Pregnancy, obstetrical and neonatal outcomes in women exposed to physician-related occupational hazards: a scoping review

OBJECTIVE

Evidence is needed to guide organisational decision making about workplace accommodations for pregnant physicians. Our objective was to characterise the strengths and limitations of current research examining the association between physician-related occupational hazards with pregnancy, obstetrical and neonatal outcomes.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE/PubMed, EMBASE, CINAHL/ EBSCO, SciVerse Scopus and Web of Science/Knowledge were searched from inception to 2 April 2020. A grey literature search was performed on 5 April 2020. The references of all included articles were hand searched for additional citations.

ELIGIBILITY CRITERIA

English language citations that studied employed pregnant people and any 'physician-related occupational hazards', meaning any relevant physical, infectious, chemical or psychological hazard, were included. Outcomes included any pregnancy, obstetrical or neonatal complication.

DATA EXTRACTION AND SYNTHESIS

Physician-related occupational hazards included physician work, healthcare work, long work hours, 'demanding' work, disordered sleep, night shifts and exposure to radiation, chemotherapy, anaesthetic gases or infectious disease. Data were extracted independently in duplicate and reconciled through discussion.

RESULTS

Of the 316 included citations, 189 were original research studies. Most were retrospective, observational and included women in any occupation rather than healthcare workers. Methods for exposure and outcome ascertainment varied across studies and most studies had a high risk of bias in data ascertainment. Most exposures and outcomes were defined categorically and results from different studies could not be combined in a meta-analysis due to heterogeneity in how these categories were defined. Overall, some data suggested that healthcare workers may have an increased risk of miscarriage compared with other employed women. Long work hours may be associated with miscarriage and preterm birth.

CONCLUSIONS

There are important limitations in the current evidence examining physician-related occupational hazards and adverse pregnancy, obstetrical and neonatal outcomes. It is not clear how the medical workplace should be accommodated to improve outcomes for pregnant physicians. High-quality studies are needed and likely feasible.

Night shift work undertaken by women and fertility treatment interact to increase prevalence of urogenital anomalies in children

OBJECTIVE

To investigate the role of maternal night shift work in occurrence of urogenital anomalies in offspring, considering a possible interaction with mode of conception.

METHODS

A population-based cohort comprising births in South Australia (1986-2002) was produced via linkage of fertility clinic records, perinatal and birth defects data. This study concerned first births to women in paid employment (n=98 103). Potential exposure to night shift was imputed by applying a job-exposure matrix to recorded occupation. Associations were examined using logistic regression, first for nurses and other night shift workers separately, then combined. An interaction term for night shift work and mode of conception was included in all models, while adjusting for covariates.

RESULTS

Associations were similar for nurses and other night shift workers, although only statistically significant for the former when considered separately. A multiplicative interaction was supported: for natural conceptions, maternal night shift work was not associated with offspring urogenital anomalies (OR=0.99, 95% CI 0.84 to 1.15); where a birth arose from fertility treatment, urogenital anomalies were significantly higher among births to all night shift workers compared with day workers (OR=2.07, 95% CI 1.20 to 3.55). This was not due to differences in the type of fertility treatment received.

CONCLUSIONS

Women in occupations that probably involved night shift did not have offspring with increased prevalence of urogenital anomalies if they conceived naturally. When night shift workers conceived with fertility treatment, the prevalence of urogenital anomalies was elevated. Possibly these women had the greatest exposure to night shift work, or least tolerance for this work schedule, or heightened sensitivity to hormonal aspects of fertility treatment.

[Working at the hospital during pregnancy: A descriptive national cross-sectional study in France]

OBJECTIVE

The objective of the article is to describe the follow-up of pregnancies at work and occupational exposure to potential risks for pregnancy.

METHODS

A descriptive cross-sectional study was performed from April 1, 2017 to October 31, 2017 in the occupational health departments of French hospitals. After delivery and at the time of returning to work, 1,165 eligible workers were interviewed by occupational health physicians (OHPs). Socio-demographic information was self-reported. Occupational exposures were assessed by an OHP. Birth weight, gestational age, and sick leaves were also collected.

RESULTS

Among recruited workers, 51.8% were exposed to more than 5 occupational hazards. Biological and physical hazards were the most common hazards at the workplace. Note that heavy lifting ≥ 15 kg concerned 9.5% of workers. Only 20.1% of workers had a specific "pregnancy at work" medical visit with OHP during pregnancy; 26.8% benefited from workstation adjustments. In contrast, the level of sick leaves was high (86.7%).

