Pregnancy is an interplay of biopsychosocial and emotional processes that may lead to preterm birth (PTB) and low birth weight (LBW) via hormonal, biological, stress and emotional pathways. When intimate partner violence (IPV) is experienced in pregnancy, a multitude of biological and psychosocial health problems increase for the mother, fetus, and newborn. Psychosocial and social risk factors associated with Mental Health Disorders ([MHD]; stress, anxiety, depression, and IPV) are multi-dimensional factors associated with PTB and LBW. PTB and LBW are associated with increase in neonatal morbidity and mortality, which is particularly concerning since many causes are modifiable. The American College of Obstetrics and Gynecology and Association of Women’s Health, Obstetric, and Neonatal Nurses advocates psychosocial, social, and domestic violence screening of women throughout prenatal care regardless of social status, educational level, race or ethnicity.
Methods: This study was a descriptive correlational secondary data analysis of 2,637 women who delivered at a metropolitan hospital in the United States over one year. The Abuse Assessment Screen and an investigator-developed record review form from the original study identified IPV, MHDs, referrals, and birth outcomes.
A literature search from 1998 -2017 was conducted using MEDLINE, PubMed, CINAHL ,Cochrane Library, and Google Scholar, merging the terms “pregnancy”, “nurse assessment”, “psychosocial risks (MHD, PTD, PTL, and LBW)”, “mental health disorders”, and “intimate partner violence”. The study question was “What is the association between psychosocial risk factors (MHDs and IPV) during pregnancy and nurse assessments and referrals with birth outcomes (PTB, LBW)?” with the objective of identifying nurse assessment and referral practices for patients with MHDs and IPV to improve birth outcomes.
Results: Twenty-one peer-reviewed publications that met the criteria were identified and reviewed. Several themes were identified that influence pregnancy outcomes: 1) psychosocial risk factors; 2) nurse screening practices; and, 3) referral to social services.
Over one-third of patients did not have a documented Abuse Assessment Screen on admission. Four percent (n = 107) reported IPV and/or MHDs during pregnancy. MHDs were significantly associated with lack of referral, PTB in gestational age in weeks, birth weight less than 2500 grams, and birth prior to 37 completed weeks. There was a statistically significant difference in mean gestational age for women with MHD compared to women without MHD. No statistically significant association or difference in birth outcomes (PTB, LBW) was found for IPV status. Women with IVP and/or MHDs had great than 30% missed opportunities by nurses for assessment and referral to social services.
Conclusion: The study found that women with documented MHDs are at a greater risk of PTB and LBW infants, but not women who experience IPV. This study identified MHD as a significant risk factor in preterm deliveries. It was found IPV was not statistically significant in the birth outcomes (LBW and PTB). There is no consensus in the literature currently as to how often the woman should be assessed for MHD, only that there should be assessment prenatally, and especially postpartum.
Mental health disorders are associated with PTB and LBW. Nurses identifying IPV and MHDs during perinatal risk assessments were inconsistent in initiating referrals to social services. MHDs should be included when assessing pregnant patients who may be at risk for PTB and LBW at each visit. The findings of our study strengthen the importance of emphasizing a more comprehensive approach to risk assessment and service presentation in high risk perinatal women with MHDs. When assessment indicates, the healthcare provider should refer the patient for further evaluation or intervention. Additional research is warranted to explore patient follow-up with referrals and effectiveness of maternal and neonatal intervention outcomes.