Sandra Valongueiro

Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study.

BACKGROUND Partner violence against women is common during pregnancy and might have an adverse effect on the mental health of women after delivery. We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women by their intimate partners during pregnancy. METHODS In a prospective cohort study undertaken in Recife, northeastern Brazil, between July, 2005, and December, 2006, we enrolled pregnant women (aged 18-49 years) in their third trimester of pregnancy who were attending primary health-care clinics. The women were interviewed during pregnancy and after delivery. The form of partner violence in pregnancy was assessed with a validated questionnaire, and the Edinburgh postnatal depression scale was used to measure postnatal depression. Associations were estimated with odds ratios (ORs), adjusted for confounding factors contributing to the association between postnatal depression and intimate partner violence. FINDINGS 1133 pregnant women were eligible for inclusion in the study, of whom 1045 had complete data for all variables and were included in the analysis. 270 women (25.8%, 95% CI 23.2-28.6) had postnatal depression. The most common form of partner violence was psychological (294 [28.1%, 25.4-31.0]). Frequency of psychological violence during pregnancy was positively associated with occurrence of postnatal depression, and although this association was attenuated after adjustment, women reporting the highest frequency of psychological violence were more likely to have postnatal depression even after adjustment (adjusted OR 2.29, 95% CI 1.15-4.57). Women who reported physical or sexual violence in pregnancy were more likely to develop postnatal depression (OR 3.28, 2.29-4.70), but this association was substantially reduced after adjustment for psychological violence and confounding factors. INTERPRETATION Psychological violence during pregnancy by an intimate partner is strongly associated with postnatal depression, independently of physical or sexual violence. This finding has important policy implications since most social policies focus on prevention and treatment of physical violence. FUNDING Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, e Insumos Estratégicos, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil).

Freqüência e padrão da violência por parceiro íntimo antes, durante e depois da gravidez

