Intimate partner violence and its association with pregnancy loss and pregnancy planning.

OBJECTIVE: To examine the effect of physical partner violence on pregnancy loss and unplanned pregnancy.  DESIGN: Cross-sectional, self-reported questionnaire survey. SETTING: A maternity ward of a university hospital in Munich, Germany.  SAMPLE: Women who gave birth within the previous seven days.  METHODS: The effects of physical partner violence on pregnancy loss and unplanned pregnancy were estimated using descriptive statistics based on χ(2) tests, bivariate logistic regression and multivariate logistic regression.  MAIN OUTCOME MEASURES: Physical partner violence was assessed using the Abuse Assessment Screen, information on pregnancy loss was derived from women's medical files and the assessment of pregnancy planning was based on women's self-reports.  RESULTS: The survey had a response rate of 73%; 29% of the women experienced pregnancy loss, 13% reported that their last pregnancy was unplanned and 4% revealed physical violence by a current or previous partner. Physical partner violence was significantly associated with pregnancy loss (odds ratio 8.33, 95% confidence interval 2.01-34.59) and unplanned last pregnancy (odds ratio 5.03, 95% confidence interval 1.21-21.26), even after adjusting for other commonly known explanatory factors, such as number of children, women's age and women's and their partners' education level and employment, marital status, financial situation and support during pregnancy.  CONCLUSIONS: Physical partner violence is an important factor in understanding pregnancy loss and unplanned pregnancy. Inquiring about the existence of intimate partner violence among these women might help to identify women in need of domestic violence services

Acceptance of routine or case-based inquiry for intimate partner violence: a mixed method study.

BACKGROUND: The prevalence and detrimental health effects of intimate partner violence have resulted in international discussions and recommendations that health care professionals should screen women for intimate partner violence during general and antenatal health care visits. Due to the lack of discussion on routine or case-based inquiry for intimate partner violence during antenatal care in Germany, this study seeks to explore its acceptability among pregnant German women. METHODS: A mixed methods approach was used, utilizing a self-administered survey on the acceptability of routine or case-based inquiry for intimate partner violence in a university hospital's maternity ward in Munich and in-depth interviews with seven women who experienced violence during pregnancy. RESULTS: Of the 401 women who participated in the survey, 92 percent were in favor of routine or case-based inquiry for intimate partner violence during antenatal care. Acceptance of routine or case-based inquiry for intimate partner violence during antenatal care was significantly associated with women's experiences of child sexual abuse, being young, less educated, single or divorced and smoking during pregnancy. Open-ended survey questions and in-depth interviews stressed adequate training for screening, sufficient time and provision of referral information as important conditions for routine or case-based inquiry for intimate partner violence. CONCLUSIONS: Women in this study showed an overwhelming support for routine or case-based screening for intimate partner violence in antenatal care in Germany. Until adequate training is in place to allow providers to inquire for intimate partner violence in a professional manner, this study recommends that health care providers are made aware of the prevalence and health consequences of violence during pregnancy

Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases

Objective To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs).Methods Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients’ vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression.Results In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14–347) days in patients being double-vaccinated, and after 88 (range 14–270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p<0.001). Mortality was 2% in unvaccinated, 1.8% in the double-vaccinated and 0.6% in triple-vaccinated patients. Compared with unvaccinated patients, double-vaccinated (OR 0.43, 95% CI 0.29 to 0.62) and triple-vaccinated (OR 0.13, 95% CI 0.08 to 0.21) patients showed a significant lower risk of COVID-19-related hospitalisation. Using multivariable analysis, the third vaccination was significantly associated with a lower risk for COVID-19-related death (OR 0.26; 95% CI 0.01 to 0.73).Conclusions Our cross-sectional data of COVID-19 infections in patients with IRD showed a significant reduction of hospitalisation due to infection in double-vaccinated or triple-vaccinated patients compared with those without vaccination and even a significant reduction of COVID-19-related deaths in triple-vaccinated patients. These data strongly support the beneficial effect of COVID-19 vaccination in patients with IRD.Trial registration number EuDRACT 2020-001958-21