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Violence during pregnancy and newborn outcomes: a cohort study in a disadvantaged population in Brazil

Maria Angélica Antunes Nunes, Suzi Camey, Cleusa P. Ferri, Patrícia Manzolli, Carlo Nunes Manenti, Maria Inês Schmidt
DOI: http://dx.doi.org/10.1093/eurpub/ckp241 92-97 First published online: 24 February 2010


Background: Violence against pregnant women is an increasing public health concern. The purpose of this study is to estimate the prevalence of violence during pregnancy, to identify characteristics associated and to assess the impact of violence on newborn outcomes. Methods: Prospective cohort study of 652 pregnant women attending primary care clinics in Southern Brazil, from June 2006 to September 2007. Women with gestational age ranging from 16th and 36th were enrolled and their exposure to violence and mental disorder was assessed. After the birth they were contacted by telephone when information on obstetric and neonatal outcomes was obtained. Results: Any violence during current pregnancy was reported by 18.3% [95% confidence interval (CI) 15.3–21.4%] participants, 15.0% (95% CI 12.3–17.8%) psychological violence, 6% (95% CI 4.2–7.8%) physical violence and 3% (0–0.5%) sexual violence. These women were more often of low income, did not work or study and had inadequate prenatal care and pregnancy weight gain. There was a statistically significant crude association between exposure to physical and psychological violence [relative risk (RR) 3.21 (1.51–6.80)]. After adjustment for family income, number of prenatal visits, length of gestation and gestational weight gain, the effect size decreased, but remained statistically significant (RR 2.18; 95% CI 1.16–4.08%). Conclusion: In disadvantaged settings in Brazil, violence in pregnancy is frequent; it is associated with inadequate maternal weight gain during pregnancy and prenatal care, and increases risk of low birth-weight. Thus, violence in pregnancy imposes a challenge to effective prenatal care delivery with potential benefits to the mother and her baby.

  • low birth-weight
  • newborn outcomes
  • pregnancy
  • violence


Violence against women has been recognized as an important societal problem of increasingly greater public health concern worldwide. A study promoted by WHO found prevalence of violence at any point in life varying from 15% in Japan to 71% in Etiopia.1 Pregnant women are not free of risk. A systematic review found higher prevalence of 4–29% in low- and middle-income countries (LAMIC) than in high-income countries in general (3.45–11%), with similar findings from North America.2

Violence in pregnancy has been associated with low socio-economical conditions, unplanned pregnancy and unhealthy lifestyle such as smoking, substance abuse and unhealthy eating patterns,2 all factors that may by themselves increase the risk of pregnancy adverse outcomes. Some studies have shown increased risk of low-birth weight (LBW), miscarriage and fetal distress associated with abuse during pregnancy, although there have been conflicting findings.3–7 Most studies assessed violence in pregnancy during the hospital admission for delivery.6 Only a few studies have assessed violence to pregnant women while they were pregnant, which may reduce under reporting of events. Furthermore, only a few studies have investigated these problems in the primary care setting using prospective design to evaluate their impact in neonatal outcomes.8,9 Additionally, the role of the mental health of the pregnant women has not been taken into account in the analyses10,11 as well as maternal pregnancy weight gain, known to be related to birth weight.

Given the public health importance of an adequate birth weight and its relationship with violence during pregnancy, the aim of this longitudinal study conducted in disadvantaged areas of Southern Brazil is 3-fold: first, to estimate the prevalence of psychological, physical and sexual violence during current pregnancy and at anytime in life; second to identify demographic, obstetric, behavioral characteristics and depressive symptoms of those at most risk; and third, to assess the impact of violence during pregnancy on newborn outcomes.


Design and setting

ECCAGE—the Study of Food Intake and Eating Behaviors in Pregnancy—is a prospective cohort study of pregnant women followed until the immediate postnatal period. Baseline measures were carried out in eighteen primary care units located in poor neighborhoods in two cities of southern Brazil, between June 2006 and September 2007. This length of time was the period necessary to reach the recruitment goal.

Consecutive pregnant women attending prenatal care clinics, with gestational age ranging from 16th to 36th weeks, were invited to participate.

