Violence, mental health and nutritional status in pregnant women: the Araraquara Cohort Study

Abstract Objective: To investigate the relationship between violence and the nutritional status of pregnant women, and whether mental health could be a mediator in this relationship. Design: Cross-sectional study. Violence and mental health status were investigated using the following questionnaires: WHO-Violence Against Women (WHO-VAW), Abuse Assessment Screen (AAS), Patient Health Questionnaire (PHQ-9) and General Health Questionnaire (GHQ). Demographic, socio-economic, obstetric and lifestyle factors (smoking/alcohol consumption) were also investigated. The nutritional status of the women was assessed by the BMI. Setting: Data were collected from February 2021 to August 2022 in Araraquara city, Brazil. Participants: Four hundred pregnant women recruited at thirty-four health units and the municipal maternity hospital. Results: Experience of violence was reported by 52·2 % of the women, and psychological violence in the last 12 months was the most prevalent type of domestic violence (19·5 %). Approximately 43 % of the women showed mental health changes and 59·7 % had a risk of major depression. Women with mental health changes had an increased risk (OR = 2·34) of obesity. Psychological violence in the last 12 months was associated with obesity (P = 0·01) when mediated by mental health changes. The mediation effect was significant (β = 0·708; 95 % bias-corrected and accelerated (BCa) CI = 0·004, 1·460), with mental health changes mediating 46·1 % of the relationship between psychological violence and obesity. Conclusions: The relationship between psychological violence and obesity during pregnancy was mediated by changes in mental health. This original study shows that nutritional status is not limited to biological factors and highlights the importance of social, mental and psychological factors.