Children Prenatally Exposed to Intimate Partner Violence: A Systematic Review on Physical and Behavioral Health and Health Care Use

Background and Purpose: Intimate partner violence (IPV) is a global health issue most prevalent among women of reproductive age. While pregnant women face a further increased risk of IPV, there is a dual concern for potential harm to the fetus. During the prenatal stage, children can experience IPV as physical trauma and/or acute stress. Although negative consequences on selected birth outcomes are relatively well-established, the effects of prenatal IPV exposure on physical and behavioral health through later developmental stages remain undersummarized. Further, viewing these health consequences on health care access is essential to understanding health disparities and to inform future policy. This systematic review, informed by ecobiodevelopmental theory, examines the short- and long-term impacts of prenatal exposure to IPV on children’s physical and behavioral health and health care use.

Methods: A literature search of eligible studies through December 2016 was conducted using CINAHL, ERIC, LexisNexis, Medline, PsychINFO, Social Science Citation Index, and Social Work Abstracts and the references cited by relevant review papers, resulting in 12,579 de-duplicated citations. Two research assistants independently coded each citation for inclusion to, or exclusion from, the systematic review on IPV-exposed children’s outcomes. Conflicting coding decisions were resolved by a third doctoral-level research assistant. Included studies had participants aged birth to 18 years old, a control group, and validated outcome data. Adult retrospective reports, qualitative case studies, and correlational or descriptive designs were excluded. Eligibility criteria were applied and subcategories of IPV-exposed children’s outcome categories were identified, resulting in 12 studies included for review. 

Results: Included studies were conducted in seven countries with children between 0 and 10 years old. Prenatal IPV exposure is associated with poorer fetal and neonatal growth, specifically low birth weight, and heightened risk for perinatal and neonatal death. Adverse consequences of prenatal IPV exposure are also indicated in school-age growth and infant morbidity, particularly in girls. Prenatal IPV exposure is associated with increased trauma symptomatology and difficult temperament during infancy and internalizing and externalizing behavioral symptoms during middle childhood. Prenatal IPV exposure is associated with diminished use of formal (prenatal, delivery, well-child care) and informal (breast-feeding) health care from in-utero through toddlerhood.

Conclusions and Implications: This review emphasizes the need for research to discern links between prenatal IPV exposure and long-term physical and behavioral health and health care use. Future studies should clarify ecobiodevelopmental mechanisms explaining how prenatal IPV exposure impacts long-term outcomes. Potential risk and protective factors should be identified while considering the gendered pathways and differences between types of prenatal IPV. Consistent and accurate measures of IPV and replication of findings are also needed. These advancements can inform effective interventions for children exposed to IPV prenatally. Implementation of trauma-informed care to reduce potential revictimization during screening at prenatal visits, continuity of community-based services (e.g., home-visitation) beyond clinical settings, and prenatal prevention education for high-risk mothers (e.g., those with lower prenatal visits and/or prenatal drug use) and fathers (e.g., teenagers, men with histories of IPV perpetration) may mitigate the consequences of IPV.