The interrelationships between abuse, substance use, and psychosocial stress during pregnancy.

OBJECTIVE

To describe the association between abuse during pregnancy and substance use and psychosocial stress.

DESIGN

Prospective study of pregnant women.

SETTING

Urban prenatal clinics.

PARTICIPANTS

1,937 predominately low-income, ethnically diverse women.

MAIN OUTCOME MEASURES(S): Three questions from the Abuse Assessment Screen were used to measure abuse. For the total sample, 25.7% reported physical abuse in the past year, 10.5% physical abuse since pregnancy, and 4.5% sexual abuse in the past year. Adolescents were significantly more likely to report any abuse (37.6%) than were adults (22.6%) (chi-square = 44.94; df = 1; p < 0.001). White abused women were significantly more likely to report use of tobacco (chi-square = 17.34; df = 1; p < 0.001) and alcohol (chi-square = 5.65; df = 1, p < 0.01). Abused Asian women were more likely to smoke (chi-square = 12.13; df = 1, p < 0.001), as were women ethnically described as "other" (chi-square = 8.39; df = 1, p < 0.001). There was a higher, but not statistically significant, rate of substance use between abused and nonabused African-American, Native-American, and Hispanic women. Abused women of all races reported higher stress, less support from partners, less support from others, and lower self-esteem.

CONCLUSIONS

Abuse during pregnancy is associated with an increased incidence of substance use and psychosocial stress. These relationships must be incorporated into the clinical care of abused pregnant women.