Counseling helps moms-to-be with abusive partner

In a large study conducted in Washington, D.C., a short intervention reduced repeat episodes of domestic violence among a group of pregnant African-American women. The intervention also made it less likely for the pregnancy to end in very premature births.

The intervention involved counseling sessions during prenatal care visits. Trained psychologists or social workers advised women in abusive relationships on safety behaviors and preventive options like filing protection orders, and provided information on types of violence and violence cycles. Information on smoking cessation and depression care was also provided.

“Many programs intervene on a single risk and I think it is important to address multiple problems at once,” Dr. Michele Kiely, of the National Institute of Child Health and Human Development in Bethesda, Maryland, told Reuters Health. “I think that was part of our success. If I were to do it again, I would consider adding interventions on alcohol and on illicit drug use. ”

In the study, Kiely and colleagues randomly assigned 1,044 pregnant African-American women to receive either usual care or the intervention. At the first interview, 169 women in the intervention group and 167 women in the usual care group said they had been abused by their partner.

Overall, the intervention cut the chances of recurrent episodes of violence by more than half, according to a report in the medical journal Obstetrics and Gynecology.

When separated by the severity of the violence, the intervention lowered the risk of recurrence both during pregnancy and after delivery among women who experienced minor abusive episodes. Among women who suffered severe violence, the intervention only affected recurrence after the pregnancy.

The intervention also appeared to improve some pregnancy outcomes. Only two women in the intervention group suffered a very preterm birth (before 33 weeks of pregnancy, instead of the normal 40 weeks), compared with nine women in the usual care group, which was a statistically significant improvement.

The length of pregnancy was also extended by more than one full week in the intervention group. “To extend gestation by more than a week in this population is an extremely important finding,” Kiely told Reuters Health. “I truly believe if the study sample had been larger, I think the biological outcomes would have been even stronger,” she said.

She added that although the intervention could be implemented elsewhere, in this case there were advantages that might not be available in all settings. All of the professionals delivering the intervention had at least a master’s degree in related fields and underwent three weeks of intensive training. “There are challenges that require both skill and flexibility in delivering such an intervention,” Kiely acknowledged.

But the payoff could be big, she and colleagues note in their report, and they think larger studies testing the effectiveness of this type of intervention would be worthwhile.

SOURCE: Obstetrics and Gynecology, February 2010

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