title: Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence.
abstract: BACKGROUND
  There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12-19 years of age) or adults present with different obstetric outcomes than women with no record of such violence.
  
  
  METHODS
  We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993-2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01-2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03-1.88), antepartum bleeding (RR 1.95, 95% CI 1.22-3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00-1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61-1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34-0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates.
  
  
  CONCLUSIONS
  Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes.
authors.affiliation: Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Agnes
authors.initials: A
authors.lastname: Gisladottir
authors.affiliation: London School of Hygiene and Tropical Medicine, Department of Non-Communicable Diseases Epidemiology, London, United Kingdom.|Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Luque-Fernandez
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Harlow
authors.affiliation: Rape Trauma Service and the Trauma Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.|Psychology Department, University of Iceland, Reykjavik, Iceland.
authors.forename: Berglind
authors.initials: B
authors.lastname: Gudmundsdottir
authors.affiliation: Rape Trauma Service and the Trauma Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Eyrun
authors.initials: E
authors.lastname: Jonsdottir
authors.affiliation: Department of Obstetrics and Gynecology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Ragnheidur I
authors.initials: RI
authors.lastname: Bjarnadottir
authors.affiliation: Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Arna
authors.initials: A
authors.lastname: Hauksdottir
authors.affiliation: Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.|The Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.affiliation: Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.|Harvard School of Public Health, Boston, Massachusetts, United States of America.|Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Unnur A
authors.initials: UA
authors.lastname: Valdimarsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007055:Iceland; D011247:Pregnancy; D011256:Pregnancy Outcome; D012742:Sex Offenses; D055815:Young Adult