Background:
Preterm birth (PTB) and low birth weight (LBW) are leading causes of infant mortality and account for substantial negative health sequelae. While multiple factors operate increasing risk for PTB and LBW, recent attention has focused on complex biobehavioral interactions.  Psychosocial factors that pose significant risk include intimate partner violence (IPV), stress, and mental health disorders.
Intimate partner violence is consistently linked to poor pregnancy outcomes (Boy & Salihu, 2004). Partner violence is also linked to stress and poor mental health (Bonomi et al., 2006) and stress and mental health disorders have been linked to increase risk for poor obstetric outcomes (Andersson et al., 2004; Borders et al., 2007; Neggers et al., 2006). Current literature supports the concept of a biological process explaining the relationship of stress and mental health disorders with preterm birth and low birth weight (Farina & Winkelman, 2005).
No studies were identified that included both IPV and mental health disorders in the analysis of risk for PTB and LBW.
Study Aims:

1. To identify the relationship of IPV and mental health disorders with PTB, LBW, and APGAR scores, controlling for other potential risk factors.
   
2. To identify the prevalence of social work and mental health referrals in women with documented IPV and/or mental health disorders
   

Design:  retrospective case-control design
Sample: All prenatal and delivery records from January 1, 2006 through December 31, 2006 were reviewed utilizing the computerized IPRoB system.

Methods
IRB approval was obtained.  Descriptive techniques, independent samples t-tests, and multiple regression techniques were used to identify risk for PTB and LBW with documented IPV, mental health disorders, and potential confounders.

Results:  Sample size was 2,643 singleton deliveries at 23 weeks gestation or greater. Six percent (n = 108) of women screened positive for IPV. Adjusting for gestational age, women who are abused have twice the odds of having an infant with a 1-minute APGAR score less than 7 (B = .741, aOR = 2.1;  p = .03) and over 4 ½ times the odds of having an infant with a 5-minute APGAR score less than 7 (B = 1.5, aOR = 4.7;  p = .02). Current psychiatric disorder was documented for 2.4% of the sample (n = 63). There were no significant relationships with APGAR scores and current psychiatric disorder. Adjusting for smoking, IPV, and prior history of PTB, women with current psychiatric disorders were at significantly greater risk of having a preterm infant (23 – 33 weeks) (B = 1.2, aOR = 0.3, p = .02). There was no relationship of current psychiatric disorder with birth weight adjusting for gestational age and substance use.  Referrals to social work were documented in approximately ½ of women reporting IPV or current psychiatric disorder. 
 Conclusions: Current IPV and psychiatric disorder are significant risks for poorer obstetrical outcomes. Improved referrals are needed to provide appropriate services for women with psychosocial stress in order to mitigate the negative health sequelae of these conditions. Additional research is warranted to explore biologically plausible relationships with IPV, psychiatric disorders and preterm birth.