OBJETIVO: Estimar a prevalencia e analisar o padrao da violencia por parceiro intimo antes e durante a gestacao e no pos-parto. METODOS: Estudo de coorte realizado com 960 mulheres de 18 a 49 anos, cadastradas no Programa Saude da Familia da cidade do Recife, PE, entre 2005 e 2006. As mulheres foram entrevistadas durante a gestacao e no puerperio, utilizando-se um questionario adaptado do Estudo Multipaises sobre a Saude da Mulher e Violencia Domestica da Organizacao Mundial da Saude. Para avaliar o padrao de ocorrencia da violencia por parceiro intimo, entre um determinado periodo e o subsequente, o odds ratio foi calculado com intervalos de 95% de confianca (IC95%). RESULTADOS: A prevalencia de violencia por parceiro intimo antes, durante e/ou depois da gestacao foi estimada em 47,4% e, para cada periodo isolado, em 32,4%, 31,0% e 22,6%, respectivamente. As mulheres que relataram violencia antes da gravidez tiveram chance 11,6 vezes maior (IC95%: 8,3;16,2) de relatar violencia durante a gravidez. Quando as mulheres relataram violencia durante a gravidez, a chance de relatos no pos-parto foi 8,2 vezes maior (IC95%: 5,1;11,7). A violencia psicologica foi a de maior prevalencia, principalmente durante a gestacao (28,8%; IC95%: 26,0%;31,7%); a sexual, a menos prevalente, especialmente no pos-parto (3,7%; IC95%: 2,6%;5,0%); e a fisica diminuiu quase 50% durante a gestacao em comparacao com o periodo anterior. CONCLUSOES: Parcela significativa das mulheres em idade reprodutiva vivencia situacoes de violencia por parceiro intimo. Os periodos de consultas de pre-natal e de puericultura sao oportunidades para que o profissional de saude possa identificar situacoes de violencia.OBJETIVO: Estimar la prevalencia y analizar el patron de violencia por pareja intima, antes y durante la gestacion y en el postparto. METODOS: Estudio de cohorte realizado con 960 mujeres de 18 a 49 anos, catastradas en el Programa Salud de la Familia de la ciudad de Recife, Noreste de Brasil, entre 2005 y 2006. Las mujeres fueron entrevistadas durante la gestacion y en el puerperio, utilizandose un cuestionario adaptado del Estudio Multipaises sobre la Salud de la Mujer y Violencia Domestica de la Organizacion Mundial de la Salud. Para evaluar el patron de ocurrencia de la violencia por pareja intima, entre un determinado periodo y el subsecuente, el odds ratio (OR) fue calculado con intervalos de 95% de confianza (IC95%). RESULTADOS: La prevalencia de violencia por pareja intima antes, durante y/o despues de la gestacion fue estimada en 47,4% y para cada periodo aislado, en 32,4%, 31,0% y 22,6%, respectivamente. Las mujeres que relataron violencia antes del embarazo tuvieron chance 11,6 veces mayor (IC95%:8,3;6,2) de relatar violencia durante el embarazo. Cuando las mujeres relataron violencia durante el embarazo, el chance de relatos en el postparto fue 8,2 veces mayor (IC95%:5,1;11,7). La violencia psicologica fue la de mayor prevalencia, principalmente durante la gestacion (28,8%; IC95%:26,0%;31,7%); la sexual, la menos prevalente, especialmente en el postparto (3,7%; IC95%: 2,6%;5,0%); y la fisica disminuyo casi 50% durante la gestacion en comparacion con el periodo anterior. CONCLUSIONES: Parcela significativa de as mujeres en edad reproductiva experimenta situaciones de violencia por pareja intima. Los periodos de consultas de prenatal y de puericultura son oportunidades para que el profesional de salud pueda identificar situaciones de violencia.OBJECTIVE To estimate the prevalence and analyze the pattern of intimate partner violence, before and during pregnancy and in the postpartum period. METHODS This was a cohort study undertaken on 960 women aged 18 to 49 years, who were registered in the Family Health Program of the city of Recife, Northeastern Brazil, between 2005 and 2006. The women were interviewed during pregnancy and in the postpartum period, using a questionnaire adapted from the World Health Organizations Multi-country Study on Womens Health and Domestic Violence. To assess the pattern of intimate partner violence occurrences between a given time period and the subsequent period, the odds ratio (OR) was calculated with 95% confidence intervals (95%CI). RESULTS The prevalence of intimate partner violence before, during and/or after pregnancy was estimated to be 47.4%. For the three periods separately, it was 32.4%, 31.0% and 22.6% respectively. The women who reported violence before pregnancy were 11.6 times more likely to report violence during pregnancy (95%CI: 8.3;16.2). When the women reported violence during pregnancy, the chance of reports in the postpartum period was 8.2 times higher (95%CI: 5.1;11.7). Psychological violence was more prevalent, especially during pregnancy (28.8%; 95%CI: 26.0%;31.7%). Sexual violence was less prevalent, especially after delivery (3.7%; 95%CI: 2.6%;5.0%). Physical violence diminished by almost 50% during pregnancy, in comparison with the preceding period. CONCLUSIONS A significant proportion of women of reproductive age experience situations of intimate partner violence. The periods of prenatal and childcare consultations are opportunities for healthcare professionals to identify situations of violence.

Frequency and pattern of intimate partner violence before, during and after pregnancy

