the context of intimacy typically associated with domestic violence often keeps women from spontaneously externalizing this problem . a large number of studies have dealt with the issue of domestic violence during pregnancy , focusing on its prevalence , risk factors , and consequences , and on the role of health teams in its detection , prevention , and treatment [ 13 ] . the prevalence rates of domestic violence during pregnancy range between 4.8% and 8.1% in most international studies . in chile , in the metropolitan and araucana regions , 10% of the women who experienced domestic violence reported having been hit by their partners during pregnancy . some of the problems associated to domestic violence during pregnancy are femicide , abortion , infant mortality , obstetric complications , infant morbidity , and mental health problems for the mother , as well as risk behaviors , and deterioration of mother - child attachment [ 512 ] . although the evidence is controversial to suggest that it is a particularly risky period , it has been observed that pregnancy does not protect women from intimate partner violence [ 1 , 5 ] . the association between violence during pregnancy and adverse mother and perinatal outcomes stresses the need to identify this situation in antenatal care [ 6 , 13 ] . this would help pregnant women subjected to violence to speak out , escape the emotional and social isolation which they commonly experience , and receive specialized help . the objectives for this study are   ( 1 ) to evaluate the magnitude of the problem of domestic violence during pregnancy in a sample of pregnant women who attend primary health centers in pealoln for their antenatal care ; ( 2 ) to explore the risk factors of domestic violence during pregnancy in this group ; ( 3 ) to establish associations between domestic violence and mental symptoms during pregnancy . 256 pregnant women attending pealoln health centers for antenatal care , between september 2006 and january 2007 , were asked to respond to a set of instruments composed by a screening questionnaire for pregnancy violence based on the abuse assessment screen , the goldberg 's general health questionnaire for psychic discomfort symptoms , and a form to gather sociodemographic data . the data were collected by 12 qualified interviewers , psychology students , who received training to apply the instruments and to respect the ethical conditions of their task : privacy and comfort during the application of the instruments , informed consent , and confidentiality . the positive cases for domestic violence were informed via written reports , and with the women 's informed consent , to the head midwives of the relevant units , for the future mothers to receive support or to be referred to a specialized intervention . the data collection procedure was the following : in the waiting rooms of midwives ' offices , during pregnant women 's antenatal care , they were invited to participate in the study , received information about its objectives , the procedures involved , and the confidentiality of the data gathered . all the pregnant women who agreed to participate were included ; no exclusion criteria were set . the sample size was determined in order to have appropriate statistical power for the expected effect size . conservatively , we estimated that for r = 0.2 , alpha = 0.01 to have power = 0.8 we needed 244 cases . this instrument was based on the abuse assessment screen ( aas ) , developed by mcfarlane et al .   to detect domestic violence during pregnancy . it is a short questionnaire , easy to apply , validated , and widely used in international studies . the final questionnaire included 5 questions from the original instrument : occurrence of physical and/or emotional violence in the woman 's life ; occurrence of physical violence exerted by the intimate partner , ex - partner , or a relative during the last year ; occurrence of sexual violence exerted by the woman 's intimate partner or ex - partner in the last year ; if the woman fears her intimate partner , ex - partner or a relative , the occurrence of physical violence during current pregnancy . a sixth question was added to establish the occurrence of emotional violence exerted by the woman 's intimate partner , ex - partner , or a relative during pregnancy . the questions about physical and emotional violence include a description and examples of the manifestations of such abuse . the question about sexual violence refers to whether the woman has been forced to engage in sexual acts against her will . it evaluates , with an adequate degree of reliability and validity , a person 's psychological discomfort or emotional symptoms in the last month , and it is considered an indicator of symptomatology associated to mental disorders . it comprises twelve questions with four alternatives each , two of them scoring zero points ( 0 ) and the other two scoring one ( 1 ) , which results in a possible minimum score of zero ( 0 ) and a maximum of twelve . a score equal to or higher than five ( 5 ) is regarded as suggesting risk of emotional pathology . the form included questions about the woman 's age , marital status , educational level , occupation , family members with whom she lives , number of people who live with her , number of children , weeks of pregnancy , gestational age at the beginning of her antenatal care , presence of pregnancy pathologies , referral to a program for risky pregnancies , and nutritional state . women subjected to violence of some sort during pregnancy were asked about their relationship with their assailant and his use of alcohol and/or illegal drugs . frequency analyses were developed to establish the prevalence of domestic violence and the presence of mental symptoms during pregnancy . to explore significant associations with the control variables ( age , number of people in the household , weeks of pregnancy , and number of children ) , a one - factor anova was conducted ; to observe the relation between domestic violence during pregnancy and the rest of the variables ( nominal ) , non - parametric correlation tests were used ( chi - square , cramer 's v , and phi ) . the sample evaluated was comprised of 256 cases , in which the average age was 25 years ( sd = 6.65 ) ; the average number of pregnancy weeks was 28.2 ( sd = 8.06 ) ; the average number of people who lived with the women sampled was 4.5 ( sd = 2.39 ) , and the average number of children was 0.9 ( sd = 1.06 ) . most participants ( 64.1% ) were housewives , 30.9% were students or had a stable job , and 5% had sporadic jobs . regarding their educational level , most women had complete high school studies ( 45.3% ) , or incomplete ones ( 27.3% ) ; 10.2% had completed elementary school , 8.6% had not , and the same percentage of women ( 8.6% ) had completed their technical or university studies . concerning their marital state , 43% of the women sampled lived with their couples , not being married to them , 29% were single , and 28% were married . most of the participants started their ante natal care with less than 12 weeks of gestation ( 79% ) , while 21% did so after 12 weeks . with respect to their nutritional state , 56.6% of the women had a normal weight ; 27% were overweight , 9.8% were obese , and 6.6% were below their normal weight . 82.4% of the women sampled were not part of the program to control the risk of a premature birth , whereas 82.8% had no obstetric complications . in the evaluation of domestic violence , a high percentage of the pregnant women ( 42.2% ) reported antecedents of domestic violence in their lives ( history of violence ) ; 14.5% reported having suffered physical violence in the last year , and 3.5% mentioned having suffered sexual violence in the last year . 11.3% of the sample pointed out that they feared their intimate partner , ex - partner , or a relative . regarding the occurrence of domestic violence in their current pregnancy , 5.9% reported having suffered physical violence and 30.1% reported the presence of emotional violence ( see table 1 ) . all the women who reported physical violence in their pregnancy also stated that they had suffered emotional violence ; thus , 30.1% of the sample reported having suffered violence of some sort during the current gestational process .   when violence was reported ( either physical , emotional , or both ) , it was exerted by the woman 's intimate partner in 53.2% of the cases , by another family member ( 31.2% ) , by the woman 's former partner ( 11.7% ) , or by her partner and a relative ( 3.9% ) . 33.8% of the assailants were heavy or problem drinkers , according to the pregnant women , while 15.6% of them used illegal drugs .   with regard to the assessment of mental discomfort , 42.2% of the women evaluated had a ghq-12 score classified as positive , in other words , they presented anxious or depressive mental symptoms . to evaluate the presence of a connection between domestic violence during pregnancy and the other variables observed , whether there was a significant connection with the control variables ( age , number of people in the household , weeks of pregnancy , and number of children ) , a one - factor anova was conducted ; to observe the relation between the presence of domestic violence during pregnancy and the rest of the variables ( nominal ) , non - parametric correlation tests were used , such as chi - square , cramer 's v , and phi , which revealed the following significant associations . a statistically significant , direct , and moderate correlation was found between violence during pregnancy and a woman 's history of domestic violence ( r = 0.46 , p = .000 ) ( see table 2 ) , that is to say , the presence of antecedents of domestic violence at any point of a woman 's life is associated to domestic violence during pregnancy . there is a statistically significant , direct , and low correlation between domestic violence during pregnancy and physical violence during the last year ( r = 0.38 , p = .000 ) ( see table 3 ) ; also , a statistically significant , direct , and low correlation was found between violence during pregnancy and fear of the partner , ex - partner , or a relative ( r = 0.30 , p = .000 ) . the ghq-12 results obtained , that is , the presence of psychological discomfort symptoms ( 5 or more points ) , also reveals a direct and low correlation with the occurrence of domestic