At baseline, 780 pregnant women were consecutively enrolled, of whom 68 (8.7%) refused to participate or did not stay for the interview. From the total of 712 women interviewed at baseline, 43 did not turn in the violence questionnaire. For one woman, birth weight was not obtained and for two, follow up information was not available. From the remaining 666 women, we excluded 14 women (4 cases of twin pregnancy, 7 cases of abortion and 3 cases of stillbirth), and thus, data from 652 women were available for current analysis.

Procedures and ethics

The questionnaire at baseline had four sections, inquiring about eating habits and behavior, mental disorder and violence. Interviews were conducted by trained interviewers in a private setting. Women were contacted by telephone, after the expected date of birth and information on obstetric and neonatal outcomes were obtained.

All participants signed an informed consent. The instrument on violence had a self-report format and participants were asked to insert it in a sealed box after completion. Interviewers had no access to this information. When participants could not read, help was provided by the interviewer in a private setting. Participants were provided with the study coordinator’s phone number in case they felt need for an advice on how to seek help for problems related to violence and depression.

The project was approved by the Committee on Ethics in Research of the Federal University of Rio Grande do Sul and by a similar research committee related to the primary care units involved in the study.


Experience of violence

The instrument on violence was based on the Abuse Assessment Screen translated and validated to Brazilian portuguese12 and focused on psychological or verbal abuse (including humiliation, and being offended with aggressive words), on physical abuse (have you been hit, slapped, kicked, or otherwise physically hurt by someone; threats of abuse, including use of a weapon, wound from weapons?), and sexual violence (has anyone forced you to have sexual activities?). Time of event (lifetime and/ or during pregnancy) and information about the perpetrator was also obtained. We considered two kind of perpetrator: a partner and/or a family member or a strange.

We examined categories of suffering only psychological or only physical (including sexual) violence, as well as combinations of both. One woman reporting only one isolated episode of violence with weapon (husband) was included in no violence category.

Newborn outcomes

APGAR score was defined as below 7 at 5 min.12 Birth weight was obtained in grams and LBW was defined as 2500 g or less.13 The cutoff point for premature delivery was 37 weeks of gestation age.13 Gestational age was calculated by routine ultrasonography conducted during prenatal care. When gestational age was above 20 weeks on the date of ultrasonography, we used the mean value between the gestational age obtained by ultrasonography and that obtained by the date of the last menstrual period. When ultrasonography was not available, gestational age was calculated according to the date of the last menstrual period. Small for gestational age was defined as a birth weight below the 10th percentile and large for gestational age, as a birth weight above the 90th percentile obtained from a reference table for birth weight according to gestational week.14

Potential confounders, mediators and covariates

Socio-demographics: At baseline, an interview elicited information on social demographics variables (i.e. age, schooling, work and/or study, family income, marital status, number of people in the household).

Health risk behaviors: Tobacco use (yes or no during pregnancy) and consumption of alcohol (no, less than once a month, at least once a week).

Obstetric and clinical history: Weight and height prior to current pregnancy, parity, number of children, planned or unplanned pregnancy was obtained.

Psychiatric morbidity: The instrument used to assess psychiatric symptoms was the Primary Care Evaluation of Mental Disorders (PRIME-MD),15 translated and validated to Brazilian Portuguese16 as a screening instrument for depressive symptoms. The module assessing depressive disorders has nine questions, each of them regarding one symptom. Total score varied from 0 to 9. Conservatively, the highest quartile of depressive symptoms was chosen to define depression and included pregnant women with six or more positive symptoms.

Pre-natal care: After delivery, information about each pre-natal consultation (number of visits, weight, blood pressure, gestational age) were computed from the official medical records and information about delivery was collected directly with each woman by telephone, including type of delivery, length of hospitalization and complications at delivery. Total weight gain during pregnancy was calculated as the difference between the final gestational weight and the pre-gestational self-reported weight obtained at enrollment. The final gestational weight was the last recorded value, at maximum 2 weeks prior to labor. Number of prenatal visits was considered adequate when there were atleast six visits during the length of the pregnancy.17

Statistical analysis

Means and standard deviations (SDs) for continuous variables are reported.

The associations between pregnancy outcomes (LBW) and type of violence were investigated using Poisson Regression with robust variance18,19 and the corresponding relative risks (RR) were estimated. The effects of potential confounders on RR were investigated one at a time. If a change of atleast 10% was noted in the size of the RR, the corresponding potential confounders was selected for multivariable modeling; family income and adequate number of prenatal visits were also included in multivariable modeling because of their well-known effect on adverse pregnancy outcomes. Statistical analysis was carried out with the SPSS v16.0 package.