OBJETIVO: Estimar a prevalencia e analisar o padrao da violencia por parceiro intimo antes e durante a gestacao e no pos-parto. METODOS: Estudo de coorte realizado com 960 mulheres de 18 a 49 anos, cadastradas no Programa Saude da Familia da cidade do Recife, PE, entre 2005 e 2006. As mulheres foram entrevistadas durante a gestacao e no puerperio, utilizando-se um questionario adaptado do Estudo Multipaises sobre a Saude da Mulher e Violencia Domestica da Organizacao Mundial da Saude. Para avaliar o padrao de ocorrencia da violencia por parceiro intimo, entre um determinado periodo e o subsequente, o odds ratio foi calculado com intervalos de 95% de confianca (IC95%). RESULTADOS: A prevalencia de violencia por parceiro intimo antes, durante e/ou depois da gestacao foi estimada em 47,4% e, para cada periodo isolado, em 32,4%, 31,0% e 22,6%, respectivamente. As mulheres que relataram violencia antes da gravidez tiveram chance 11,6 vezes maior (IC95%: 8,3;16,2) de relatar violencia durante a gravidez. Quando as mulheres relataram violencia durante a gravidez, a chance de relatos no pos-parto foi 8,2 vezes maior (IC95%: 5,1;11,7). A violencia psicologica foi a de maior prevalencia, principalmente durante a gestacao (28,8%; IC95%: 26,0%;31,7%); a sexual, a menos prevalente, especialmente no pos-parto (3,7%; IC95%: 2,6%;5,0%); e a fisica diminuiu quase 50% durante a gestacao em comparacao com o periodo anterior. CONCLUSOES: Parcela significativa das mulheres em idade reprodutiva vivencia situacoes de violencia por parceiro intimo. Os periodos de consultas de pre-natal e de puericultura sao oportunidades para que o profissional de saude possa identificar situacoes de violencia.OBJETIVO: Estimar la prevalencia y analizar el patron de violencia por pareja intima, antes y durante la gestacion y en el postparto. METODOS: Estudio de cohorte realizado con 960 mujeres de 18 a 49 anos, catastradas en el Programa Salud de la Familia de la ciudad de Recife, Noreste de Brasil, entre 2005 y 2006. Las mujeres fueron entrevistadas durante la gestacion y en el puerperio, utilizandose un cuestionario adaptado del Estudio Multipaises sobre la Salud de la Mujer y Violencia Domestica de la Organizacion Mundial de la Salud. Para evaluar el patron de ocurrencia de la violencia por pareja intima, entre un determinado periodo y el subsecuente, el odds ratio (OR) fue calculado con intervalos de 95% de confianza (IC95%). RESULTADOS: La prevalencia de violencia por pareja intima antes, durante y/o despues de la gestacion fue estimada en 47,4% y para cada periodo aislado, en 32,4%, 31,0% y 22,6%, respectivamente. Las mujeres que relataron violencia antes del embarazo tuvieron chance 11,6 veces mayor (IC95%:8,3;6,2) de relatar violencia durante el embarazo. Cuando las mujeres relataron violencia durante el embarazo, el chance de relatos en el postparto fue 8,2 veces mayor (IC95%:5,1;11,7). La violencia psicologica fue la de mayor prevalencia, principalmente durante la gestacion (28,8%; IC95%:26,0%;31,7%); la sexual, la menos prevalente, especialmente en el postparto (3,7%; IC95%: 2,6%;5,0%); y la fisica disminuyo casi 50% durante la gestacion en comparacion con el periodo anterior. CONCLUSIONES: Parcela significativa de as mujeres en edad reproductiva experimenta situaciones de violencia por pareja intima. Los periodos de consultas de prenatal y de puericultura son oportunidades para que el profesional de salud pueda identificar situaciones de violencia.OBJECTIVE To estimate the prevalence and analyze the pattern of intimate partner violence, before and during pregnancy and in the postpartum period. METHODS This was a cohort study undertaken on 960 women aged 18 to 49 years, who were registered in the Family Health Program of the city of Recife, Northeastern Brazil, between 2005 and 2006. The women were interviewed during pregnancy and in the postpartum period, using a questionnaire adapted from the World Health Organizations Multi-country Study on Womens Health and Domestic Violence. To assess the pattern of intimate partner violence occurrences between a given time period and the subsequent period, the odds ratio (OR) was calculated with 95% confidence intervals (95%CI). RESULTS The prevalence of intimate partner violence before, during and/or after pregnancy was estimated to be 47.4%. For the three periods separately, it was 32.4%, 31.0% and 22.6% respectively. The women who reported violence before pregnancy were 11.6 times more likely to report violence during pregnancy (95%CI: 8.3;16.2). When the women reported violence during pregnancy, the chance of reports in the postpartum period was 8.2 times higher (95%CI: 5.1;11.7). Psychological violence was more prevalent, especially during pregnancy (28.8%; 95%CI: 26.0%;31.7%). Sexual violence was less prevalent, especially after delivery (3.7%; 95%CI: 2.6%;5.0%). Physical violence diminished by almost 50% during pregnancy, in comparison with the preceding period. CONCLUSIONS A significant proportion of women of reproductive age experience situations of intimate partner violence. The periods of prenatal and childcare consultations are opportunities for healthcare professionals to identify situations of violence.

Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study

BACKGROUND A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. METHODS We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. FINDINGS We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. INTERPRETATION The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. FUNDING Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Enfrentamento da violência infligida pelo parceiro íntimo por mulheres em área urbana da região Nordeste do Brasil

OBJETIVO: Descrever as formas de enfrentamento a violencia fisica adotadas por mulheres agredidas por parceiro intimo. METODOS: Estudo transversal realizado na linha de base de estudo de coorte, com gestantes cadastradas no Programa Saude da Familia, entre julho de 2005 e marco de 2006, em Recife, PE. Foram selecionadas 283 gestantes de 18 a 49 anos com historico de violencia fisica pelo parceiro de entao ou mais recente antes e/ou durante a gestacao. As entrevistas foram realizadas face a face, com questionario estruturado e pre-codificado, e realizou-se analise descritiva. Foi coletada informacao sobre caracteristicas sociodemograficas das mulheres, tipos e gravidade da violencia fisica cometida pelo parceiro, formas de enfrentamento da violencia, pessoas e servicos de apoio procurados pelas mulheres, motivos para a mulher ter alguma vez abandonado e retornado a casa em razao da violencia. RESULTADOS: Das mulheres que sofreram violencia fisica pelo parceiro intimo, 57,6% conversaram com alguem, 3,5% procuraram ajuda institucionalizada, 17,3% conversaram e procuraram ajuda institucionalizada e 21,6% nao procuraram nenhuma forma de ajuda. As pessoas mais procuradas foram os pais (42,0%), amigo/amiga (31,6%) e irmao/irma (21,2%). Os servicos mais procurados pelas mulheres foram: policia/delegacia (57,6%), servicos de saude (27,1%) e instituicoes religiosas (25,4%). Relataram nao ter obtido qualquer tipo de ajuda 44,8% das mulheres; 32,1% disseram ter saido de casa alguma vez na vida, pelo menos por uma noite, das quais 5,9% nao retornaram a casa. Foram motivos para deixar a casa: a exacerbacao da violencia e o medo de ser morta; para o retorno: a esperanca de mudanca do parceiro e o desejo de preservar a familia. CONCLUSOES: Grande parte das mulheres que sofriam violencia por parceiro intimo buscou alguma forma de ajuda. A rede social primaria (familiares e amigos) foi a mais procurada pelas mulheres para romper o ciclo violento. Os resultados apontam a necessidade de maior divulgacao dos servicos de apoio e a importância da ampliacao e qualificacao da rede de servicos (policia, justica, saude, assistencia psicossocial) para que estes possam acolher e apoiar as mulheres, dando-lhes suporte efetivo para romper com a situacao de VPI.

Incidence and risk factors for intimate partner violence during the postpartum period

OBJECTIVE To estimate the incidence and identify risk factors for intimate partner violence during postpartum. METHODS This prospective cohort study was conducted with women, aged between 18-49 years, enrolled in the Brazilian Family Health Strategy in Recife, Northeastern Brazil, between 2005 and 2006. Of the 1.057 women interviewed during pregnancy and postpartum, 539 women, who did not report violence before or during pregnancy, were evaluated. A theoretical-conceptual framework was built with three levels of factors hierarchically ordered: women’s and partners’ sociodemografic and behavioral characteristics, and relationship dynamics. Incidence and risk factors of intimate partner violence were estimated by Poisson Regression. RESULTS The incidence of violence during postpartum was 9.3% (95%CI 7.0;12.0). Isolated psychological violence was the most common (4.3%; 95%CI 2.8;6.4). The overlapping of psychological with physical violence occurred at 3.3% (95%CI 2.0;5.3) and with physical and/or sexual in almost 2.0% (95%CI 0.8;3.0) of cases. The risk of partner violence during postpartum was increased for women with a low level of education (RR = 2.6; 95%CI 1.3;5.4), without own income (RR = 1.7; 95%CI 1.0;2.9) and those who perpetrated physical violence against their partner without being assaulted first (RR = 2.0; 95%CI 1.2;3.4), had a very controlling partner (RR = 2.5; 95%CI 1.1;5.8), and had frequent fights with their partner (RR = 1.7; 95%CI 1.0;2.9). CONCLUSIONS The high incidence of intimate partner violence during postpartum and its association with aspects of the relationship’s quality between the couple, demonstrated the need for public policies that promote conflict mediation and enable forms of empowerment for women to address the cycle of violence.