CONCLUSIONS

Our data suggest that pregnant workers in hospitals must be strictly supervised.

An update systematic review of fetal death, congenital anomalies, and fertility disorders among health care workers

BACKGROUND

Health care workers (HCWs) are occupationally exposed to various hazards, some associated with adverse pregnancy outcomes in previous reviews. This systematic review aims at synthesizing the recent literature on occupational exposures among HCWs related to fetal death, congenital anomalies, and fertility disorders.

METHODS

We searched the Medline database from 2000 to 2015 for articles about all potential occupational exposures of women and men working in this sector.

RESULTS

We retained 32 studies, most of them (n = 30) among women HCWs. Studies based on job title reported excess risks of some congenital anomalies (especially nervous and musculoskeletal systems) among HCWs compared to non-HCWs but no evidence about fetal death. Excess risks associated with specific exposures includes reports of some congenital anomalies for women exposed to anesthetic gases. Exposure to some sterilizing agents and, with less evidence, to antineoplastic drugs and to ionizing radiation, is associated with increased risks of miscarriage but not stillbirth. Strenuous work schedules appear to be associated with fertility disorders, but the evidence is limited. Only a few studies have been published since 2000 about non-ionizing radiation, or about fertility disorders related to chemical or physical agents, or about male HCWs.

CONCLUSIONS

Despite the establishment of recommendations to limit exposures of HCWs, some excess risks of adverse pregnancy outcomes are still reported and need to be explained.

Potential exposure to endocrine disrupting chemicals and selected adverse pregnancy outcomes: a follow-up study of pregnant women referred for occupational counselling

BACKGROUND

Experimental evidence indicates that fetal exposure to xenobiotics with the potential to interfere with the endogenous steroid hormone regulation of fetal development may reduce birth weight. However, epidemiological studies are limited. The aim of the study was to investigate whether potential occupational exposure to endocrine disrupting chemicals (EDC) of the mother during pregnancy is associated with preterm birth and low birth weight.

METHODS

Pregnant women referred to an Occupational Health Clinic (OHC) in two Danish regions (Copenhagen or Aarhus) between 1984 and 2010, suspected of being exposed to occupational reproductive hazards were included in the study. A job exposure matrix enabled estimation of potential occupational exposure to EDC on the basis of job title. Births by women potentially exposed to EDC (n = 582) were compared to births by women referred to an OHC on the suspicion of other exposures than EDC (n = 620), and to a sample of births by all occupationally active women in the same geographical regions (n = 346,544), including 1,077 births of the referred women's non-referred pregnancies.

RESULTS

No indications of reduced birth weight or increased risk of preterm birth were found among women potentially exposed to EDC. Women potentially exposed to EDC had children with a higher birth weight compared to the sample of occupationally active women but not compared to other women referred to an OHC.

CONCLUSIONS

Potential maternal exposure to EDC at Danish workplaces is not related to low birth weight or preterm birth among women referred to occupational counselling. Occupational exposures might be too weak on the average to cause these adverse effects or counselling at the OHCs is effective in preventing them.

A Grounded Theory Study of How Nurses Integrate Pregnancy and Full-Time Employment: Becoming Someone Different

BACKGROUND

A holistic exploration of the experience of how nurses integrate pregnancy and employment is lacking among the global nursing literature.

OBJECTIVE

The purpose of this research was to explore how primiparous U.S. nurses integrated pregnancy and full-time employment.

METHODS

Using a grounded theory approach, 20 nurses from the United States, who were pregnant and delivered their first baby-while employed full time on 12-hour work shifts-provided a firsthand account of how they incorporated pregnancy with professional nursing employment.

RESULTS

The basic social process, "becoming someone different," emerged to explain how U.S. nurses integrated pregnancy and full-time employment in early and late stages. Four core categories were: (a) "looking different, feeling different,"(b) "expectations while expecting," (c) "connecting differently," and (d) "transitioning labor."

DISCUSSION

Within early and late stages, pregnant nurses becoming someone different navigate through various social interactions with peers and patients alike, with meaning assigned to those experiences. Research with pregnant nurses from other countries, nurses working in settings other than acute care, and multiparous nurses is needed to further expand on these findings.

Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort

BACKGROUND

Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes.

METHODS

We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption.

RESULTS

Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs) was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small.

CONCLUSION

Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.