Prevalence of self-reported violence

Table 1 presents frequency of reporting violence suffered by pregnant women participating in the study. Of the 652 women, 294 [45.9%; 95% confidence interval (CI) 42.1–49.8%] reported having suffered violence, 115 (18.4%; 95% CI 15.3–21.4%) during current pregnancy.

View this table:
Table 1

Frequency of exposure to violence reported by the 652 pregnant women attending primary care clinics in Southern Brazil, 2006–07

Reported exposure to violence
LifetimeCurrent pregnancy
Type of violenceaNPercentage95% CINPercentage95% CI
With weapons8313.0(10.4–15.6)132.0(0.9–3.1)
Any type29445.9(42.1–49.8)11518.4(15.3–21.4)
  • a: Events reported by each woman were not exclusive to one type of violence.

A total of 196 (30.1%; 95% CI 26.5–33.6%) reported having suffered lifetime psychological violence and 98 (15.0%; 95% CI 12.3–17.8%), that it occurred during current pregnancy. Of these 98 women, 79 indicated that the perpetrator was a partner or a family member; only 13 women did not disclose who the aggressor was.

Lifetime physical violence was reported by 172 (26.4%; 95% CI 23.0–29.8%) women, 39 (6.0%; 95% CI 4.2–7.8%) during pregnancy. Of these 39 women, 33 indicated that the perpetrator was a partner or a family member; only 5 women did not disclose who the aggressor was.

Lifetime violence with weapons was reported by 83 (12.7%; 95% CI 10.4–15.6%) women, during current pregnancy, by 13 (2.0%; 95% CI 0.9–3.1%) women. Of these 13 women, 10 indicated that the perpetrator was a partner or a family member.

Lifetime sexual violence was reported by 47 (7.2%; 95% CI 5.4–9.5%) women and during current pregnancy, by 3 (0.5%; 95% CI 0.0–1.0%) women. For all women, the perpetrator was the partner.

Characteristics for study sample and their relation to categories of violence

Mean age was 24.7 years (SD = 6.4 years), ranging from 13 to 42 years; mean years of education was 7.6 years (SD = 2.7 years). Table 2 provides characteristics for the study sample according to categories of violence suffered during pregnancy. Violence occurred more frequently among women not working or studying outside their home, having less income, presenting more inadequate prenatal care, drinking alcohol weekly and having more depressive symptoms.

View this table:
Table 2

Socio-demographic and clinical characteristics according to categories of violence suffered during pregnancy by women attending primary care clinics in Southern Brazil, 2006–07 (n = 652)

