Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women.
OBJECTIVE
With a prevalence of around 20%, childhood sexual abuse (CSA) is a relevant problem in obstetric care. The aim of our systematic review was to present the current knowledge on the influence of CSA on pregnancy, delivery, and early parenthood.


METHODS
All English, French, or German primary and secondary literature from the reference lists found after screening the data banks Pubmed, PsycInfo, and Psyndex for publications that include the terms CSA or childhood traumatization and pregnancy, birth, delivery, labor, childbearing, breast feeding, or postpartum, and published after 1970 were reviewed for relevant data.


METHODS
Investigations of psychological/medical data banks and cross references revealed 43 relevant studies. Given the paucity of data on this important subject, we opted to review all of these studies.


RESULTS
Although research projects on this topic are rare and the methodological quality of studies published to date is generally poor, women with a history of CSA seem to present a variety of long-term sequelae referring to pregnancy, delivery, and early parenthood. These sequelae include risk behaviors during pregnancy and disturbance of delivery by sudden memories of sexual abuse situations. Prenatal care is often complicated by the tendency to avoid situations that can trigger memories.


CONCLUSIONS
As effective treatment programs to improve sequelae of CSA are available today, the question of such abuse experiences should be raised as early as possible and adequate interdisciplinary models to care for victimized patients should be established. However, to improve knowledge on the long-term effect of sexual abuse experiences in obstetrical care, methodologically well-designed research projects focusing on the kind and incidence of sequelae, mediating factors as well as prophylactic and therapeutic options are needed.
Leeners
Brigitte
B
Department of Gynaecology and Obstetrics, University Hospital Zürich, CH 8091 Zurich, Switzerland. Birgitte.Leeners@usz.ch
Richter-Appelt
Hertha
H
Imthurn
Bruno
B
Rath
Werner
W
D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy / Q000523:psychology*