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Dietz PM, Spitz AM, Anda RF, et al. Unintended Pregnancy Among Adult Women Exposed to Abuse or Household Dysfunction During Their Childhood. JAMA. 1999;282(14):1359–1364. doi:10.1001/jama.282.14.1359
Author Affiliations: National Center for Chronic Disease Prevention and Health Promotion (Drs Dietz, Anda, Williamson, Santelli, and Kendrick and Ms Spitz), the National Center for Injury Prevention and Control (Dr McMahon), Centers for Disease Control and Prevention and the Department of Pediatrics, Emory University School of Medicine (Dr Nordenberg) Atlanta, Ga; and the Department of Preventive Medicine, Southern California Permanente Medical Group, San Diego (Dr Felitti).
Context Studies have identified childhood sexual and physical abuse as a risk
factor for adolescent pregnancy but the relationship between exposure to childhood
abuse and unintended pregnancy in adulthood has, to our knowledge, not been
Objective To assess whether unintended pregnancy during adulthood is associated
with exposure to psychological, physical, or sexual abuse or household dysfunction
Design and Setting Analysis of data from the Adverse Childhood Experiences Study, a survey
mailed to members of a large health maintenance organization who visited a
clinic in San Diego, Calif, between August and November 1995 and January and
March 1996. The survey had a 63.4% response rate among the target population
for this study.
Participants A total of 1193 women aged 20 to 50 years whose first pregnancy occurred
at or after age 20 years.
Main Outcome Measure Risk of unintended first pregnancy by type of abuse (psychological,
physical, or sexual abuse; peer sexual assault) and type of household dysfunction
(physical abuse of mother by her partner, substance abuse by a household member,
mental illness of a household member).
Results More than 45% of the women reported that their first pregnancy was unintended,
and 65.8% reported exposure to 2 or more types of childhood abuse or household
dysfunction. After adjustment for confounders (marital status at first pregnancy
and age at first pregnancy), the strongest associations between childhood
experiences and unintended first pregnancy included frequent psychological
abuse (risk ratio [RR], 1.4; 95% confidence interval [CI], 1.2-1.6), frequent
physical abuse of the mother by her partner (RR, 1.4; 95% CI, 1.1-1.7), and
frequent physical abuse (RR, 1.5; 95% CI, 1.2-1.8). Women who experienced
4 or more types of abuse during their childhood were 1.5 times (95% CI, 1.2-1.8)
more likely to have an unintended first pregnancy during adulthood than women
who did not experience any abuse.
Conclusions This study indicates that there may be a dose-response association between
exposure to childhood abuse or household dysfunction and unintended first
pregnancy in adulthood. Additional research is needed to fully understand
the causal pathway of this association.
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