Reported exposure to violence during pregnancy
TotalNo violenceOnly psychologicalOnly physicalBothP-value
(N = 652) n (%)(N = 539) n (%)(N = 74) n (%)(N = 15) n (%)(N = 24) n (%)
    <20 years165 (25.3)129 (78.2)25 (15.2)5 (3)6 (3.6)0.58
    20–29 years331 (50.8)278 (84)32 (9.7)8 (2.4)13 (3.9)
    ≥30 years156 (23.9)132 (84.6)17 (10.9)2 (1.3)5 (3.2)
    0–4 years91 (14)77 (84.6)9 (9.9)1 (1.1)4 (4.4)0.60
    5–8 years317 (48.6)255 (80.4)43 (13.6)9 (2.8)10 (3.2)
    9 years or more244 (37.4)207 (84.8)22 (9)5 (2)10 (4.1)
Work and/or study
    Yes386 (59.2)232 (87.2)23 (8.6)6 (2.3)5 (1.9)0.04
    No266 (40.8)307 (79.5)51 (13.2)9 (2.3)19 (4.9)
Family income
    ≤1 minimal wage114 (17.5)83 (72.8)19 (16.7)4 (3.5)8 (7)0.04
    1.01–3.00 minimal wages341 (52.3)286 (83.9)40 (11.7)5 (1.5)10 (2.9)
    >3.00 minimal wages197 (30.2)170 (86.3)15 (7.6)6 (3)6 (3)
Number of people in household
    0–2164 (25.2)137 (83.5)20 (12.2)2 (1.2)5 (3)0.15
    3–4287 (44)246 (85.7)24 (8.4)5 (1.7)12 (4.2)
    >5201 (30.8)156 (77.6)30 (14.9)8 (4)7 (3.5)
Living with a partner
    Yes520 (79.8)437 (84)54 (10.4)12 (2.3)17 (3.3)0.28
    No132 (20.2)102 (77.3)20 (15.2)3 (2.3)7 (5.3)
Number of children
    None298 (45.7)248 (83.2)33 (11.1)7 (2.3)10 (3.4)0.46
    1173 (26.5)150 (86.7)15 (8.7)2 (1.2)6 (3.5)
    ≥2181 (27.8)141 (77.9)26 (14.4)6 (3.3)8 (4.4)
Planned pregnancy
    Yes243 (37.3)213 (87.7)19 (7.8)5 (2.1)6 (2.5)0.06
    No409 (62.7)326 (79.7)55 (13.4)10 (2.4)18 (4.4)
First prenatal visita
    Before 12 weeks311 (51.7)267 (85.9)30 (9.6)5 (1.6)9 (2.9)0.43
    At 12 weeks or after290 (48.3)235 (81)36 (12.4)8 (2.8)11 (3.8)
Enrollment in the study
    2nd trimester468 (71.8)399 (85.3)46 (9.8)8 (1.7)15 (3.2)0.04
    3rd trimester184 (28.2)140 (76.1)28 (15.2)7 (3.8)9 (4.9)
Number of prenatal visitsa
    Adequate for duration of pregnancy350 (53.8)294 (84)39 (11.1)8 (2.3)9 (2.6)0.30
    Inadequate300 (46.2)244 (81.3)34 (11.3)7 (2.3)15 (5)
Use of tobacco
    No132 (20.2)439 (84.4)54 (10.4)11 (2.1)16 (3.1)0.11
    Yes520 (79.8)100 (75.8)20 (15.2)4 (3)8 (6.1)
Use of alcohol
    Less than once a month602 (92.3)506 (84.1)62 (10.3)13 (2.2)21 (3.5)0.01
    At least once a week50 (7.7)33 (66)12 (24)2 (4)3 (6)
Depressive symptoms
    <6 symptoms476 (73)430 (90.3)31 (6.5)6 (1.3)9 (1.9)<0.001
    ≥6 symptoms176 (27)109 (61.9)43 (24.4)9 (5.1)15 (8.5)
  • a: Total numbers differ because of missing values.

Violence during pregnancy and pregnancy outcomes

Table 3 presents incidence of main pregnancy outcomes according to categories of violence suffered during pregnancy. Women suffering only physical violence during pregnancy had higher rates of LBW and of small for gestational age than women not reporting violence. Insufficient pregnancy weight gain was more frequent among women who suffered violence during pregnancy. Except for caesarean delivery, all other adverse outcomes were more frequent among women suffering both psychological and physical violence.

View this table:
Table 3

Frequency of pregnancy outcomes according to categories of self reported exposure to violence suffered during pregnancy by women attending primary care clinics in Southern Brazil, 2006–07 (n = 652)

Reported exposure to violence during pregnancy
TotalNo violenceOnly psychologicalOnly physicalBothP-value
n (%)(N = 540) n (%)(N = 74) n (%)(N = 15) n (%)(N = 24) n (%)
    Yes57 (8.7)42 (7.8)6 (8.1)3 (20.0)6 (25.0)<0.001
    No595 (91.3)497 (92.2)68 (91.9)12 (80.0)18 (75.0)
Small for gestational agea
    Yes101 (15.5)83 (15.4)10 (13.7)3 (20.0)5 (20.8)0.82
    No549 (84.5)455 (84.6)63 (86.3)12 (80.0)19 (79.2)
Pregnancy weight gaina
    Adequate172 (26.9)153 (28.9)13 (18.3)2 (13.3)4 (16.7)0.005
    Insufficient191 (29.9)140 (26.6)32 (45.1)8 (53.3)11 (45.8)
    Excessive276 (43.2)236 (44.5)26 (36.6)5 (33.3)9 (37.5)
Type of deliverya
    Vaginal404 (62.8)343 (64.2)39 (54.2)9 (64.3)13 (56.5)0.37
    Caesarean239 (37.2)191 (35.8)33 (45.8)5 (35.7)10 (43.5)
  • a: Total numbers differ because of missing values.

