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ment; therefore, the findings may not apply towomen who experience ongoing occupation-al problems. Noting the implications for infanthealth, the investigators conclude, “Publichealth efforts to reduce the incidence of lowbirth weight might usefully target women ex-periencing such underemployment events forspecial preventive interventions.”—S. London

REFERENCE1. Dooley D and Prause J, Birth weight and mothers’adverse employment change, Journal of Health andSocial Behavior, 2005, 46(2):141–155.

Wilcoxon rank-sum test, Student t test and chi-square were used for the statistical analyses.

Women were eligible for participation if theywere carrying a single fetus of greater than 24weeks’ gestation, but were excluded if they re-quired immediate care or were about to deliv-er, among other factors. In all, 16,041 womenwere asked to be interviewed about abuse theyhad experienced during their pregnancy. Thevast majority of women (93%) denied any abuse;1% reported physical abuse, 5% reported ver-bal abuse and 1% declined to be interviewed.Most of the participants were Hispanic(64–85%) and young (mean ages of 23.4–24.9years), and had received prenatal care (96–97%);only 90% of those who declined to be inter-viewed had received prenatal care. Across allgroups, 29–39% had never given birth before.

There were striking differences in regard toadverse pregnancy outcomes among the fourstudy groups. Infants born to women who re-ported verbal abuse only had a significantly in-creased incidence of low birth weight, com-pared with those born to women in theno-abuse group (8% vs. 5%). Infants born towomen in the physical-abuse group were atgreater risk for death than were those born towomen who had not been abused (2% vs.0.2%); however, infants born to women in thephysical-abuse group did not show an in-creased incidence of low birth weight.

The women who declined to be interviewedhad higher rates of placental abruption and pre-mature births (32 or fewer weeks’ gestation)

when compared with the no-abuse group (2%vs. 0.2% and 5% vs. 1%, respectively). Infantsborn to women in the declined-interview grouprequired admission to the neonatal intensivecare unit at a higher rate than all other groups—7% versus 2%. These infants also had an in-creased rate of low birth weight (13%, com-pared with 5% in the no-abuse group). Infantsborn to women who declined to be interviewedweighed less than those born to women whoreported no abuse (mean weight, 3,192 g vs.3,366 g).

Noting that the women most unwilling todiscuss the issue of domestic violence are at thehighest risk for adverse pregnancy outcomes,the investigators speculate that these womenare being abused and do not speak up for fearof retribution. They suggest that “future effortsto study and prevent domestic violence dur-ing pregnancy should consider that the womenwho remain silent when questioned about thesubject may, in fact, be speaking the loudest.”Although they provided women who declinedto be interviewed with the same interventionoffered to the women who reported abuse (thetelephone number of a crisis center), the re-searchers suggest that subsequent studies focuson new interventions to help “those who donot (cannot) respond to questions about theircircumstances.”—L. Melhado

REFERENCE1. Yost NP et al., A prospective observational studyof domestic violence during pregnancy, Obstetrics &Gynecology, 2005, 106(1):61–65.

For Pregnant Women,Silence on DomesticViolence Speaks Loudly

Pregnant women reporting abuse are at in-creased risk for certain adverse pregnancy out-comes: When compared with women who re-port no abuse, those reporting verbal abuse aremore likely to deliver an infant of low birthweight, and those reporting physical abuse bearinfants with a higher neonatal death rate, ac-cording to an observational study conductedfrom December 2000 to March 2002.1 Butpregnant women who do not wish to discussdomestic violence may be at greater risk forpregnancy complications and adverse infantoutcomes than those who consent to suchdiscussions.

Because there are few data to support thecommon belief that abuse during pregnancyincreases the likelihood of complications, re-searchers at the University of Texas South-western Medical Center in Dallas sought to ex-amine the associations between domesticviolence and adverse pregnancy outcomes.Women presenting at the labor and deliveryunit were asked if they would answer somequestions “about physical or emotional trau-ma.” Each woman who agreed was asked, in aface-to-face interview, the four questions thatmake up the HITS survey, a validated ques-tionnaire for assessing domestic violence:whether a partner or family member had phys-ically hurt her, insulted her or talked down toher, threatened her with harm, or screamed orcursed at her during this pregnancy. Womenanswering yes to any of the questions were of-fered the phone number of a 24-hour domes-tic violence intervention center. The results ofthe survey were matched to delivery data usingthe facility’s database containing informationon all obstetric and neonatal outcomes. The

Seven in 10 women in a diverse sample of pre-natal care patients said that they would con-sider terminating a subsequent pregnancy, butamong this group, the proportions who wouldconsider having an abortion for various rea-sons ranged widely.1 For example, althoughthree-quarters would think about undergoingthe procedure if they knew that their infantwould be affected by a chromosomal abnor-mality, only one-quarter would do so becauseof financial hardship. Half of women whowould consider having an abortion would beopen to it only during the first trimester.

The sample consisted of 1,082 women whowere less than 20 weeks pregnant and were re-ceiving care at one of several obstetric practicesin the San Francisco Bay Area in 1997–1998.

In Certain Circumstances, Women in Prenatal CareWould Not Rule Out Having an Abortion in the Future

During in-home interviews with speciallytrained researchers, they provided informationabout their demographic and socioeconomiccharacteristics; reproductive histories; and at-titudes related to pregnancy, prenatal testing,the health care system and abortion. Researchersused multiple logistic regression to identify fac-tors associated with women’s abortion attitudes.

On average, participants were 32.7 years old;the majority were married or living with a part-ner (84%). Thirty-one percent were white, 27%Asian or Pacific Islander, 22% Hispanic, 18%black and 1% members of other races; nearlyhalf were foreign-born. The sample was diversewith respect to educational attainment, house-hold income and a subjective measure of so-cioeconomic status. Roughly half of the women