Gender‐based violence during pregnancy and adverse perinatal outcomes in an urban low‐ and middle‐income setting: A prospective cohort study

OBJECTIVE: To evaluate the association between gender-based violence (GBV) assessed in early pregnancy and adverse perinatal outcomes using relative and absolute effect measures in an urban low- and middle-income setting. METHODS: We conducted a prospective cohort study including 3890 singleton pregnancies recruited from two public healthcare institutions in Mexico City between October 2020 and April 2023. GBV was assessed at first-trimester enrollment using a standardized screening procedure and analyzed as any reported violence versus none. The primary outcome was a composite of low birth weight, fetal growth restriction, or perinatal mortality. Associations were estimated using Poisson regression with robust variance to obtain adjusted risk ratios and risk differences. Secondary analyses examined fetal growth restriction, stillbirth, and neonatal mortality. RESULTS: GBV was reported by 162 (4.16%) participants. After adjustment for sociodemographic factors, GBV was associated with higher risk of the composite adverse perinatal outcome (adjusted risk ratio [aRR] 1.23, 95% [confidence interval] CI: 1.06-1.44). The adjusted absolute risk difference was +0.099 (95% CI: 0.020-0.177), corresponding to approximately 99 additional adverse outcomes per 1000 births among women reporting GBV. GBV was not significantly associated with isolated fetal growth restriction but was associated with increased odds of stillbirth; no statistically significant association was observed with neonatal mortality. CONCLUSION: In this urban cohort, GBV reported at first-trimester screening was associated with a clinically meaningful increase in adverse perinatal outcomes, largely driven by stillbirth.