Eleven babies had an Apgar score at 5 min less than 7. Mean hospital stay was 3 days (SD = 2 days) for the mother and 3.6 days (SD = 5.1 days) for the baby. No differences were found according to categories of violence.

Association between categories of violence and LBW were examined with Poisson regression. Initially, the relationship was assessed taking into account possible confounders and mediators one at a time, Statistically significant crude associations were not seen for those reporting only physical or only psychological violence during pregnancy; although for those reporting only physical violence, RRs were large and generally of borderline statistical significance. For those referring physical and psychological violence, associations were generally larger and statistically significant. Comparing crude RRs with the corresponding adjusted RRs, a meaningful change (>10%) was seen only when adding gestational weight gain or length of pregnancy, indicating their possible roles as confounders or effect mediators in the association of LBW and violence during pregnancy.

Table 4 shows multivariable models of increasing complexity for the association of birth weight with categories of violence. All potential confounders and mediators were entered as continuous variables to obtain a more complete adjustment, as well as to avoid unstable estimates given the small number of outcomes. Including only family income and adequate number of prenatal visits (Model 1) statistically significant association for birth weight with categories of violence was seen only for physical plus psychological violence; including additionally length of pregnancy (Model 2), the association decreased in magnitude, but remained statistically significant; when adjusting additionally for gestational weight gain (Model 3), further decrease was seen, but remained statistically significant. In this last model, association for only physical violence was also statistically significant.

View this table:
Table 4

Models of the association between LBW and the different categories of self-reported exposure to violence during pregnancy in Southern Brazil, 2006–07 (n = 652)

Model 1Model 2Model 3
Crude RRadjusted RRadjusted RRadjusted RR
(95% CI)(95% CI)(95% CI)(95% CI)
Violence in pregnancy
    Only psychological1.04 (0.46–2.36)0.95 (0.41–2.19)0.57 (0.23–1.45)0.44 (0.16–1.16)
    Only physical2.57 (0.90–7.36)2.48 (0.90–6.86)2.71 (0.75–9.77)3.19 (1.26–8.08)
    Both3.21 (1.51–6.80)3.02 (1.41–6.46)2.39 (1.29–4.39)2.18 (1.16–4.08)
  • Model 1: adjusted for family income and adequate number of prenatal visits. Model 2: adjusted additionally for length of pregnancy. Model 3: adjusted additionally for gestational weight gain.


Our results demonstrate that violence of any kind is a frequent event (18.3%) in pregnant women living in disadvantaged neighborhoods in southern Brazil; and that for most women; the perpetrator was their partner or a family member. Women suffering violence during pregnancy were of lower income, were less frequently working or studying outside of their homes and presented more depressive symptoms. They had more frequently inadequate number of prenatal visits and insufficient pregnancy weight gain. Some studies abuse during pregnancy has been associated with low socio-economic status, poor maternal weight gain, anemia, an unhealthy diet, sexually transmitted diseases and psychological morbidity.20–22

The impact of suffering violence during pregnancy to the baby was remarkable: women suffering psychological and physical violence during pregnancy had a threefold increased risk of delivering a baby weighing <2500 g compared to those not suffering any type of violence. Although this RR decreased somewhat after adjusting for various factors one at time, including depressive symptoms, associations remained statistically significant, except when adjusting for gestational weight gain. Adjusting simultaneously for family income, adequate number of prenatal visits, length of pregnancy and gestational weight gain, women suffering psychological and physical violence during pregnancy still presented increased risk of delivering a LBW baby (RR 2.18; 95% CI 1.16–4.08%).

Although it is difficult to compare findings from different studies due to differences in design, setting and age distribution across studies, a review of the prevalence of violence in pregnancy in less developed settings has shown a range of 4–29%.23 In Brazil, a recent study of pregnant women seen in primary care units reported frequencies of 19.1% of psychological and 6.5% of physical/sexual violence24 which is similar to those here described. The frequency of exposure to violence during pregnancy is higher than medical problems considered to be common such as gestational diabetes and hypertensive disorders in pregnancy.25,26

