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Licensed Unlicensed Requires Authentication Published by De Gruyter December 14, 2013

Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences

Brigitte Leeners, Werner Rath, Emina Block, Gisela Görres and Sibil Tschudin


Aims: To explore the association between childhood sexual abuse (CSA), physical abuse, as well as other adverse childhood experiences (ACE), and different obstetrical risk factors/behaviors.

Methods: In this cohort study, obstetrical risk factors and perinatal outcome in 85 women exposed to CSA were compared to 170 matched unexposed women. CSA, physical abuse, and ACE were explored by face-to-face interviews and by questionnaire. Data on perinatal outcome were extracted from medical charts. Fisher’s exact, χ2-test, and multiple logistic regression were used for statistical analysis.

Results: During pregnancy women with CSA experiences were significantly more often smoking (31.7%/9.4%; P<0.0001), had partners abusing drugs (10.6%/1.2%; P<0.0005), experienced physical (16.5%/0; P<0.0001), sexual (12.9%/0; P<0.0001), and emotional abuse (44.7%/1.7%; P<0.0001), reported depression (24.7%/1.8%; P<0.0001), and suicidal ideation (10.6%/0; P<0.0001) than women without CSA experiences. Differences in risk factors were more often correlated with physical than with sexual abuse during childhood. The probability for premature delivery was associated with CSA, physical abuse and ACE as well as with several of the risk factors investigated.

Conclusion: Women with CSA, physical, and ACE present with a variety of abuse-associated obstetrical risk factors and an increased risk for premature delivery. Therefore, all types of abusive and other ACE should be considered in prenatal care.

Corresponding author: Brigitte Leeners, Clinic for Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstr. 10, CH 8091 Zurich, Switzerland, Tel.: +41-44-255-50-09, Fax: +41-44-255-43-76, E-mail:


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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-3-14
Accepted: 2013-10-14
Published Online: 2013-12-14
Published in Print: 2014-3-1

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