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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 1 Partner abuse: episodes during pregnancy.
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Analysis 1.1

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 1 Partner abuse: episodes during pregnancy.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 2 Partner abuse: episodes during the first 3 months postpartum.
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Analysis 1.2

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 2 Partner abuse: episodes during the first 3 months postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 3 Partner abuse: abuse score first 3 months postpartum (Conflict Tactics Scale).
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Analysis 1.3

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 3 Partner abuse: abuse score first 3 months postpartum (Conflict Tactics Scale).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 4 Partner abuse: abuse score in first 3 months postpartum (Conflict Tactics Scale).
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Analysis 1.4

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 4 Partner abuse: abuse score in first 3 months postpartum (Conflict Tactics Scale).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 5 Partner abuse in the first 3 months postpartum (Current abuse score).
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Analysis 1.5

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 5 Partner abuse in the first 3 months postpartum (Current abuse score).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 6 Partner abuse: total episodes at final study assessment (pregnancy and up to 10 weeks postpartum).
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Analysis 1.6

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 6 Partner abuse: total episodes at final study assessment (pregnancy and up to 10 weeks postpartum).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 7 Partner violence at 7‐8 months postpartum.
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Analysis 1.7

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 7 Partner violence at 7‐8 months postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 8 Women with depression (after the intervention) during pregnancy.
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Analysis 1.8

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 8 Women with depression (after the intervention) during pregnancy.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 9 Mean Depression Episodes, Psychiatric Status Rating).
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Analysis 1.9

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 9 Mean Depression Episodes, Psychiatric Status Rating).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 11 Women with depression up to 3 months postpartum.
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Analysis 1.11

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 11 Women with depression up to 3 months postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 12 Depression scores up to 3 months postpartum.
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Analysis 1.12

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 12 Depression scores up to 3 months postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 13 Women with depression up to 1 year postpartum.
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Analysis 1.13

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 13 Women with depression up to 1 year postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 14 Depression scores up to 1 year postpartum.
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Analysis 1.14

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 14 Depression scores up to 1 year postpartum.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 23 Mean infant birthweight (g).
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Analysis 1.23

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 23 Mean infant birthweight (g).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 24 Number of low‐birthweight (< 2500 g) babies.
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Analysis 1.24

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 24 Number of low‐birthweight (< 2500 g) babies.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 25 Preterm labour (before 37 weeks' gestation).
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Analysis 1.25

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 25 Preterm labour (before 37 weeks' gestation).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 26 (Non‐prespecified outcome) Mean gestational age at birth (weeks).
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Analysis 1.26

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 26 (Non‐prespecified outcome) Mean gestational age at birth (weeks).

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 27 (Non‐prespecified outcome) Women adopting safety behaviours.
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Analysis 1.27

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 27 (Non‐prespecified outcome) Women adopting safety behaviours.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 28 (Non‐prespecified outcome) stress score in late pregnancy.
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Analysis 1.28

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 28 (Non‐prespecified outcome) stress score in late pregnancy.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 29 (Non‐prespecified outcome) Did not discuss abuse with care providers.
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Analysis 1.29

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 29 (Non‐prespecified outcome) Did not discuss abuse with care providers.

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Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 30 (Non‐prespecified outcome) Women reporting any domestic violence 2‐4 years postpartum.
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Analysis 1.30

Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 30 (Non‐prespecified outcome) Women reporting any domestic violence 2‐4 years postpartum.

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Summary of findings for the main comparison. Any intervention to prevent violence (all interventions) versus standard care for preventing or reducing domestic violence against pregnant women

Any intervention to prevent violence (all interventions) versus standard care for preventing or reducing domestic violence against pregnant women

Patient or population: all pregnant women
Settings: three trials conducted in the USA
Intervention: any intervention to prevent violence (all interventions) versus standard care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Any intervention to prevent violence (all interventions) versus standard care

Partner abuse: episodes during pregnancy

Study population

RR 0.5
(0.25 to 1.02)

220
(1 study)

⊕⊝⊝⊝
very low1,2

182 per 1000

91 per 1000
(45 to 185)

Partner abuse: episodes during the first 3 months postpartum

Study population

RR 0.6
(0.35 to 1.04)

271
(1 study)

⊕⊝⊝⊝
very low1,2

212 per 1000

127 per 1000
(74 to 220)

Partner abuse: abuse score in the first 3 months postpartum (Conflict Tactics Score*) The CTS is a 19‐item self‐report scale listing behaviours that the respondent’s partner might use in conflicts. Women report the frequency of partner behaviours over the past year on a 7‐point scale where 0 = never and 6 = 20 or more times.

The mean partner abuse: abuse score in the first 3 months postpartum in the intervention groups was
4.2 higher
(10.74 lower to 19.14 higher)

46
(1 study)

⊕⊝⊝⊝
very low1,3

Partner abuse in the first 3 months postpartum (Current Abuse Score**)

The Current abuse score consists of 2 scales: 1) Abuse Assessment Screen (AAS) and 2) Prenatal Psychosocial Profile (PPP).

