To the Editor: Valladares et al. concluded that partner violence during pregnancy is a stressor provoking high levels of cortisol and reduction of birth weight (1). Social resources, perceived stress, and socio-economic conditions were also studied. However, nothing was said about addiction.
This ignored the clinical practice issue that domestic violence is the hidden face of addiction. Addiction is easier to diagnose. Help and treatment for cessation should be provided, but domestic violence should be looked for.
If one is concerned about a scientific issue, there is extensive evidence that cigarette smoking increases cortisol levels; this effect being more remarkable in women than men (2).
Smoking is the most frequent form of addiction seen during pregnancy, entailing also the least frequent appropriate delivery of care, as well as the highest impact on mortality and morbidity (3). Smoking is the most frequent and serious violence during pregnancy; it causes fetal hypoxia due to carbon monoxide, which binds very easily with fetal hemoglobin, in turn rendering it ineffective for delivering oxygen to the fetal tissues. The most deprived mothers tend to be younger, more likely to smoke, and more exposed to partner violence. To isolate this latter condition alone is shortsighted and deleterious to the delivery of care during pregnancy.