[Physical, psychological, emotional, and sexual violence during pregnancy as a reproductive-risk predictor of low birthweight in Costa Rica].
OBJECTIVE
To determine the prevalence of physical, psychological, emotional, and sexual violence during pregnancy and the association that that violence has with low birthweight.


METHODS
For 118 women who gave birth between September 1998 and November 1999 we explored the violence that they had suffered during their pregnancy. All the women were residents of Finca San Juan, a low-income urban settlement in the Rincón Grande de Pavas section of San José, Costa Rica. We used a previously validated questionnaire with closed questions. A multiple linear regression model was used to adjust the average weights of the newborns according to the characteristics of the mother: age, years of schooling, marital status, desire for the pregnancy, harmful habits (smoking, drinking alcohol), number of previous pregnancies and childbirths, birth interval, physical stature, total increase in weight during the pregnancy, and illnesses during the gestation. A logistic regression model was used to measure the direct effect of violence on low birthweight, and a nonparametric method was used to calculate the attributable fraction among the exposed women.


RESULTS
The newborns of the mothers who suffered acts of violence weighed on average 449.4 g less that the newborns of the women who had not been exposed to acts of violence (P < 0.001). The mothers who suffered acts of violence were three times as likely to have a newborn with low birthweight (95% confidence interval: 1.39 to 8.10). The variables that were most closely associated with low birthweight were violence suffered by the mother (direct association) and the mother's weight gain during pregnancy (inverse relation).


CONCLUSIONS
Our results indicate the need to investigate this subject more deeply, to train health workers concerning violence toward women as a reproductive-risk factor, and to form groups of experts on this subject to develop specialized protocols for the early identification of pregnant women subject to violence.
Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Ministerio de Salud, San José, Costa Rica. hnunez@inciensa.sa.cr
Hilda Patricia
HP
Núñez-Rivas
Rafael
R
Monge-Rojas
Carla
C
Gríos-Dávila
Ana María
AM
Elizondo-Ureña
Ana
A
Rojas-Chavarría
D000293:Adolescent; D000328:Adult; D018585:Battered Women / Q000523:psychology / Q000706:statistics & numerical data*; D001724:Birth Weight; D002648:Child; D003364:Costa Rica / Q000453:epidemiology; D017579:Domestic Violence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011204:Poverty Areas; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D037841:Pregnant People / Q000523:psychology; D015995:Prevalence; D017584:Reproductive History; D012742:Sex Offenses / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*