The relationship of child sexual abuse to the birthweight of infants born to low-income women

Abstract

The purpose of this dissertation is to examine the relationship between a maternal history of child sexual abuse (CSA) and poor pregnancy outcome defined as low birthweight or prematurity among low income women. Pregnant women (n = 241) between 23 and 29 weeks gestation were interviewed during obstetric clinics in the UMMS using the Russell (1986) unwanted sexual experience survey and Lederman's (1984) Prenatal Self-Evaluation Questionnaire. The mean birthweight for the infants of all women was 3026.57 grams with 42 women (17.4%) delivering LBW infants (2500 grams or less) and 41 women (17%) delivering preterm ({dollar}>{dollar}37 weeks). Unwanted sexual experiences were reported by 97 women (40.2%) of which 68 women (28.2%) met Russell's criteria for child sexual abuse. Sixteen women (16.5%) who reported unwanted sexual experiences delivered LBW infants. Both Russell's broad and narrow definitions of child sexual abuse were correlated with poor prenatal psychosocial adaptation, drug use and different types of child maltreatment (lack of attachment, lack of continuity of care, physical abuse and neglect). The broad definition of child sexual abuse was a small but significant positive determinant in the birthweight model which controlled for race, maternal age, parity and medical factors. Characteristics of the CSA such as the intrusiveness of the abuse, the current presence of the offender in the woman's environment and multiple victimizations were significant negative determinants in the gestational age model. An unwanted sexual incident under the age of 14 and support from others were positive predictors in the birthweight model. The relationship between the broad or narrow definition of CSA and birthweight was proposed to be mediated through different health practices (smoking, alcohol and drug use, level of prenatal care, and maternal weight gain) and psychosocial adaptation. The data did not support a mediating relationship. The findings suggest that there is a relationship between CSA and the two dependent variables birthweight and gestational age which is complicated by the different characteristics of CSA producing both positive and negative predictors.