The mean partner abuse in the first 3 months postpartum (current abuse score) in the intervention groups was
0.12 lower
(0.31 lower to 0.07 higher)

191
(1 study)

⊕⊝⊝⊝
very low4,5

Partner abuse: total episodes at final study assessment (pregnancy and up to 10 weeks postpartum)

Study population

RR 0.62
(0.43 to 0.88)

306
(1 study)

⊕⊕⊕⊝
moderate1

378 per 1000

234 per 1000
(163 to 333)

Number of low‐birthweight (< 2500 g) babies

Study population

RR 0.74
(0.41 to 1.32)

306
(1 study)

⊕⊕⊝⊝
low1,6

154 per 1000

114 per 1000
(63 to 203)

*The Abuse Assessment Screen (AAS) tool was used to for screening. Respondents who answered ‘yes’ to being physically or emotionally hurt by someone or forced to have sexual activities within the last year were considered abused. These women, who responded "Yes" to AAS tool, were administered the Conflict Tactics Score (CTS).
**The AAS contains 4 questions on emotional, physical, and sexual abuse at any time during the woman’s life, within the previous year and during pregnancy. The severity of physical violence is classified from levels 1 to 5: level 1 = slapping to level 5 = wounding with a weapon. The PPP is a 44‐item Likert‐type scale that measures stress, social support from partner and from others and self‐esteem during pregnancy. Each 11 item sub‐scale asks women to rate their stress from no stress (1) to severe stress (4).

RR: risk ratio; CI: confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 All studies contributing data had design limitations.
2 Wide confidence crossing the line of no effect and small sample size.
3 Wide confidence interval crossing the line of no difference and small sample size.
4 All studies contributing data has serious design limitations.
5 Estimate based on small sample size.
6 Wide confidence interval crossing the line of no effect.

Figuras y tablas -
Summary of findings for the main comparison. Any intervention to prevent violence (all interventions) versus standard care for preventing or reducing domestic violence against pregnant women
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Comparison 1. Any intervention to prevent violence (all interventions) versus standard care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Partner abuse: episodes during pregnancy Show forest plot

1

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.25, 1.02]

2 Partner abuse: episodes during the first 3 months postpartum Show forest plot

1

271

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.35, 1.04]

3 Partner abuse: abuse score first 3 months postpartum (Conflict Tactics Scale) Show forest plot

1

46

Mean Difference (IV, Fixed, 95% CI)

4.20 [‐10.74, 19.14]

4 Partner abuse: abuse score in first 3 months postpartum (Conflict Tactics Scale) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Psychological abuse

1

106

Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.45, ‐0.17]

4.2 Minor physical violence score

1

106

Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.82, ‐0.10]

4.3 Severe physical violence score

1

106

Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.28, 0.44]

4.4 Sexual abuse score

1

106

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.24, 0.06]

5 Partner abuse in the first 3 months postpartum (Current abuse score) Show forest plot

1

191

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.31, 0.07]

6 Partner abuse: total episodes at final study assessment (pregnancy and up to 10 weeks postpartum) Show forest plot

1

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.43, 0.88]

7 Partner violence at 7‐8 months postpartum Show forest plot

1

181

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.23, 1.21]

8 Women with depression (after the intervention) during pregnancy Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.04, 4.31]

9 Mean Depression Episodes, Psychiatric Status Rating) Show forest plot

1

46

Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.97, 0.05]

10 Depression scores (after the intervention) during pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Women with depression up to 3 months postpartum Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Empowerment training

1

106

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.20, 0.75]

11.2 Psychological therapy intervention

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.38, 5.18]

12 Depression scores up to 3 months postpartum Show forest plot

1

46

Mean Difference (IV, Fixed, 95% CI)

‐1.88 [‐5.24, 1.48]

13 Women with depression up to 1 year postpartum Show forest plot

1

182

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.37, 1.98]

14 Depression scores up to 1 year postpartum Show forest plot

1

182

Mean Difference (IV, Fixed, 95% CI)

‐0.65 [‐2.41, 1.11]

15 Apgar score less than 7 at 1 minute

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Apgar score less than 7 at 5 minutes

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 Stillbirth

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Neonatal death

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

19 Miscarriage (up to 20 weeks)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Maternal mortality

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Antepartum haemorrhage

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

22 Placental abruption

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

23 Mean infant birthweight (g) Show forest plot

1

306

Mean Difference (IV, Fixed, 95% CI)

41.0 [‐106.19, 188.19]

24 Number of low‐birthweight (< 2500 g) babies Show forest plot

1

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.41, 1.32]

25 Preterm labour (before 37 weeks' gestation) Show forest plot

1

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.40, 1.20]

26 (Non‐prespecified outcome) Mean gestational age at birth (weeks) Show forest plot

1

306

Mean Difference (IV, Fixed, 95% CI)

1.40 [0.33, 2.47]

27 (Non‐prespecified outcome) Women adopting safety behaviours Show forest plot

1

204

Risk Ratio (M‐H, Fixed, 95% CI)

2.6 [1.41, 4.79]

28 (Non‐prespecified outcome) stress score in late pregnancy Show forest plot

1

191

Mean Difference (IV, Fixed, 95% CI)

‐2.06 [‐3.34, ‐0.78]

29 (Non‐prespecified outcome) Did not discuss abuse with care providers Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.04, 0.66]

30 (Non‐prespecified outcome) Women reporting any domestic violence 2‐4 years postpartum Show forest plot

1

735

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.60, 1.08]
Figuras y tablas -
Comparison 1. Any intervention to prevent violence (all interventions) versus standard care
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