violence during pregnancy ( r = 0.32 , p = .000 ) . afterwards , the relation between participants ' ghq-12 score and the rest of the variables was tested , in order to observe if a positive test score could be predicted based on the variables assessed . there is a direct and low correlation between ghq-12 and a history of domestic violence ( r = 0.247 , p = .000 ) . there is a direct and low correlation between ghq-12 and the presence of physical domestic violence in the last year ( r = 0.256 , p = .000 ) . there is a direct and low correlation between ghq-12 and the presence of emotional domestic violence during pregnancy ( r = 0.32 , p = .000 ) . in brief , the presence of psychic discomfort symptoms in pregnant women displays a positive , but low , connection not only with the occurrence of all forms of violence during pregnancy , but also with physical violence in the last year and with all sorts of domestic violence in their lifetime ( see table 4 ) . within the sample , the prevalence of physical domestic violence during pregnancy reached 5.9% , which is comparable to that observed in other settings [ 6 , 17 ] . this finding is consistent with studies which have shown that pregnancy does not protect women from violence , and that violence is likely to continue even when it is present . most of previous studies do not include the emotional violence variable ; if considered , it makes the figure climb to 30.1% in the sample . as this variable shows a positive and significant association with the presence of psychological discomfort symptoms in pregnant women , it seems relevant to include the assessment of emotional violence during pregnancy . the variables with a significant association to violence during pregnancy are : history of domestic violence , physical violence in the last year , the presence of fear , and a positive ghq-12 score . these elements in a pregnant woman may suggest that she is experiencing domestic violence in her pregnancy , but at this point a limitation of the current study must be pointed out regarding   the fact that statistical analysis were not adjusted for potential confounding   variables . nevertheless , a woman 's history of domestic violence and the presence of physical violence in the last year should be considered an alert to domestic violence during pregnancy and , therefore , these women should be carefully followed up during pregnancy . a previous chilean study showed a strong association between women mental disorders , family violence and socioeconomic factors . the combination of these variables increases the association and this is particularly evident when there is a history of family violence . in our study , positive and significant associations were found between the presence of mental symptoms ( psychcological discomfort ) during pregnancy and a history of domestic violence , physical violence in the previous year , domestic violence in any of its forms during pregnancy , and specifically emotional violence during pregnancy . these findings clearly show the connection between violence and pregnant women 's mental health , and point to two relevant aspects : the importance of an early detection of violence , and alertness regarding the possibility of finding violence during the pregnancy in women with depressive and/or anxiety symptoms . regarding the screening of violence during pregnancy , it can be advanced that , for pregnant women subjected to violence , healthcare workers can be an important point of contact with the public services capable of providing support and information [ 10 , 19 ] ; also , there is evidence that brief and direct questionnaires produce better data than normal obstetric interviews , which do not include direct questions about domestic violence . the results presented in this study with pregnant women from pealoln suggest the importance of addressing this issue for preventing any adverse consequences in pregnant women and their children .
objective . to determine the prevalence of domestic violence in a sample of pregnant women attending   primary health centers   in pealoln ( pealoln is a low income district in the metropolitan region in santiago de chile . ) , to explore risk facts for domestic violence during pregnancy , and to establish associations with their psychological health . 
 method and materials . 
 256 pregnant women were assessed with a domestic violence screening and a questionnaire on mental symptoms . 
 frequency and correlations analysis were developed . 
 results .   5 , 9% of the participants reported physical violence during current pregnancy . 
 emotional violence ascended to 30 , 1% of the cases . 
 main risk facts found were as follows : having suffered violence along lifetime and physical violence during the last year . 
 anxiety and depressive symptoms positively correlated to domestic violence during pregnancy , but also to previous domestic violence experiences . 
 conclusions . domestic violence during pregnancy 
 is a prevalent problem and domestic violence history constitutes an alert to its occurrence . positive and significant association to psychological disturbances suggests the need to detect it early during antenatal care .