report having been abused. INTERPRETATION: Findings indicate that many women report high-risk behaviors or experience high-risk conditions before, during, and shortly after pregnancy. Furthermore, several specific groups of women were significantly more likely to report these behaviors or experience these conditions. In many states, women who were younger, less educated, and Medicaid recipients were more likely to experience unintended pregnancy, enter prenatal care after the first 3 months of pregnancy or not at all, smoke during the last 3 months of pregnancy, and never initiate breast-feeding. PUBLIC HEALTH ACTION: These findings are useful for state agencies to monitor trends in behaviors and experiences and to design public health programs and policies that addre