Thália Velho Barreto de Araújo

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).

Initial Description of the Presumed Congenital Zika Syndrome.

OBJECTIVES To provide an initial description of the congenital syndrome presumably associated with infection by Zika virus compared with other syndromes including congenital infections of established etiologies. METHODS We provide an overview of a published case series of 35 cases, a clinical series of 104 cases, and published and unpublished reports of clinical and laboratory findings describing cases diagnosed since the beginning of the epidemic of microcephaly in Brazil. RESULTS About 60% to 70% of mothers report rash during pregnancy; mainly in the first trimester. Principal features are microcephaly, facial disproportionality, cutis girata, hypertonia/spasticity, hyperreflexia, and irritability; abnormal neuroimages include calcifications, ventriculomegaly, and lissencephaly. Hearing and visual abnormalities may be present. CONCLUSIONS Preliminary data suggest that severe congenital abnormalities are linked to Zika virus infection. Cases have severe abnormalities, and although sharing many characteristics with congenital abnormalities associated with other viral infections, abnormalities presumably linked to the Zika virus may have distinguishing characteristics. These severe neurologic abnormalities may result in marked mental retardation and motor disabilities for many surviving offspring. POLICY IMPLICATIONS Affected nations need to prepare to provide complex and costly multidisciplinary care that children diagnosed with this new congenital syndrome will require.

Adequação da assistência pré-natal em gestantes atendidas em dois hospitais de referência para gravidez de alto risco do Sistema Único de Saúde, na cidade de Recife, Estado de Pernambuco

OBJETIVOS: investigar a adequacao da assistencia pre-natal realizada por gestantes usuarias do Sistema Unico de Saude (SUS) da cidade do Recife, Pernambuco. METODOS: estudo de corte transversal de 612 mulheres atendidas por ocasiao do parto em duas unidades do SUS, referencias para gravidez de alto risco no Recife, no periodo de junho a outubro de 2004. A avaliacao do Pre-Natal foi baseada nos criterios do Programa de Humanizacao do Pre-Natal e Nascimento do Ministerio da Saude. RESULTADOS: a cobertura de pre-natal foi de 96,1%, sendo a media de consultas de 5,3. Apenas 38,0% das mulheres iniciaram o pre-natal ate o quarto mes de gestacao e realizaram seis ou mais consultas. Dentre as entrevistadas, 31% tiveram peso, pressao arterial, altura uterina e os batimentos cardiofetais aferidos em todas as consultas. A atencao pre-natal foi considerada adequada em 17,8% e nao-adequada em 82,2% dos casos. CONCLUSOES: A assistencia pre-natal disponivel para as gestantes na cidade do Recife, apesar de apresentar elevada cobertura, deve ser revista do ponto de vista qualitativo.

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.

Fatores de risco para histerectomia em mulheres brasileiras

A case-control study was conducted to investigate risk factors for hysterectomy among women using the public health system in Northeast Brazil. The cases were 373 women aged 30-54 years that had undergone elective hysterectomy for benign pelvic conditions. Controls were 742 women with preserved uterus selected from public health clinics. Data were collected through a review of medical records and a personal interview using a structured, pre-tested questionnaire. Unconditional multiple logistic regression was applied in the analysis. Women at greater risk for hysterectomy were those with a higher per capita family income, zero to three children, a history of medical consultation for menstrual problems, hospitalization for gynecological problems, or tubal ligation before age 30 years. Menopause and a history of stillbirth appeared as protective factors in the statistical analysis.

Fatores de risco para mortalidade materna em área urbana do Nordeste do Brasil

A case-control study was conducted to investigate risk factors for maternal mortality in Recife, Pernambuco State, Brazil, in 2001-2005. Cases were 75 maternal obstetric deaths in Recife, identified from the Mortality Information System, investigated and analyzed by an expert committee on maternal mortality. Controls, selected from the Information System on Live Births using systematic sampling, were 300 women living in Recife whose last pregnancy occurred during the same period and ended in live births. Increased risk of maternal death was associated with use of the public health system (OR = 4.47; 95%CI: 1.87-10.29), age > 35 years (OR = 3.06; 95%CI: 1.59-5.92), < 4 years of schooling (OR = 4.95; 95%CI: 2.43-10.08), cesarean section (OR = 3.06; 95%CI: 1.77-5.29), and lack of prenatal care or fewer than four prenatal visits (OR = 9.78; 95%CI: 5.52-17.34). The results confirm social inequalities in maternal mortality in Recife and indicate the need to improve healthcare for women during the prenatal period, delivery, and postpartum.

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.