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

Abstract

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.