JOURNAL CLUB PRESENTATION

Dr Monisha Mary P
Associations between domestic violence
and poor pregnancy outcomes in
Taiwanese women:
a nested case-control study

2
Recent studies indicate 4.68 –25% of women have
reported experiencing some form of Domestic
Violence(DV)

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National Intimate Partner and Sexual Violence Survey: 2015
 Reasons for Article Selection

Nested Case–control Global Concern.

Study

Risk of DV
Domestic violence association with
poor pregnancy
outcomes
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 Information on the Journal
Journal name
Bio Med Central BMC
Womens Health Open access Impact factor
article 2.742

Indexing
PubMed, MEDLINE, CAS,
EMBASE, Scopus, Cinahl,
Google Scholar

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 Information on the article

Received Published
20 March 2023 1 September 2023

Accepted
16 August 2023
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Information on the article

Keywords: Abortion,
Domestic violence,
Nested case-control
study; Poor pregnancy
outcomes

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 Information on the authors
Chia-Ling Lin
Department of Nursing, Chang
Gung University of Science and
Technology, Taiwan
Jui-Chiung Sun
Department of Nursing, Chang
Gung University of Science and
Technology, Taiwan
Chun-Ping Lin
Department of Nursing, Shu-Zen Junior
College of Medicine and Management,
Kaohsiung, Taiwan
Chi-Hsiang Chung
School of Public Health, National
Defense Medical Center, Taipei, Taiwan
Wu-Chien Chie
Department of Medical Research, Tri-
Service General Hospital, Taiwan
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 Contents

❖ Abstract

❖ Overview of the article

❖ Critical appraisal

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 The Abstract

Background
and aims Results

Methods Conclusions

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ABSTRACT

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 Introduction

Abnormal pregnancy
Domestic Poor pregnancy outcomes and the
violence(DV) outcomes(PPO) intensity and frequency of
DV

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 Method
Data source

Reliable data ICD -9 CM

Taiwan National Population-based

Health Insurance claimed database
Research Database
(NHIRD) 13
Study design and sampled participants

Population- Case Control

based nested group-without
case-control PPOs
design 1:4
Case group
-PPOs
identified by
ICD-9-CM

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 Design of a case control study
Cases Controls

Have the disease Do not have the disease

Were Were not Were not

Were exposed
exposed exposed exposed

Outcome Exposure

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 Nested case control study
DEFINED COHORT

DEVELOP HAVE NOT DEVELOPED THE

TIME DISEASE DISEASE

I YEAR
CASE 1 CONTROL 1
2 YEARS
CASE 2 CONTROL 2
3 YEARS

4 YEARS

5 YEARS CASE 3 AND 4

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 Definition of DV

▪ Participants who had experienced

DV based on ICD-9-CM codes

▪ 2000 To 2015

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 Definition of comorbidity
Eclampsia, gestational
diabetes mellitus
Anxiety
Cardiovascular
disease

Type 1 diabetes
Type 2 diabetes

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 Definition of comorbidity
Syphilis, thalassemia, and
alcoholism

Depression

Obesity,
preeclampsia

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 Data analysis

▪ SPSS version 22

▪ Rate of the outcomes

▪ χ2 test

▪ Student’s t-test

▪ Conditional logistic regression -

correlation

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 Statistical analysis

Data are
presented as
odds ratios with Adjusted odds ratio
95% confidence
intervals

P values provided
Age, comorbidities, are two sided, with
urbanization level, the level of
parity, and delivery significance at 0.05
type two-sided

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The flowchart of the
study

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Table 1 – Characteristics of case group and matched control group

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Table 1 – Characteristics of case group and matched control group

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Table 1 – Characteristics of case group and matched control group

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Table 2 – Factors of poor pregnancy outcomes stratified by variables listed in a
table using conditional logistic regression

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Table 2 – Factors of poor pregnancy outcomes stratified by variables listed in a
table using conditional logistic regression

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Table 3 – Factors of poor pregnancy outcomes subtypes by using conditional
logistic regression

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Table 4 – Factors of poor pregnancy outcomes among different violence
exposure period by using conditional logistic regression

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Table 5 – Factors of poor pregnancy outcomes among different violence
exposure period by using conditional logistic regression

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 Results
▪ Mean age was 35.53 in the 41,730 female participants
▪ The overall incidence rate of PPOs of the participants, who had experienced
DV, was 84.05 per 100,000 person-years. which was significantly higher than
that for the controls (18.19 per 100,000 person-years).
▪ Risk of PPOs was higher in the participants who had
experienced DV than in the controls
▪ Longer a participant has been suffering DV, the risk
of PPOs was higher

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Discussion

Women who
experienced DV
had a 3.31 times
higher risk of
PPOs compared
to controls.

