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Bergeron J, Avraam D, Calas L, Fraser W, Harris JR, Heude B, Mandhane P, Moraes TJ, Muckle G, Nader J, Séguin JR, Simons E, Subbarao P, Swertz MA, Tough S, Turvey SE, Fortier I, Rod NH, Andersen AMN. Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts. Eur J Epidemiol 2024; 39:773-783. [PMID: 38805076 PMCID: PMC11344005 DOI: 10.1007/s10654-024-01126-4] [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: 05/12/2023] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.
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Affiliation(s)
- Julie Bergeron
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Research Institute of the McGill University Health Center, Montreal, Canada.
| | - Demetris Avraam
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Lucinda Calas
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - William Fraser
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrook, Canada
| | - Jennifer R Harris
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Barbara Heude
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Theo J Moraes
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Quebec, Canada
| | - Johanna Nader
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Jean R Séguin
- Department of Psychiatry and Addictology, Université de Montréal and CHU Ste-Justine Research Center, Montreal, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Morris A Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Tough
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Becene I, Rinne GR, Schetter CD, Hollenbach JP. Prenatal stress and hair cortisol in a sample of Latina women. Psychoneuroendocrinology 2024; 164:107017. [PMID: 38503196 PMCID: PMC11373737 DOI: 10.1016/j.psyneuen.2024.107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Stress during pregnancy adversely impacts maternal and infant health. Dysregulation of the hypothalamic pituitary axis is a mediator of the relationship between stress and health. Evidence supporting an association between prenatal chronic stress and cortisol is limited, and the majority of research published has been conducted amongst White participants, who experience less chronic stress than people of color. AIM This study investigated associations between various measures of prenatal stress and hair cortisol concentrations which is a biomarker of the integrated stress response in a sample of Latina participants during the third trimester of pregnancy. METHOD Pregnant women (n=45) were surveyed with scales measuring chronic stress, perceived stress, pregnancy-related and pregnancy-specific anxiety. Hair samples were collected as an objective neuroendocrine measure of chronic stress. Linear regression analyses were performed to assess associations between stress measures and hair cortisol. Pre-pregnancy BMI, smoking during pregnancy, and steroid use during pregnancy were used as covariates in adjusted models. RESULTS Chronic stress, operationalized as maternal reports of neighborhood/housing strain, daily activities and relationship strain, discrimination, and financial strain, was significantly associated with higher hair cortisol concentrations. No significant associations were found between hair cortisol and perceived stress, pregnancy-related anxiety, nor pregnancy-specific anxiety in adjusted models. CONCLUSION Chronic stress may be a more robust correlate of physiological stress, as measured by hair cortisol in pregnancy, than other common measures of prenatal stress and anxiety.
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Affiliation(s)
- Iris Becene
- Yale University School of Medicine, New Haven CT 06510, United States
| | - Gabrielle R Rinne
- UCLA Department of Psychology, Los Angeles CA 90095-1563, United States
| | | | - Jessica P Hollenbach
- CT Children's Medical Center, Hartford, CT 06016; Department of Pediatrics, University of Connecticut Health Center, School of Medicine, Farmington CT 06030, United States.
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Minich DM. The Phytoneuroendocrine System: Connecting Plants to Human Systems Biology. Integr Med (Encinitas) 2024; 23:28-31. [PMID: 38618161 PMCID: PMC11007616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Traditional medicine, exemplified by systems such as Ayurveda, inherently adopts a holistic framework. This framework extends beyond mere consideration of the human body to encompass broader systems of health, integrating elements of nature, particularly plants. Over time, there has been a notable integration between traditional medical philosophies and modern scientific methodologies. This integration is evident in published works that blend these disciplines, resulting in the creation of innovative terminology, such as «Ayurnutrigenomics». Concurrently, the lexicon within medical science has evolved to highlight the connection of body systems, as illustrated by terms like «gut-brain axis», which emphasize the relationship between physiological and psychological factors. This integration of perspectives is further demonstrated by terms such as «psychoneuroendocrine» and «mind-heart-body», reflecting a holistic approach to health. Alongside the emergence of these novel terms, there has been a proliferation of literature exploring the diverse functions of plants, particularly focusing on phytonutrients such as those found in the polyphenol category of compounds. In many ways, these emerging findings suggest a fundamental relationship between humans and plants, aligning with the principles of traditional medicine and indicating a profound connection between the two. Thus, in harmony with the increasing recognition of the interconnectedness between human systems biology, the study of phytochemicals, and the ability of plants to influence neuroendocrine responses, this article proposes a new term: the phytoneuroendocrine system.
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Bah HAF, Santos NRD, Costa DO, Carvalho CFD, Martinez VO, Gomes-Júnior EA, Antônio Menezes-Filho J. Environmental neurodevelopment toxicity from the perspective of Bronfenbrenner's bioecological model: a case study of toxic metals. CAD SAUDE PUBLICA 2023; 39:e00202022. [PMID: 37729303 PMCID: PMC10513156 DOI: 10.1590/0102-311xen202022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/04/2022] [Accepted: 06/16/2023] [Indexed: 09/22/2023] Open
Abstract
A growing body of literature reports the need for an integrated approach to study the effects of the physical environment on the neurodevelopment of children. Assessment of the true neurotoxicity of pollutants cannot be performed separately from the ecological and multidimensional contexts in which they act. In this study, from the perspective of the Bronfenbrenner's bioecological model, a conceptual model was developed that encompasses the social and biological characteristics of children from the gestational period to childhood, considering exposure to toxic metals. First, we present the toxicity of the main metals and some concept notions that we used in our framework, such as social and structural determinants of health, allostatic load, embodiment, and epigenetic concepts. Then, the main aspects of the Bronfenbrenner's bioecological model, which allow integration of the gene-social relationship in addition to the physical environment, where these metals act, are explained. Finally, we present and discuss the conceptual framework showing how, in real life, biological and social factors may together influence the neurodevelopment of children. Although this model is based on a group of contaminants, it opens new horizons on how environmental sciences, such as neurotoxicology and environmental epidemiology, can articulate with the theoretical models from human sciences to provide a broader approach to study the effects on human neurodevelopment.
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Affiliation(s)
- Homègnon Antonin Ferréol Bah
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | | | - José Antônio Menezes-Filho
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
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Verheyen VJ, Remy S, Bijnens EM, Colles A, Govarts E, Martin LR, Koppen G, Bruckers L, Nielsen F, Vos S, Morrens B, Coertjens D, De Decker A, Franken C, Den Hond E, Nelen V, Covaci A, Loots I, De Henauw S, van Larebeke N, Teughels C, Nawrot TS, Schoeters G. Long-term residential exposure to air pollution is associated with hair cortisol concentration and differential leucocyte count in Flemish adolescent boys. ENVIRONMENTAL RESEARCH 2021; 201:111595. [PMID: 34186082 DOI: 10.1016/j.envres.2021.111595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exposure to air pollution and traffic noise are associated with adverse health outcomes in adolescents. Chronic endocrine stress and systemic inflammation have been hypothesized to underlie the adverse health effects. Simultaneous assessment of inflammation and chronic endocrine stress in epidemiological studies is lacking. The aim of the study was to investigate biomarkers of chronic endocrine stress and inflammation in relation to long-term residential exposure to air pollution and traffic noise in adolescents. METHODS In Flemish adolescents (14-15 years), we determined hair cortisol concentration (HCC) as a chronic stress biomarker in 3-cm scalp-near hair sections (n = 395), and leucocyte and leucocyte subtype counts (neutrophils, monocytes, lymphocytes) as inflammatory biomarkers in peripheral blood (n = 385). Daily particulate matter (PM2.5, PM10), nitrogen dioxide (NO2) and black carbon (BC) concentrations were modelled at the residential address and averaged over 3-month and 1-year periods prior to sampling. Residential traffic noise level was estimated and classified in 5 dB intervals. Sex-specific associations between residential exposures and effect biomarkers were studied using linear regression models, adjusted for a priori selected covariates. RESULTS In boys, HCC increased with a factor 1.30 (95% CI: 1.10, 1.54) for an increase in 1-year mean NO2 from the 25th to 75th percentile (p75/p25), after adjustment for age, BMI, personal and neighborhood socioeconomic status. The corresponding estimate for PM10 was 1.24 (95% CI: 1.02, 1.51). Total leucocyte count in boys, adjusted for the aforementioned covariates and recent health complaints, was positively associated with PM2.5, PM10, NO2 and BC. In particular, the neutrophil count increased with a factor 1.11 (95% CI: 1.03, 1.19) for a (p75/p25)-factor increase in 1-year mean BC, corresponding estimates for PM2.5, PM10 and NO2 were 1.10 (95% CI: 1.01, 1.19), 1.10 (95% CI: 1.01, 1.20) and 1.08 (95% CI: 1.00, 1.16). Lymphocyte count increased with a factor 1.05 (95% CI: 1.01, 1.10) for a (p75/p25)-factor increase in 1-year mean NO2. Similar results were observed for 3-month mean exposures. Results were robust to adjustment for recent air pollution exposure. In girls, air pollutants were not associated with HCC or differential leucocyte count. Residential traffic noise level was not associated with HCC or leucocyte counts in boys nor girls. CONCLUSIONS Long-term residential exposure to air pollutants was positively associated with chronic endocrine stress and inflammation in adolescent boys, not in girls. This study may contribute to a better understanding of the early pathophysiological changes that may underlie adverse health effects of air pollution exposure in adolescents.
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Affiliation(s)
- Veerle J Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium
| | - Esmée M Bijnens
- Centre for Environmental Sciences, Hasselt University, Agoralaan building D, 3590, Diepenbeek, Belgium
| | - Ann Colles
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium
| | - Laura Rodriguez Martin
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Flemming Nielsen
- Institute of Public Health, Department of Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Stijn Vos
- Centre for Environmental Sciences, Hasselt University, Agoralaan building D, 3590, Diepenbeek, Belgium
| | - Bert Morrens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Dries Coertjens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Annelies De Decker
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Carmen Franken
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Elly Den Hond
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Vera Nelen
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Ilse Loots
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Nicolas van Larebeke
- Analytical, Environmental and Geo- Chemistry, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiotherapy and Experimental Cancerology, Ghent University, Ghent, Belgium
| | - Caroline Teughels
- Flemish Planning Bureau for the Environment and Spatial Development, Koning Albert II laan 20, bus 8, 1000, Brussels, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan building D, 3590, Diepenbeek, Belgium
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Abstract
Massage is systematic touch and manipulation of the soft tissues of the body that is increasingly being used as an adjunctive therapy for stress relief and to promote relaxation and wellbeing during pregnancy and as an alternative to pharmacologic or invasive forms of analgesia during labor. Literature to support the use of massage in pregnancy and labor is limited; however, evidence to support its use has been increasing over the past 30 years. Massage has been shown to be valuable to pregnant women with anxiety, depression, leg, and back pain, and has shown significant benefit in perception of pain during labor.
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Affiliation(s)
- Sarah L Pachtman Shetty
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Sarah Fogarty
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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Alves AC, Cecatti JG, Souza RT. Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health. ScientificWorldJournal 2021; 2021:9512854. [PMID: 34434079 PMCID: PMC8382548 DOI: 10.1155/2021/9512854] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.
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Affiliation(s)
- A. C. Alves
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - J. G. Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - R. T. Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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Wyszynski DF, Hernandez-Diaz S, Gordon-Dseagu V, Ramiro N, Koenen KC. Stress levels among an international sample of pregnant and postpartum women during the COVID-19 pandemic. J Matern Fetal Neonatal Med 2021; 35:7043-7051. [PMID: 34157929 DOI: 10.1080/14767058.2021.1936489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Stress is a complex condition that can have a profound effect on an individual's sense of wellbeing and their ability to live a happy and healthy life. COVID-19 and its associated stressors have the potential to disrupt numerous facets of our everyday lives. Pregnant and postpartum women are especially vulnerable to changes in the availability of routine health and social care services and of their support networks. The current study sought to explore stress levels and their influencers among an international cohort of pregnant and postpartum women during the COVID-19 pandemic. METHODS We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was hosted on the Pregistry platform and made available in 12 languages, with respondents sought through a variety of social media platforms and parenting forums. In addition to levels of stress, we collected data related to demographics, COVID-19 exposure and worries, lifestyle changes, traditional and social media use, precautionary measures related to COVID-19, and mental health. RESULTS In total, 7185 women were included in our sample. We found statistically significant (p-value <0.05) reductions in stress score among older women (≥35 years of age), those either living with a partner or married, those who had graduated from college, and those with medical coverage. Higher stress scores were found among women who resided in Africa, Asia and the Pacific, the Middle East, and North America compared with those in Europe. When race and ethnicity were included in the model, black women were found to have higher stress compared to white women. Level of family and community support was inversely associated with level of stress. CONCLUSION Our study is one of the first to explore stress levels among pregnant and postpartum women during the COVID-19 pandemic. We found statistically significant differences in stress levels by age, education, marital status, region of residence, race/ethnicity and level of support. Understanding stress during the COVID-19 pandemic, and exploring ways to address it, will be key to contributing to the mental and physical health of expectant and new mothers, as well as their children, in both the short and long term.
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Affiliation(s)
| | | | | | | | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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Elmetwally MA, Samy A, Eldesouky A, Lenis YY, Eldomany W. Uterine blood flow, fetal heart rate, gestational length, and fetal birth weight variability in response to maternal temperament in the goat. Anim Sci J 2021; 92:e13563. [PMID: 34013649 DOI: 10.1111/asj.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
This prospective study was designed to investigate the effects of maternal temperament on uterine blood flow, fetal heart rate, gestational length, and fetal birth weight in a goat experimental model. Based on the arena test, behavioral testing related to fear-eliciting stimulus, goats were divided into nervous (n = 13) and calm (n = 11) groups. After mating, the perfusion of maternal uterine arteries (UTAs) and its related Doppler parameters, blood flow volume (BFV), time-averaged mean velocity (TAMEANV), acceleration (Acce), and resistance impedance (S/D), were evaluated biweekly from week two until the end of pregnancy. Fetal heart rate (FHR) was investigated during the pregnancy in addition to the gestation length (GL) and fetal birth weight (FBW). The UTA-BFV and TAMEANV, as well as Acce and S/D, were influenced by maternal temperament (p < .05). The FHR showed no significant changes between experimental animals of different temperaments (p = .81). Both GL and FBW were increased in calm rather than nervous goats (p < .05). These results indicated that the maternal nervous (temperament) have negative impacts on uterine artery Doppler indices, fetal growth, and gestational length in a goat experimental model.
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Affiliation(s)
- Mohammed A Elmetwally
- Department of Theriogenology, Mansoura University, Mansoura, Egypt.,Institute of Reproductive Biology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Alaa Samy
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Eldesouky
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
| | - Yasser Y Lenis
- Division of Animal Science, University of Missouri, Columbia, Missouri, USA.,OHVRI, Health and Veterinary Innovative Research and Development, School of Veterinary Medicine, Faculty of Agrarian Science, Antioquia University, Medellín, Colombia.,Departamento de Ciencia Animal, Facultad de Ciencias Agropecuarias, Universidad Nacional de Colombia, Palmira, Colombia
| | - Wael Eldomany
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
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Štěpáníková I, Baker E, Oates G, Bienertova-Vasku J, Klánová J. Assessing Stress in Pregnancy and Postpartum: Comparing Measures. Matern Child Health J 2020; 24:1193-1201. [PMID: 32691358 PMCID: PMC7476971 DOI: 10.1007/s10995-020-02978-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Measuring early-life psychosocial stress is complicated by methodological challenges. This paper compares three survey instruments for the assessment of life in pregnancy/postpartum and investigates the effects of the timing of early-life stress for emotional/behavioral difficulties (EBD) of offspring during mid/late childhood and adolescence. Methods Observational data were obtained from the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ), which included 4811 pregnancies in two Czech metropolitan areas. We used data collected between 1991 and 2010 at 20 weeks of pregnancy (T1), after delivery (T2), at 6 months postpartum (T3), and at child’s age of 7 years (T4), 11 years (T5), 15 years (T6), and 18 years (T7). Life stress was assessed with (1) the Edinburgh Postnatal Depression Scale (EPDS), (2) a stressful life events (SLE) count based on 42-item inventory, and (3) the SLE measure weighted by perceived stressfulness (PS). Each stress measure was administered at T1, T2, and T3. Child’s EBD were assessed with the Strengths and Difficulties Questionnaire at T4, T5, T6, and T7. Results Each stress measure independently predicted long-term EBD. The best data fit was obtained in a model combining EPDS and SLE. Effect sizes for SLEs decreased between the first half of pregnancy and postpartum, while the effect of EPDS increased. Discussion SLE-based methods capture an aspect of perinatal stress not adequately assessed by EPDS. Combination of psychological distress measures and SLE-based measures is optimal in predicting EBD of the child. Stress measures based on SLE are suitable for early pregnancy, while self-reports of depressive symptoms may perform better in postpartum.
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Affiliation(s)
- Irena Štěpáníková
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic. .,Sociology Department, University of Alabama at Birmingham, 1401 University Blvd. HHB, Birmingham, AL, USA. .,Denisa Ludvikova Vizentova, Masarykova univerzita Kotlářská 2, Brno, 61137, Czech Republic.
| | - Elizabeth Baker
- Sociology Department, University of Alabama at Birmingham, 1401 University Blvd. HHB, Birmingham, AL, USA
| | - Gabriela Oates
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie Bienertova-Vasku
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.,Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Klánová
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic
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11
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Thongsomboon W, Kaewkiattikun K, Kerdcharoen N. Perceived Stress and Associated Factors Among Pregnant Women Attending Antenatal Care in Urban Thailand. Psychol Res Behav Manag 2020; 13:1115-1122. [PMID: 33293879 PMCID: PMC7718990 DOI: 10.2147/prbm.s290196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Perceived stress during pregnancy is associated with adverse obstetric outcomes. Antenatal perceived stress is still unaware and under-diagnosed during routine antenatal care. There has not yet been a study of prevalence and associated factors among pregnant women living in urban areas in Thailand. Understanding antenatal perceived stress is important to improve maternal and neonatal outcomes. Objective To identify the prevalence, associated factors, and predictive factors of perceived stress in pregnant women living in an urban area. Materials and Methods This cross-sectional study was conducted from December 1, 2019 to February 29, 2020 among pregnant women attending antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand. The participants were interviewed using a structured questionnaire which included demographic data, obstetric data, serious life event data, and a Thai language version of the 10-item Perceived Stress Scale (T-PSS-10) to assess perceived stress symptoms. Results Of a total 403 pregnant women, the prevalence of perceived stress symptoms in antenatal pregnant women was 23.6%. Perceived stress symptoms were significantly associated with divorce (p=0.001), separation from spouse (p=0.005), physical or psychological trauma from family (p=0.005), marital conflict (p<0.001), and family conflict (p<0.001). Results from multiple logistic regression found that significant predictive factors for perceived stress symptoms in pregnant women were marital conflict (AOR 3.10, 95% CI 1.74–5.52, p<0.001) and family conflict (AOR 3.24, 95% CI 1.59–6.60, p=0.001). Conclusion This study demonstrated that the prevalence of perceived stress symptoms in pregnant women living in an urban area in Thailand was 23.6%. Perceived stress symptoms were significantly associated with divorce, separation from spouse, physical or psychological trauma from family, marital conflict, and family conflict. Predictive factors for perceived stress symptoms were marital conflict and family conflict.
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Affiliation(s)
- Wassapol Thongsomboon
- Department of Obstetrics & Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kasemsis Kaewkiattikun
- Department of Obstetrics & Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nitchawan Kerdcharoen
- Department of Psychiatry, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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12
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Harvey MW, Braun B, Ertel KA, Pekow PS, Markenson G, Chasan-Taber L. Stress and Anxiety are Associated with Lower Gestational Weight Gain in Hispanic Women. Womens Health Issues 2020; 30:409-415. [PMID: 32994129 PMCID: PMC7704913 DOI: 10.1016/j.whi.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG. METHODS We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18-40 years of age (2006-2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records. RESULTS The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (β = -3.89; SE = 1.54; p = .012 and β = -4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (β = -3.84 lbs; SE = 1.39; p = .006, and β = -3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (β = -0.117 lbs/week; SE = 0.044; p = .008 and β = -0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles. CONCLUSIONS High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.
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Affiliation(s)
- Megan W Harvey
- Department of Health Sciences, Springfield College, Springfield, Massachusetts.
| | - Barry Braun
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - Karen A Ertel
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Penelope S Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Glenn Markenson
- Obstetrics & Gynocology, Boston University School of Medicine, Boston, Massachusetts
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
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13
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González-Ochoa R, Calleja N, Hernández-Pozo MR, Campos-Uscanga Y, Barranca-Enríquez A, Romo-González T. Design and Psychometric Analysis of the Stressors and Modulators of Gestational Stress Inventory (SMGSI). THE SPANISH JOURNAL OF PSYCHOLOGY 2020; 23:e26. [PMID: 32662375 DOI: 10.1017/sjp.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gestational stress is associated with many maternal and child complications, however, this association must be taken with care, since there are studies that find inconsistent results between stress measures and maternal complications. It is believed that the lack of convergence is due to the way in which gestational stress is evaluated.The aim of the present study was to design and validate an instrument based on a bio-psycho-social model of gestational stress. The design and validation process of the inventory was divided into four phases: (a) Construction of the items bank and content validity, (b) construct validity, (c) inventory reliability and (d) convergent and discriminant validity with psychometric instruments that have been used in other investigations to evaluate gestational stress.A valid and reliable Stressors and Modulators of Gestational Stress Inventory (SMGSI) conformed by two scales was developed: (a) Gestational stressors, which is formed by two factors, the psychological stressors and social stressors with a variance of 48.5% and 51.8% and a reliability of .79 and .67, respectively; and (b) gestational stress modulators integrated by 8 items that explain 55.2% of the variance and with a reliability of .92. In conclusion, a valid and reliable tool was obtained that measures gestational stress from a bio-psycho-social perspective. This inventory allows for the identification of allostatic and pantostatic stress, making it useful as a diagnostic tool to prevent maternal and childhood complications that are associated with chronic gestational stress.
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14
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Gitsels-van der Wal JT, Gitsels LA, Hooker A, Scholing P, Martin L, Feijen-de Jong EI. Perinatal outcomes of frequent attendance in midwifery care in the Netherlands: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:269. [PMID: 32375734 PMCID: PMC7201569 DOI: 10.1186/s12884-020-02957-1] [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: 12/09/2019] [Accepted: 04/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Over the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes. METHODS A retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief. RESULTS The study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24-3.17) and duration of dilatation (OR 1.20, 95% CI 1.04-1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17-2.95), ruptured perineum (OR 0.50, 95% CI 0.27-0.95) and episiotomy (OR 0.48, 95% CI 0.24-0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death. CONCLUSION In our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality.
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Affiliation(s)
- Janneke T. Gitsels-van der Wal
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 HV Amsterdam, The Netherlands
| | - Lisanne A. Gitsels
- ESRC funded Business and Local Government Data Research Centre (BLG DRC), School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ UK
- University College London, London, UK
| | - Angelo Hooker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, Netherlands
- Zaans Medical Center, Department of Obstetrics and Gynecology, Koningin Julianaplein 58, Zaandam, Netherlands
| | - Paula Scholing
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 HV Amsterdam, The Netherlands
| | - Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 HV Amsterdam, The Netherlands
| | - Esther I. Feijen-de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 HV Amsterdam, The Netherlands
- Department of General Practice & Elderly Medicine, University of Groningen, University Medical Center Groningen, POBox 30001, 9700 RB Groningen, the Netherlands
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15
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Lamichhane N, Olsen NJ, Mortensen EL, Obel C, Heitmann BL, Händel MN. Associations between maternal stress during pregnancy and offspring obesity risk later in life-A systematic literature review. Obes Rev 2020; 21:e12951. [PMID: 31642601 DOI: 10.1111/obr.12951] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/18/2023]
Abstract
Exposure to prenatal stress is linked to health consequences in the offspring. The objective of this systematic review was to synthesize and critically appraise primary human studies that have examined the association between prenatal exposure to psychosocial stress, or adverse life events, stress hormones, and later risk of developing obesity. We searched Medline, Embase, ScienceDirect, WorldCat, and OpenGrey up to January 2019 to identify relevant literature. We critically appraised the identified studies, assessed their quality, and summarized their findings. From a total of 5930 search results and references of studies that authors considered pertinent, we identified 15 relevant studies among which three were of high quality and the rest were medium-quality studies. We found direct association between exposure to stress in fetal life and different measures of obesity in the offspring in eight studies. The direct association was usually observed in studies that involved measurement of stress among mothers exposed to natural disasters. Due to lack of adequate and comparable data from the included studies, we did not conduct a meta-analysis. We concluded that there may be direct association between prenatal stress and later obesity, but further research with more comparable sources of stressors is recommended.
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Affiliation(s)
- Nishan Lamichhane
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Nanna Julie Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Obel
- Faculty of Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Mina Nicole Händel
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Lobmaier SM, Müller A, Zelgert C, Shen C, Su PC, Schmidt G, Haller B, Berg G, Fabre B, Weyrich J, Wu HT, Frasch MG, Antonelli MC. Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. Arch Gynecol Obstet 2019; 301:405-414. [PMID: 31781889 DOI: 10.1007/s00404-019-05390-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. METHODS Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth. RESULTS 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001]. CONCLUSION Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. TRIAL REGISTRATION Clinical trial registration: NCT03389178.
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Affiliation(s)
- Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - A Müller
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - C Zelgert
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Shen
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - P C Su
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - G Schmidt
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Buenos Aires, Argentina
| | - G Berg
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Facultad de Farmacia Y Bioquímica, Buenos Aires, Argentina
| | - B Fabre
- Facultad de Farmacia Y Bioquímica. Instituto de Fisiopatología Y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J Weyrich
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - H T Wu
- Department of Mathematics, Duke University, Durham, NC, 27705, USA.,Department of Statistical Science, Duke University, Durham, NC, 27705, USA.,Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - M G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - M C Antonelli
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Instituto de Biología Celular Y Neurociencia "Prof. E. De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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17
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Villar R, Serra L, Serra C, Benavides FG. Working conditions and absence from work during pregnancy in a cohort of healthcare workers. Occup Environ Med 2019; 76:236-242. [PMID: 30674607 DOI: 10.1136/oemed-2018-105369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the relationship between exposure to occupational risk factors during pregnancy and absence from work using two different social benefits. METHOD Three working pregnancy trajectories (WPT) were identified in a cohort of 428 pregnant workers from a healthcare institution (period 2010-2014), based on absence days and using cluster analysis. WPT1 included absences mainly covered by sickness absence benefit (32.0% of women), WPT2 included absences covered by pregnancy occupational risk (POR) benefit (28.3%) and WPT3 were pregnant workers with few absences (39.9%). Exposure to occupational risk factors was assessed by experts and association with trajectories was analysed using logistic regression. Relative risks (RR) and their 95% CIs were adjusted for age, type of contract and shift work. RESULTS WPT2 was associated with exposure to physical (RR=1.86, 95%CI 1.17 to 2.97), safety (RR=2.10, 95%CI 1.61 to 2.73), ergonomic (RR=2.52, 95%CI 1.89 to 3.36) and psychosocial (RR=1.79, 95%CI 1.31 to 2.46) factors, and with exposure level. For physicians, WPT1 was associated with safety risks (RR=3.13, 95%CI 1.22 to 7.99), WPT2 with chemical and ergonomic for administrative/technical support (RR=12.20, 95%CI 1.69 to 88.09; RR=14.09, 95%CI 1.34 to 148.61, respectively), with safety and ergonomic risks for nursing aides (RR=1.84, 95%CI 1.12 to 3.02; RR=3.94, 95% CI 2.38 to 6.53, respectively), and with physical (RR=1.72, 95%CI 1.04 to 2.86), safety (RR=2.21, 95%CI 1.62 to 3.03), ergonomic (RR=2.02, 95%CI 1.44 to 2.86) and psychosocial factors (RR=1.96, 95%CI 1.32 to 2.90) for nurses. CONCLUSIONS Absences from work covered by POR benefit show a consistent relationship with exposure to occupational risks. Sickness absence is the most frequent benefit used by pregnant workers. Current social benefits are apparently used adequately for protecting women from occupational exposures. Future studies are needed to clarify this further.
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Affiliation(s)
- Rocio Villar
- Occupational Health Service, Consorci MAR Parc de Salut de Barcelona, Barcelona, Spain.,Center for Research in Occupational Health, IMIM - Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain
| | - Laura Serra
- Center for Research in Occupational Health, IMIM - Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Consol Serra
- Occupational Health Service, Consorci MAR Parc de Salut de Barcelona, Barcelona, Spain.,Center for Research in Occupational Health, IMIM - Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Fernando G Benavides
- Center for Research in Occupational Health, IMIM - Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
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