Our findings characterize women who suffer violence during pregnancy as being of lower income and who additionally are not working neither studying outside their homes suggest a high degree of dependence on their partner or family and thus are more vulnerable to a submissive behavior. They additionally exhibit more adverse health behaviors such as unplanned pregnancy, inadequate prenatal care and alcohol drinking during pregnancy. Such women had also more depressive symptoms and insufficient pregnancy weight gain. Although it is difficult to establish what comes first, the conjunction of these factors together with violence poses these women to a major burden.27,28

The occurrence of violence during pregnancy has been associated with poor adherence to prenatal care29 and insufficient pregnancy weight gain30 two factors associated to LBW. Research on adolescent pregnancy suggested that violence during pregnancy was associated with poorer newborn outcomes, including LBW;6 another study reported increased neonatal mortality.31

The major impact of violence to the new born was LBW. It is a major source of infant mortality and long-term adverse health outcomes for children.32 In developed countries such as Canada, LBW accounts for most neonatal mortality and contributes significantly to infant and childhood morbidity, as well as to rising health care costs. A review of studies conducted in the USA and Europe showed a weak, but significant, association between physical, sexual or psychological abuse during pregnancy and LBW (OR 1.4; 95% CI 1.1–1.8%).33 The association between violence and LBW has been explained by factors such as premature labor (caused by trauma), substance abuse (such as smoking) and low socio-economic status (leading to hunger), maternal medical problems and maternal mental illness.34 Research finds that violence during pregnancy is associated with negative maternal outcomes, it has also been suggested that many of the factors associated with increased risk for violence (e.g. alcohol use, low income) are the same factors associated with LBW.35 In our study, after adjusting for factors related to LBW, the association remained. The lack of an association between exposure to physical violence and LBW might result from a type 1 error since there were a small number of babies (three) with LBW among women suffering physical violence during pregnancy. As the two latter factors (length of pregnancy and gestational weight gain) may be mediators of the associations between violence in pregnancy and LBW, the adjusted decreased risks may be explained by pathways that go beyond maternal nutrition during pregnancy and premature labor.

Our study has some limitations. Since violence was assessed at enrollment and this occurred at gestational ages as early as the 16th week, events of violence happening afterwards might have been missed which would lead to an underestimation of the true prevalence. This study was not statistically powered to detect differences of small magnitude, but the fact that we found an association between violence and LBW shows that this has not led to a type 2 error in relation to this outcome. Although we adjusted for most recognized correlates of violence and LBW, the possibility of residual confounding cannot be excluded.

On the other hand, our study, being a prospective cohort study conducted in the primary care setting, allowed ascertainment of violence before outcomes were measured, avoiding potential bias associated with the retrospective determination of this exposure. Additionally, our study had a high response rate, which can be explained in part by the anonymous, self-reported questionnaire on violence, which was completed by 94% of the participants.

Abuse during pregnancy is considered to be a potentially modifiable risk factor for LBW. The prevention of LBW poses a challenge in perinatal care.36

Our results provide further evidence for the importance of detecting women experiencing violence during prenatal care so that appropriate interventions can be implemented. Mothers exposed to violence during pregnancy should be also monitored closely for weight gain, fetal growth and psychological status to assure a successful pregnancy and a healthy newborn. We need to strengthen the trend toward the assessment of psychosocial issues during pregnancy as a standard of care.


This work was supported by Brazilian agencies: Programa de Apoio a Núcleos de Excelência (PRONEX) (661041/1998-4 project – 5669), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ). Oral presentation: XXVI Brazilian Psychiatry Congress, Brasilia, Brazil, 2008 and XVIII IEA World Congress of Epidemiology VII Brazilian Congress of Epidemiology, Porto Alegre, Brazil, 2008. Assessment of food intake, mental disorders and violence in pregnant women (ECCAGE) Investigators: Rafael Marques Soares, MSc, Andressa Giacomello, MSc, Michele Drehmer, MSc, Caroline Buss, MSc, Juliana Hoffmann, Cristiane Melere, Silvia Ozcariz.

Conflicts of interest: None declared.

Key points

  • Few studies using a prospective design in primary care settings and none have taken into account the mental health of the pregnant women.

  • Our results demonstrate that suffering psychological and physical violence during pregnancy increases three fold the risk of having a baby weighing <2500 g.

  • Mothers exposed to violence during pregnancy should be also monitored closely for weight gain, fetal growth and psychological status to assure a successful pregnancy and a healthy newborn.


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