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 Positive correlation between the duration and
frequency of DV exposure in women and their
risk of experiencing PPOs

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 Based on comprehensive literature review
,

This study is the first to

investigate the association
this study is the first to
investigate the association

between the intensity of DV

and PPOs using a nested case-
control design and longitudinal
observation
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Effects of Domestic Violence

Hypothalamic–pituitary–
adrenal (HPA) function

Direct physical trauma from

the abuse

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 Effects of Domestic Violence

25% decrease in 20% decrease in the

the use of use of skilled
adequate delivery care
antenatal care

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DV on fetal outcomes at different DV may influence labor outcomes
gestational weeks
Often Health care providers are
the first line of help for people
experiencing DV.
Thus Health care providers
provide a safe and private
space for diagnosis, treatment,
and interviews

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 STRENGTHS

Maternal DV and the Apply diagnostic

exposure to increased risk criteria
DV of PPO

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 LIMITATIONS

Potential Medical records

confounders from the NHIRD

Severity of DV Type of DV Prevalence of

exposure to DV-0.52%

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 Maternal health
policy and Women’s
human rights exposure to DV
perspectives

Decrease in the DV is a
burden of DV significant factor

Early detection Protect care for

women
CONCLUSION

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 Funding
Tri-Service General Hospital Research Foundation

Data Availability
National Health Institute Research Database
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 Ethics approval and consent to participate
World Medical Association (Declaration of Helsinki)

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 CRITICAL APPRAISAL

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Appraisal tool for Case Control Study (STROBE)
 Title

Associations between domestic violence

and poor pregnancy outcomes in Taiwanese
women: a nested case-control study

Exposure Population
Outcome (poor The study design
(domestic (Taiwanese
pregnancy outcomes) (nested case-
violence) women)
control)

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 Abstract Background (domestic violence
as a risk factor for women's
Background and health)
aims
Aim (to explore the association
between DV and poor pregnancy
outcomes).

Study design (nested case-control)

Data source (Taiwan National

Methods Health Insurance Research
Database)

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 Incidence rates of poor pregnancy
outcomes

Results
Adjusted odds ratios

Shows the association

Conclusions

Highlights the increased risk

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 Introduction

▪ Outlines the background of ▪ Justifies the need

domestic violence (DV) for the study

▪ Clearly states the ▪ References

aim of the study previous research
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 Methods
STUDY DESIGN

▪ Description of the study design is clear.

▪ Definition of the case group (participants

with PPOs)

▪ Definition of the Control group

(participants without PPOs)

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 Data sources and study size

▪ Clear explanation of the

Taiwan National Health
Insurance Research
Database (NHIRD) and its
relevance for the study

▪ Total number of participants

included in the study (41,730
participants)

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 Participants
▪ Database's population coverage

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 Variables
Exposure Variable Outcome Variables

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 Bias

▪ Potential biases like selection bias or

confounding

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 Statistical methods

Utilized both Test hypotheses

descriptive and regarding the association
inferential statistics

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 Results
▪ Demographic Data Description

▪ Use of Regression Analysis for

Association
▪ Presentation of Results with Measures of
Association

▪ Stratification and Subgroup Analyses

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Discussion
▪ Discussion of Key Findings

▪ Interpretation of Results

▪ Comparisons with Existing Literature

▪ Recommendations and Implications

▪ Strengths and Limitations

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References

28 References

Vancouver style referencing

2018 to 2022

Author, Title, Publisher, Year

c
of original publication
Other information

❑ Data Availability and Declarations

❑ Funding Disclosure

❑ Declarations

❑ Ethic approval

❑ Consent for Publication

❑ Competing interests

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Thank you

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