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Cognitive behavioral intervention during pregnancy reduces partner violence

Clinical Question:
Does cognitive behavioral intervention during pregnancy reduce self-reported intimate partner violence and improve pregnancy outcomes?

Bottom Line:
Cognitive behavioral intervention during pregnancy to reduce intimate partner violence leads to a reduction in the recurrence of self-reported violence episodes. Such an intervention may contribute to a reduction in very low birthweight babies, but further research is needed. (LOE = 1b-)

Reference:
Kiely M, El-Mohandes AA, El-Khorazaty MN, Gantz MG. An integrated intervention to reduce intimate partner violence. Obstet Gynecol 2010;115(2 Pt 1):273-283.  [PMID:20093899]

Study Design:
Randomized controlled trial (single-blinded)

Allocation:
Concealed

Setting:
Outpatient (primary care)

Synopsis:
This randomized controlled study tested an integrated cognitive behavioral intervention to improve outcomes for pregnant women and their babies. The investigators enrolled 1044 urban, self-identified African American women in prenatal care and randomly assigned them to the intervention or usual care. Among the enrolled women 336 reported intimate partner violence within the past year at the initial interview. Categories of violence were described in detail.The intervention was delivered during prenatal care in 4 to 8 prenatal sessions with mean duration of 35 minutes by Master?s level social workers or psychologists, and included components tailored to the individual. The intervention component related to intimate partner violence provided information about abuse and violence, a danger assessment, and prevention options. A total of 41% of participants with intimate partner violence did not receive the intervention. Other components were oriented to smoking cessation and depression treatment. Data were collected by masked interviewers at 22 to 26 weeks' and 34 to 38 weeks' gestation, and at 8 to 10 weeks postpartum. Logistic regression analysis showed that women in the intervention group were less likely to have recurrent episodes of intimate partner violence (odds ratio = 0.48; 95% CI, 0.29-0.80). The rates of low birthweight were 13% in the intervention group versus 18% in the control group, which was not statistically different (P = .20), despite the authors statement the study was powered to detect a 25% difference between groups. The contribution to the outcomes of the violence prevention component of the intervention versus the other components was not clear.

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