Common mental disorders in late pregnancy in women who wanted or attempted an abortion

BACKGROUND In countries where legal abortion is restricted, many unwanted pregnancies are carried to term. Attempting an unsuccessful abortion may influence womens mental health. This study investigated the common mental disorders (CMDs) of depression and anxiety in the third trimester of pregnancy in women who wanted or had attempted an abortion in a poor region of Brazil. METHOD CMDs were assessed by using the 20-item Self-Reporting Questionnaire (SRQ-20) in all pregnant women aged 18-49 years who were registered with publicly funded primary health care in Recife, Northeast Brazil. RESULTS The study achieved a high response rate and 1121 (98.9%) women completed the interview. The prevalence of CMDs for the sample was 43.1% [95% confidence interval (CI) 40.2-46.1], and 63.6% (95% CI 55.4-71.2) among the 13.7% of women who attempted an abortion. The association between CMDs and attempted an abortion [odds ratio (OR) 2.05, 95% CI 1.3-3.1] remained after adjustment for confounders. CONCLUSIONS This study found that attempting an abortion in the current pregnancy was associated with CMDs. Good access to family planning programs, including access to contraceptive methods and safe abortion, should help to improve the mental health of women.

Avaliação de procedimentos para identificar mortes maternas

The main problems identified during maternal mortality surveillance in Pernambuco State, Brazil, were low coverage and poor quality of data, as well as the inadequacy of data-collection instruments. Based on these findings, a new instrument called the Confidential Form for Reporting Deaths of Reproductive-Age Women was developed, and later an evaluation was conducted on the available procedures for distinguishing maternal deaths among female deaths. The RAMOS method, using the new questionnaire, was applied in Camaragibe (a city in Greater Metropolitan Recife) based on the female deaths recorded in 2000. According to the results, this method, using the new form, showed improved recording of socio-demographic and female mortality variables as compared to both the maternal mortality surveillance conducted by the Municipal Epidemiological Department and the death certificate system. This finding reinforces the need to improve maternal mortality surveillance in the study area, taking into account the RAMOS method and the new instrument.

Intimate partner violence and unintended pregnancy: prevalence and associated factors

This study investigated the association between unintended pregnancy and intimate partner violence before pregnancy. A cross-sectional study was carried out with 1,054 women, aged 18 to 49, in Recife, Northeastern Brazil, from July 2005 to March 2006. Non-conditional logistic regression analysis was performed with a hierarchical strategy for entering variables into the model, according to the conceptual framework defined. Unintended pregnancy was reported by 60.3% (636) women. Intimate partner violence prior to the pregnancy was associated with unintended pregnancy (OR adj = 1.57; 95%CI: 1.17-2.11), even when adjusted for the womens sociodemographic characteristics, the partners behaviour, and the relationship dynamic. When the association was adjusted for the use of contraception and the partners refusal to use contraception, the association was no longer significant, suggesting that the effect of partner violence on unintended pregnancy may be mediated by these variables. The findings point to the need of screening for intimate partner violence in reproductive health services.

Common mental disorders and intimate partner violence in pregnancy

OBJETIVO : Investigar associacao entre transtornos mentais comuns e violencia por parceiro intimo durante a gravidez. METODOS : Estudo transversal realizado com 1.120 mulheres gravidas com idade entre 18 e 49 anos, cadastradas no Programa Saude da Familia da cidade do Recife, PE, entre 2005 e 2006. Os transtornos mentais comuns foram avaliados pelo Self-Reporting Questionnaire (SRQ-20). A violencia por parceiro intimo foi definida por atos concretos de violencia psicologica, fisica e sexual infligidos a mulher pelo parceiro. Foram estimadas odds ratios simples e ajustadas para a associacao estudada, utilizando-se analise de regressao logistica. RESULTADOS : A violencia psicologica foi a forma mais frequente de violencia por parceiro intimo. A prevalencia de transtornos mentais comuns foi 71,0% entre as mulheres que relataram todas as formas de violencia e 33,8% entre as que nao relataram violencia por parceiro intimo. Os transtornos mentais mantiveram-se associados a violencia psicologica (OR = 2,49, IC95% 1,8;3,5), mesmo na ausencia de violencia fisica ou sexual. Quando a violencia psicologica esteve combinada com violencia fisica ou sexual, o risco dos transtornos mentais comuns foi ainda mais elevado (3,45; IC95% 2,3;5,2). CONCLUSOES : Ser agredido por alguem com quem voce esta emocionalmente envolvido pode desencadear sentimentos de impotencia, baixa autoestima e depressao. A gravidez provavelmente aumenta a vulnerabilidade das mulheres aos transtornos mentais comuns.OBJECTIVE To investigate the association between common mental disorders and intimate partner violence during pregnancy. METHODS A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis. RESULTS The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2). CONCLUSIONS Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders