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Begtrup LM, Bonde JPE, Flachs EM, Mehlum IS, Brauer C, Pedersen M, Tøttenborg SS, Hougaard KS, Sejbaek CS. Cohort Profile: DOC*X-Generation-a nationwide Danish pregnancy cohort with OCcupational eXposure data. Int J Epidemiol 2024; 53:dyae090. [PMID: 39002173 DOI: 10.1093/ije/dyae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Luise Mølenberg Begtrup
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ingrid Sivesind Mehlum
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Institute of Occupational Health (STAMI), Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marie Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Camilla Sandal Sejbaek
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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MacDonald LA, Johnson CY, Lu ML, Santiago-Colón A, Adam GP, Kimmel HJ, Napolitano PG, Saldanha IJ. Physical job demands in pregnancy and associated musculoskeletal health and employment outcomes: a systematic review. Am J Obstet Gynecol 2024; 230:583-599.e16. [PMID: 38109950 PMCID: PMC11139607 DOI: 10.1016/j.ajog.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE A decline in musculoskeletal health during pregnancy is an underappreciated adverse outcome of pregnancy that can have immediate and long-term health consequences. High physical job demands are known risk factors for nontraumatic musculoskeletal disorders in the general working population. Evidence from meta-analyses suggest that occupational lifting and prolonged standing during pregnancy may increase risk of adverse pregnancy outcomes. This systematic review examined associations between occupational lifting or postural load in pregnancy and associated musculoskeletal disorders and related sequalae. DATA SOURCES Five electronic databases (Medline, Embase, CINAHL, NIOSHTIC-2, and Ergonomic Abstracts) were searched from 1990 to July 2022 for studies in any language. A Web of Science snowball search was performed in December 2022. Reference lists were manually reviewed. STUDY ELIGIBILITY CRITERIA Eligible studies reported associations between occupational lifting or postural load and musculoskeletal health or sequelae (eg, employment outcomes) among pregnant and postpartum workers. METHODS Data were extracted using a customized form to document study and sample characteristics; and details of exposures, outcomes, covariates, and analyses. Investigators independently assessed study quality for 7 risk-of-bias domains and overall utility, with discrepant ratings resolved through discussion. A narrative synthesis was conducted due to heterogeneity. RESULTS Sixteen studies (11 cohort studies, 2 nested case-control studies, and 3 cross-sectional studies) from 8 countries were included (N=142,320 pregnant and N=1744 postpartum workers). Limited but consistent evidence with variable quality ratings, ranging from critical concern to high, suggests that pregnant workers exposed to heavy lifting (usually defined as ≥22 lbs or ≥10 kg) may be at increased risk of functionally limiting pelvic girdle pain and antenatal leave. Moreover, reports of dose-response relationships suggest graded risk levels according to lifting frequency, ranging from 21% to 45% for pelvic girdle pain and 58% to 202% for antenatal leave. Limited but consistent evidence also suggests that postural load increases the risk of employment cessation. CONCLUSION Limited but consistent evidence suggests that pregnant workers exposed to heavy lifting and postural load are at increased risk of pelvic girdle pain and employment cessation. Job accommodations to reduce exposure levels may promote safe sustainable employment for pregnant workers.
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Affiliation(s)
- Leslie A MacDonald
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH.
| | - Candice Y Johnson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH; Division of Occupational and Environmental Medicine, Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Ming-Lun Lu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | | | - Peter G Napolitano
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI; Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Adane HA, Iles R, Boyle JA, Gelaw A, Collie A. Maternal Occupational Risk Factors and Preterm Birth: A Systematic Review and Meta-Analysis. Public Health Rev 2023; 44:1606085. [PMID: 37937117 PMCID: PMC10625911 DOI: 10.3389/phrs.2023.1606085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
Objective: This systematic review and meta-analysis aimed to summarize the evidence on the relationship between physical occupational risks (high physical workload, long working hours, shift work, whole-body vibrations, prolonged standing, and heavy lifting) and preterm birth. Methods: A systematic review and meta-analysis was conducted across six databases to investigate the relationship between physical occupational risks and preterm birth. Result: A comprehensive analysis of 37 studies with varying sample sizes found moderate evidence of positive associations between high physical workload, long working hours, shift work, whole-body vibration, and preterm birth. Meta-analysis showed a 44% higher risk (OR 1.44, 95% CI 1.25-1.66) for preterm birth with long working hours and a 63% higher risk (OR 1.63, 95% CI 1.03-2.58) with shift work. Conclusion: Pregnant women in physically demanding jobs, those working long hours or on shifts, and those exposed to whole-body vibration have an increased risk of preterm birth. Employers should establish supportive workplaces, policymakers implement protective measures, healthcare providers conduct screenings, and pregnant women must stay informed and mitigate these job-related risks. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], Identifier [CRD42022357045].
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Affiliation(s)
- Haimanot Abebe Adane
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jacqueline A. Boyle
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Asmare Gelaw
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Adane HA, Iles R, Boyle JA, Collie A. Maternal occupational risk factors and preterm birth: Protocol for a systematic review and meta-analysis. PLoS One 2023; 18:e0283752. [PMID: 37432928 DOI: 10.1371/journal.pone.0283752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Preterm birth, which accounts for 33.1% of neonatal death globally, is the main cause of under-five mortality. A growing number of studies indicate that occupational risk factors during pregnancy are linked to an increased likelihood of poor pregnancy outcomes. The effect of physical occupational risks on preterm birth has received very little attention, and previous reviews have produced inconclusive results. This systematic review aims to update the evidence on the relationship between maternal physical occupational risks and preterm birth. METHOD AND ANALYSIS We will search electronic databases including Ovid Medline, Embase, Emcare, CINAHL, Scopus, and Web of science to find peer-reviewed studies examining the relationship between six common maternal physical occupational risks (heavy lifting, prolonged standing, heavy physical exertion, long working hours, shift work, and whole-body vibrations) and preterm birth. Articles published in English after 1 January 2000 will be included without geographic restrictions. Two reviewers will screen titles and abstracts independently, and then select full-text articles that meet inclusion criteria. Methodological quality of the included studies will be evaluated using the Joanna Briggs Institute (JBI) critical appraisal method. The quality of evidence across each exposure and the outcome of interest will be examined by using the GRADE (Grade of Recommendations, Assessment, Development, Evaluation) method. Accordingly, a high level of evidence will lead to "strong recommendations". A moderate level of evidence will lead to "practice considerations". For all evidence levels below moderate, the message will be "not enough evidence from the scientific literature to guide policymakers, clinicians, and patients. If data permits, a meta-analysis will be conducted using Stata Software. In case where meta-analysis is not possible, we will perform a formal narrative synthesis. DISCUSSION AND CONCLUSION Evidence suggests that preterm birth is linked to a number of maternal occupational risk factors. This systematic review will update, compile, and critically review the evidence on the effect of maternal physical occupational risk on preterm birth. This systematic review will provide guidance to support decision-makers including maternal and child health services, other health care providers, and government policy agencies. TRIAL REGISTRATION PROSPERO registration number: CRD42022357045.
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Affiliation(s)
- Haimanot Abebe Adane
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross Iles
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Center for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hayman M, Brown WJ, Brinson A, Budzynski-Seymour E, Bruce T, Evenson KR. Public health guidelines for physical activity during pregnancy from around the world: a scoping review. Br J Sports Med 2023; 57:940-947. [PMID: 36604155 DOI: 10.1136/bjsports-2022-105777] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite the known health benefits of physical activity (PA), pregnancy is a time of marked decline in PA levels. To provide women with reliable and trustworthy information, and to encourage greater participation in PA during pregnancy, many governments have developed guidelines for PA during pregnancy. Our aim was to synthesise the most recent public health guidelines on PA during pregnancy from different countries in order to understand the nature and extent of advice that is available. DESIGN Scoping review. DATA SOURCES Search of the grey literature, direct contact with international experts, screening of relevant academic literature and citation searching. ELIGIBILITY CRITERIA Public health guidelines developed or endorsed by government departments published since 2010. RESULTS Our search located 30 eligible guidelines, published in 11 different languages. There is remarkable concordance in the advice offered. For women with uncomplicated pregnancy, guidelines recommend: 150-300 min/week of moderate intensity aerobic activity; pelvic floor and muscle strengthening exercises; modification of some exercises (eg, supine position); and provide lists of warning signs to cease activity (eg, persistent dizziness, vaginal bleeding) and activities that should be avoided (eg, if high risk of falling/collision). Few guidelines offer specific advice for highly active women (eg, athletes), or trimester-specific or culturally specific considerations. CONCLUSIONS This review provides a summary of public health recommendations for PA during pregnancy around the world. The challenge is now to ensure that all who provide healthcare for women understand the guidelines and encourage safe participation in PA during pregnancy.
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Affiliation(s)
- Melanie Hayman
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alison Brinson
- Anthropology, University of North Carolina College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | | | - Tracy Bruce
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Henrotin JB, Gulisano F. Sick leave during pregnancy and occupational factors: a systematic review. Occup Med (Lond) 2022; 72:550-558. [PMID: 36250790 DOI: 10.1093/occmed/kqac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The reported prevalence of sick leave (SL) during pregnancy is high among European pregnant workers (PW). The causes of SL during pregnancy are complex, and further research is necessary to explain their occurrence. AIMS Summarize the evidence for an association between occupational risks for pregnancy and SL. METHODS A systematic review was conducted by two independent reviewers using PRISMA guidelines. Two databases (Pubmed, Embase) were interrogated between January 1990 and November 2021. The search question integrated key terms according to the PICOS acronym (free terms, MeSH, EMTREE). The quality of the selected studies was assessed according to the Methodological Index for Non-randomized Studies score. RESULTS This review assessed 11 epidemiological studies. Overall, the mean Methodological Index for Non-Randomized Studies score was 11, indicating moderate study quality. The results of the limited number of studies showed limited evidence for associations between psychosocial and physical work-related risk factors and the occurrence of SL among PW. However, this assessment was strengthened by the observation in several studies of a dose-response relationship between the number of occupational risks during pregnancy and SL. CONCLUSIONS The analysis of this review implicates PW'S exposure to occupational risks in the occurrence of SL. However, the few studies that support this conclusion have provided weak evidence; thus, further research is necessary.
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Affiliation(s)
- J B Henrotin
- Medical inspection service, Regional Management of Labor, 21 Boulevard Voltaire, Dijon, 21011, France
| | - F Gulisano
- University Faculty of Medicine, 7 Boulevard Jeanne d'Arc, Dijon, 21079, France
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van Beukering MDM, Schuster HJ, Peelen MJCS, Schonewille MEA, Hajenius PJ, Duijnhoven RG, Brand T, Painter RC, Kok M. Working conditions in low risk nulliparous women in The Netherlands: are legislation and guidelines a guarantee for a healthy working environment? A cohort study. Int Arch Occup Environ Health 2022; 95:1305-1315. [PMID: 35708771 PMCID: PMC9273547 DOI: 10.1007/s00420-022-01888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
Objective Hazardous working conditions increase the risk of adverse pregnancy outcomes. In this study, we examine adherence to legislation and guidelines aimed at improving working conditions in pregnancy. Methods Between 2014 and 2016, we recruited a prospective cohort of low-risk nulliparous pregnant women in paid employment or self-employed in 16 community midwifery practices in The Netherlands. Participants completed two questionnaires concerning demographics, education, general health and working conditions between 10–16 and 20–24 weeks of pregnancy. We calculated the proportion of participants with work-related risk factors not in accordance with legislation and/or guidelines. Results Of 269 participants included, 214 (80%) completed both questionnaires. At 10–16 weeks 110 (41%) participants and at 20–24 weeks 129 (63%) participants continued to work under circumstances that did not meet recommendations. Employers provided mandated information on work adjustment to 37 (15%) participants and 96 (38%) participants received no information about the potential hazards while working with biological and chemical hazards. Participants with lower educational attainment (aOR 2.2 95%CI 1.3–3.9), or employment in healthcare (aOR 4.5, 95%CI 2.2–9.0), education/childcare and social service (aOR 2.6, 95%CI 1.1–6.0 2),, catering (aOR 3.6, 95%CI 1.1–12) and industry, construction and cleaning (aOR 3.3, 95%CI 1.1–10.3) more often continued work which did not meet recommendations. Conclusion There is poor adherence to national legislation and guidelines for safe working in pregnancy in The Netherlands: 50% of the pregnant women worked under hazardous conditions. Given the impact on adverse pregnancy outcomes as well as on the public purse, action to improve compliance must be taken by all stakeholders.
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Affiliation(s)
- Monique D M van Beukering
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands.
| | - Heleen J Schuster
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Myrthe J C S Peelen
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Marit E A Schonewille
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Petra J Hajenius
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Teus Brand
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
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Krief P, Mediouni Z, Abderhalden-Zellweger A, Kerr D, Nesi S, Renteria SC, Vonlanthen J, Danuser B. Evaluation of a pilot consultation for maternity protection at work in Switzerland. Swiss Med Wkly 2022; 152:w30160. [PMID: 35704946 DOI: 10.4414/smw.2022.w30160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY AIMS Switzerland's Labour Law and its Ordonnance on Maternity Protection aim to protect the health of pregnant employees and their unborn children while enabling them to continue to pursue their professional activities. Some companies encounter difficulties implementing the law's provisions. The Department of Occupational and Environmental Health, part of the Center for Primary Care and Public Health (Unisanté), has provided specialist occupational medicine consultations for pregnant employees since 2015. This study aimed to evaluate how well Swiss' maternity protection legislation is implemented by examining a list of relevant indicators measured during the occupational health consultation. The study also sought to investigate the consultation support provided to the relevant stakeholders and the adjustments made to pregnant employees' working conditions. METHODS Descriptive variables and indicators relative to the application of the Swiss maternity protection legislation for 83 pregnant employees were collected during the consultation's pilot phase (between 2015 and 2016). Descriptive statistics and cross-analyses of these indicators were made. RESULTS Most pregnant employees faced multiple exposures to occupational risks. Preventive risk analyses were rare. Few adjustments to workstations were proposed. We found a tendency for employees to leave their workstations early on in their pregnancies due to sick leave certificate prescriptions. Specialist consultation and collaboration with occupational health physicians to recommend interventions for pregnant employees can provide significant benefits and help some pregnant women to continue at their workstations with appropriate adjustments. DISCUSSION A specialised occupational health consultation is a useful instrument for identifying occupational hazards for both the pregnant woman and her unborn child. It is also an opportunity to explain employers' legal responsibilities and obligations to safeguard the health of their pregnant employees and to give specific advice for their company's situation. This consultation also enables employers to maintain their employees' valuable professional competencies in the workplace for as long as possible. Finally, occupational health consultation helps and supports healthcare providers who must, according to the law, make decisions about whether pregnant employees can continue working safely or not.
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Affiliation(s)
- Peggy Krief
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland
| | - Zakia Mediouni
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland
| | - Alessia Abderhalden-Zellweger
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland.,School of Health Sciences (HESAV,) University of Applied Sciences and Arts of Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Dominique Kerr
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland
| | | | - Saira-Christine Renteria
- Psychosocial Unit, Department of Women's, Mothers' and Children's Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Julien Vonlanthen
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland
| | - Brigitta Danuser
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne (Unil), Epalinges-Lausanne, Switzerland
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Cherry N, Beach J, Galarneau J. Ergonomic demands and fetal loss in women in welding and electrical trades: A Canadian cohort study. Am J Ind Med 2022; 65:371-381. [PMID: 35218058 PMCID: PMC9307005 DOI: 10.1002/ajim.23336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
Objectives To determine the relationship between ergonomic demands of the job at conception and fetal loss (miscarriage or stillbirth). Methods Women with a welding or electrical trade apprenticeship were identified across Canada for the Women's Health in Apprenticeship Trades–Metal and Electrical study. They completed a reproductive and employment history at recruitment and every 6 months for up to 5 years to provide details on pregnancies and work demands. Job at conception was identified and fetal loss examined in relation to ergonomic exposures/demands, allowing for potential confounders. Results A total of 885 women were recruited; 447 in welding and 438 in electrical trades. Of these, 574 reported at least one pregnancy. Analysis of 756 pregnancies since the woman started in her trade suggested no increased risk of fetal loss in those choosing welding rather than electrical work. Among 506 pregnancies conceived during a period working in a trade, 148 (29.2%) ended in fetal loss: 31.2% (73/234) in welding, and 27.6% (75/272) in electrical work. Detailed exposure information was available for 59% (299/506) of these pregnancies. In welders, the risk of fetal loss was increased with whole‐body vibration (prevalence ratio [PR] = 2.14; 95% confidence interval [CI] 1.39–3.31) and hand‐arm vibration for > 1 hour/day (PR = 2.15; 95% CI 1.33–3.49). In electrical workers risk increased with more than 8 days working without a rest day (PR = 2.29; 95% CI 1.25–4.17). Local exhaust ventilation reduced risk in welders. Conclusions There was no significant increase in fetal loss in welding trades compared to electrical work. Vibration, largely from grinding, and extended work rotations appear to be potentially modifiable factors of some importance.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine University of Alberta Edmonton Alberta Canada
| | - Jeremy Beach
- Division of Preventive Medicine University of Alberta Edmonton Alberta Canada
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Galarneau JM, Beach J, Cherry N. Pregnancy Outcome in Women Exposed to Metal Fume in Welding: A Canadian Cohort Study. Ann Work Expo Health 2022; 66:1099-1110. [PMID: 35488367 PMCID: PMC9664228 DOI: 10.1093/annweh/wxac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Welding is a physically demanding job that entails exposure to metal fume and particles. There is little information on the effect of welding exposures on the outcome of a pregnancy conceived during a period when a woman was employed as a welder. METHODS Women welders recruited to the Workers Health in Apprenticeship Trades-Metal and Electrical (WHAT-ME) study were followed-up every 6 months for up to 5 years (January 2011-August 2018), and every pregnancy recorded. At the first 6-month follow-up, a detailed questionnaire was completed for the most recent day in welding, and this information was collected again at each follow-up and also from questionnaires completed during pregnancy. The date of conception was estimated for each pregnancy and the job at that date identified. Exposures to ergonomic factors, work schedule and perceptions of noise, heat and cold were extracted for the job at conception. Exposures to metals (aluminum, chromium, manganese, and nickel) and particles in welding fume were estimated from previously validated exposure algorithms reflecting the welding process, base metal and consumables of the job at the conception date. The effects of exposures were estimated in multilevel multivariable models allowing for confounding. RESULTS There were 242 pregnancies conceived by a welder working in her trade, 87 were before the first follow-up, 3 were after first follow-up but detailed information was not collected, 22 of those potentially included in the assessment group were in-trade but not welding leaving 122 pregnancies in 90 welders for analysis. Of these 91 resulted in a live birth and 31 in a fetal loss (27 miscarriages and 4 stillbirths). Mean birth weight for live births was 3365 g and gestation 39.4 weeks. Final models showed that risk of fetal loss increased with manipulating heavy objects [odds ratio (OR) = 5.13, 95% confidence interval (CI) 2.04-12.92], whole-body vibration (OR = 5.86, 95% CI 1.81-18.92), a higher rating for noise exposure intensity (OR = 1.52, 95% CI 1.24-1.85), and decreased with use of local exhaust ventilation (OR = 0.20, 95% CI 0.03-1.18). Gestation decreased with perceived heat intensity (β = -0.15, 95% CI -0.29 to -0.02) and number of previous pregnancies (β = -0.35, 95% CI -0.65 to -0.05). Birth weight was lower in those reporting whole-body vibration (β = -596 g, 95% CI -924 to -267) and increased with the welder's body mass index (β = 36 g, 95% CI 12-61). Estimates of exposure to metals and particles were unrelated to gestation or birth weight. In a bivariate analysis, allowing for the same welder reporting >1 pregnancy, estimated airborne aluminum exposure (and to a lesser degree exposure to nickel and particles) was related to greater risk of fetal loss (OR = 1.52, 95% CI 1.04-2.24) but neither aluminum nor the other estimated elements of welding fume added to the final model. CONCLUSIONS In this group of women actively engaged in welding during the time surrounding conception, the outcome of pregnancy was strongly related to work exposures, particularly vibration (reported in grinding tasks), manipulation of heavy objects, and perceived intensity of noise and heat. The study was unable to show an independent effect of exposure to metal fume constituents.
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Affiliation(s)
- Jean-Michel Galarneau
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada,Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Calgary, Canada
| | - Jeremy Beach
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Nicola Cherry
- Author to whom correspondence should be addressed. Tel: +1-780-492-7851; e-mail:
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Kubler JM, Clifton VL, Moholdt T, Beetham KS. The effects of exercise during pregnancy on placental composition: A systematic review and meta-analysis. Placenta 2021; 117:39-46. [PMID: 34768167 DOI: 10.1016/j.placenta.2021.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Morphological changes to the placenta occur as the demands of the foetus increase throughout gestation. Physical activity during pregnancy is known to benefit both the mother and infant, however the impact of antenatal exercise training on placental development is less known. The aim of this systematic review and meta-analysis was to investigate the effects of exercise training during pregnancy on measures of placental composition. METHODS Six electronic databases were searched from inception to June 2021 for studies comparing regular antenatal exercise with either usual maternal care or no exercise for its effect on measures of placental morphological composition. Meta-analyses were performed for placental weight and the placental weight to birthweight (PWBW) ratio. RESULTS Seven randomised controlled trials and two cohort studies were included in the systematic review and meta-analysis (n = 9). There was no significant difference in placental weight (mean difference (MD) = -9.07g, p = 0.42) or the PWBW ratio (MD = 0.00, p = 0.32) between exercise and control groups. Parenchymal tissue volume was higher, represented by an increase in villous tissue, and non-parenchymal volume was lower in women who exercised regularly compared to those that were not exercising during pregnancy. DISCUSSION Exercise training during pregnancy may not alter placental weight or the PWBW ratio. However, findings from this review indicate that antenatal exercise training can promote advantageous morphological changes to placental tissues.
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Affiliation(s)
- Jade M Kubler
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Women's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Kassia S Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
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Abderhalden-Zellweger A, Politis Mercier MP, Probst I, Wild P, Danuser B, Krief P. Midwives and protection of pregnant workers in Western Switzerland: Practices, difficulties and contributions. Midwifery 2021; 102:103125. [PMID: 34428629 DOI: 10.1016/j.midw.2021.103125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. AIMS Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. METHODS 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. FINDINGS Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be-and deserves to be-formally and legally recognised and integrated into Switzerland's maternity protection legislation.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Maria-Pia Politis Mercier
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland
| | - Isabelle Probst
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011 Lausanne, Switzerland
| | - Pascal Wild
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland; INRS Scientific Management Unit, Nancy, France
| | - Brigitta Danuser
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland
| | - Peggy Krief
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, 1066 Epalinges, Switzerland
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Risk score to stratify miscarriage risk levels in preconception women. Sci Rep 2021; 11:12111. [PMID: 34103654 PMCID: PMC8187346 DOI: 10.1038/s41598-021-91567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/28/2021] [Indexed: 12/03/2022] Open
Abstract
Spontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.
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14
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van Beukering M, Velu A, Schonewille LHN, Duijnhoven R, Mol BW, Brand T, Frings-Dresen M, Kok M. Evaluation of a blended care programme for caregivers and working pregnant women to prevent adverse pregnancy outcomes: an intervention study. Occup Environ Med 2021; 78:809-817. [PMID: 33875554 PMCID: PMC8526877 DOI: 10.1136/oemed-2020-107191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
Objective Work-related activities can be a risk factor for pregnancy complications such as preterm birth. This study evaluates the effectiveness of a blended care programme, Pregnancy and Work, that provides pregnant workers and their obstetrical caregivers with advice on work adjustment. Methods Women less than 20 weeks of gestation, in paid employment or self-employed, in the care of four participating hospitals and their referring midwifery practices in the Netherlands received either the blended care programme (n=119), consisting of a training for professionals and a mobile health application, or care as usual (n=122) in a controlled intervention study with a follow-up in intervention and control populations. All participants completed three questionnaires concerning health and working conditions at 16, 24 and 32 weeks of pregnancy. Primary outcome was the percentage of women who received advice from their obstetrical caregiver about work adjustment. Secondary outcomes were work status, realised work adjustment and working conditions. Groups were compared using univariate and multivariate regression analyses. Results A total of 188 (78%) completed all three questionnaires. In the blended care group, women received more advice from obstetrical caregivers to adjust their work than in the control group, 41 (39%) vs 21 (18%) (adjusted relative risk (aRR) 2.2, 95% CI 1.4 to 3.4), but less from their employer 8 (8%) vs 31 (28%) (aRR 0.29, 95% CI 0.14 to 0.61). There were no significant differences in realised work adjustments. At 24 weeks, 30% of the pregnant women in both groups continued to work in hazardous workplaces. Conclusion Among working pregnant women, the blended care intervention increases advice on work adjustment given by midwives and obstetricians, but does not lead to more work adjustments.
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Affiliation(s)
| | - Adeline Velu
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Ruben Duijnhoven
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ben Willem Mol
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Teus Brand
- Public and Occupational Health/Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Monique Frings-Dresen
- Public and Occupational Health/Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marjolein Kok
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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15
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Vrijkotte T, Brand T, Bonsel G. First trimester employment, working conditions and preterm birth: a prospective population-based cohort study. Occup Environ Med 2021; 78:654-660. [PMID: 33627481 PMCID: PMC8380879 DOI: 10.1136/oemed-2020-107072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022]
Abstract
Objectives To explore the association between working conditions during first trimester and total preterm birth (PTB), and subtypes: spontaneous PTB and iatrogenic PTB, additionally to explore the role of hypertension. Methods Pregnant women from the Amsterdam Born Children and their Development study, filled out a questionnaire between January 2003 and March 2004, two weeks after first prenatal screening (singleton liveborn, n=7561). Working conditions were working hours/week, standing/walking hours/week, physical work load and job strain. Results Prolonged standing/walking during first trimester was associated with an increased risk for total PTB (OR=1.5; 95% CI 1.0–2.3, after adjustments). Other working conditions were not related to total PTB. The separation into spontaneous and iatrogenic PTB revealed that standing/walking was associated with iatrogenic PTB only (OR=2.09; 95% CI 1.00–4.97). The highest risk was found for the combination of a long workweek with high physical work load (OR=3.42; 95% CI 1.04–8.21). Hypertension did not mediate these associations; however, stratified analysis revealed that high physical work load was only related to iatrogenic PTB when pregnancy-induced hypertension was present (OR=6.44; 95% CI 1.21–29.76). Conclusion This study provides evidence that high physically demanding work is associated with an increased risk for iatrogenic PTB and not with spontaneous PTB. Pregnancy-induced hypertension may play a role: when present, high physical work load leads to a more severe outcome.
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Affiliation(s)
- Tanja Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Teus Brand
- Netherlands Center for Occupational Diseases, Coronel Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gouke Bonsel
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.,EuroQol Research Foundation, Rotterdam, Netherlands
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Skröder H, Pettersson H, Norlén F, Gustavsson P, Rylander L, Albin M, Selander J. Occupational exposure to whole body vibrations and birth outcomes - A nationwide cohort study of Swedish women. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 751:141476. [PMID: 32871309 DOI: 10.1016/j.scitotenv.2020.141476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/02/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND More women in reproductive ages are entering occupations where exposure to whole body vibrations (WBV) is common (e.g. in transportation and construction). Previous studies based on self-assessed exposure suggest increased risks of adverse birth outcomes, but it is unclear at what exposure levels and if the current exposure guidelines are appropriate during pregnancy. OBJECTIVES To investigate whether occupational WBV-exposure increases the risk of preterm birth, low birth weight, and/or small-for-gestational age, in a large, nationwide, prospective, cohort study. DESIGN The Fetal Air Pollution Exposure cohort (FAIR) was formed by merging data from multiple, national registers, and the present study includes singletons born 1994-2014 to working women in Sweden (n = 1,091,080 births). WBV-exposure was assessed quantitatively using a job-exposure matrix based on measurements, and calculated odds ratios were adjusted for potential confounders such as smoking and BMI, and other occupational exposures like noise, combustion particles, and physically and psychologically strenuous work. Data on absence from work (full-/part time, sick leave, parental leave, etc.) was also used. RESULTS Exposure to WBV during pregnancy, among women with low absence from work (n = 476,419), was associated with an increased risk of preterm birth, below the occupational exposure limit (1.15 m/s2). Compared to unexposed mothers, the OR was 1.38 (95% CI: 1.05, 1.83) for exposure ≥0.5 m/s2, corresponding to an increase from 47/1000 cases to 65/1000 cases. No increased risk was found for small-for-gestational age. CONCLUSIONS Exposure to WBV was associated with an increased risk of preterm birth. The results suggest that the current permissible exposure and action levels for WBV-exposure do not adequately protect pregnant women with continuous exposure.
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Affiliation(s)
- H Skröder
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
| | - H Pettersson
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - F Norlén
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - P Gustavsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - L Rylander
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Box 188, SE-221 85 Lund, Sweden
| | - M Albin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - J Selander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
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Bovbjerg ML, Misra D, Snowden JM. Current Resources for Evidence-Based Practice, November 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:605-619. [PMID: 33096044 PMCID: PMC7575432 DOI: 10.1016/j.jogn.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.
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