As part of your prenatal care, your healthcare provider may ask you a few unexpected questions, such as:

• Since you've been pregnant, have you been hit, slapped, kicked or otherwise physically hurt by someone?
• Within the last year has anyone made you do something sexual that you didn't want to do?
• Are you afraid of your partner or anyone else?

Although medical personnel are primarily trained to screen for diseases such as diabetes, preeclampsia and neural tube defects, many providers recognize the importance of screening for another health concern: intimate partner violence, sometimes called IPV.

Several studies indicate that between 4 and 8 percent of women report violence during pregnancy, and some studies reveal substantially higher rates. There are no age, educational, economic, religious or ethnic barriers to intimate partner violence. Thus, healthcare providers are encouraged to screen all women during pregnancy.

While it's hard to determine whether violence begins or increases during pregnancy, it's clear that abuse can have deleterious effects on mothers and their unborn children. Severe physical abuse can directly affect pregnancy, causing poor outcomes such as spontaneous miscarriage or fetal injury from maternal trauma.

Other forms of physical or emotional abuse may indirectly affect pregnancy by increasing maternal stress and exacerbating unhealthy behaviors such as smoking, alcohol use or drug abuse. In turn, these behaviors are associated with poor outcomes such as low birth weight, intrauterine growth restriction and fetal alcohol syndrome.

Women in abusive relationships may have a difficult time adhering to prenatal care recommendations such as maintaining healthy eating habits, taking prenatal supplements or preventing sexually transmitted infections Violence affects other members of the household as well. Children who witness violence in the home are at risk for depression, substance abuse, poor school performance and entering abusive relationships.

Intimate partner violence can take many forms: physical abuse, sexual abuse and emotional abuse, which can include threats, constant criticism and coercive acts. If you're the victim of an abusive relationship, your safety and the safety of your children is your first priority. If you're in danger, find a safe place to live, such as the home of a friend or a relative, or an emergency shelter. You may choose to call 911 or go the police. Keep in mind that intimate partner violence is a crime. You have the right to take legal action.

In deciding what to do, it's important to answer the following questions:

• Has the violence escalated recently?
• Are there weapons in your home?
• Are you or your children in danger?
• If you're not safe, do you have a safety plan?

If you choose to continue living with someone who may be abusive, it's important to have a safety plan in the event you need to leave your home quickly. Here are some common recommendations:

Leave a packed suitcase with a friend. It should contain a change of clothes for you and your children and an extra set of keys to your house and car.

Keep important items in a safe place. This should be accessible on short notice. The items would include personal documents such as identification, insurance and bank account information, important phone numbers, extra cash, a checkbook, credit cards and prescription medications.

Speak with your children. Let them know that it is not their role to stop the fighting. Teach them how to call the police or how to get help from a family member, friend or neighbor.

Identify a safe place where you can go, regardless of the time of day or night. This could be a relative's home or a shelter for battered women.

There are many resources that can help in a crisis including the police department, crisis hotlines, domestic violence programs, legal aid services, hospital emergency rooms and shelters for battered women and children.

Your prenatal provider is another resource. If your healthcare provider asks you about intimate partner violence, she may be familiar with the best resources in your community. If you wish to speak with someone at any time, you can call the 24-hour National Domestic Violence hotline: 1-800-799-SAFE and 800-787-3224 (TDD).