title: Adverse health events associated with domestic violence during pregnancy among Brazilian women.
abstract: BACKGROUND
  domestic violence during pregnancy remains an unsolved and neglected social problem despite the recognised adverse physical and mental health consequences.
  
  
  OBJECTIVE
  to examine the association between domestic violence (psychological violence and physical or sexual violence) and health problems self-reported by pregnant women.
  
  
  METHODS
  a cross-sectional analysis from a cohort study of 1,379 pregnant women attending prenatal care in public primary care units in Campinas, São Paulo, Brazil. Data were collected by interviewing women when they enroled for prenatal care. Domestic violence and alcohol abuse were ascertained by validated questionnaires. Referred morbidities, undesirable behaviours and sociodemographic characteristics were also recorded. Univariate analyses were used to estimate prevalence and unadjusted odd ratios. Multivariate logistic regression was used to identify the independent association between psychological violence and physical or sexual violence during pregnancy and women's health outcomes.
  
  
  RESULTS
  psychological violence and physical or sexual violence were reported by 19.1% (n=263) and 6.5% (n=89) of the pregnant women, respectively. Psychological violence was significantly associated with obstetric problems [odds ratio (OR) 1.95; 95% confidence interval (CI) 1.39-2.73], premature rupture of membranes (OR 1.64, 95% CI 1.01-2.68), urinary tract infection (OR 1.71, 95% CI 1.19-2.42), headache (OR 1.75, 95% CI 1.25-2.40) and sexual risk behaviours (OR 2.28, 95% CI 1.18-4.41). Physical or sexual violence was significantly associated with: obstetric problems (OR 1.72, 95% CI 1.08-2.75), premature rupture of membranes (OR 2.11, 95% CI 1.14-3.88), urinary tract infection (OR 2.05, 95% CI 1.26-3.34), vaginal bleeding (OR 1.95, 95% CI 1.10-3.43) and lack of sexual desire (OR 3.67, 95% CI 2.23-6.09).
  
  
  CONCLUSIONS
  domestic violence during pregnancy was associated with adverse clinical and psychological outcomes for women. These results suggest that a well-organised health-care system and trained health professionals, as well as multisectorial social support, are necessary to prevent or address the negative influence of domestic violence on women's health in Brazil.
authors.affiliation: State University of Campinas, Faculty of Medical Sciences, Department of Preventive and Social Medicine, P.O. Box 6111, 13081-970 Campinas, São Paulo, Brazil. celenefaudi@yahoo.com.br
authors.forename: Celene Aparecida Ferrari
authors.initials: CA
authors.lastname: Audi
authors.forename: Ana M
authors.initials: AM
authors.lastname: Segall-Corrêa
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Santiago
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008880:Midwifery / Q000458:organization & administration*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult