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Glazer TA, Gunderson KA, Deroo E, Shaffrey EC, Mann H, Matabele MN, Minter RM, Iruretagoyena JI, Rectenwald JE. Providing a Safe Pregnancy Experience for Surgeons: A Review. JAMA Surg 2024:2822314. [PMID: 39141361 DOI: 10.1001/jamasurg.2024.0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Importance Childbearing has been a particular barrier to successful recruitment and retention of women in surgery. Pregnant surgeons are more likely to have major pregnancy complications, such as preterm delivery, intrauterine growth restriction, infertility, and miscarriage, compared with nonsurgeons. The average obstetric complication rate for surgeons ranges between 25% and 82% in the literature and is considerably higher than that in the general US population at 5% to 15%. Observations The risks that pregnant surgeons experience were individually analyzed. These risks included missed prenatal care; musculoskeletal hazards, such as prolonged standing, lifting, and bending; long work hours; overnight calls; exposure to teratogenic agents, such as ionizing radiation, anesthetic gases, chemotherapy agents, and methyl methacrylate; and psychological stress and discrimination from the long-standing stigma associated with balancing motherhood and professional life. Conclusions and Relevance A clear, translatable, and enforceable policy addressing perinatal care of surgeons was proposed, citing evidence of the risks reviewed from the literature. A framework of protection for pregnant individuals is essential for attracting talented students into surgery, retaining talented surgical trainees and faculty, and protecting pregnant surgeons and their fetuses.
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Affiliation(s)
- Tiffany A Glazer
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Kirsten A Gunderson
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Elise Deroo
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Ellen C Shaffrey
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Hayley Mann
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Maya N Matabele
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
| | - J Igor Iruretagoyena
- University of Wisconsin School of Medicine and Public Health, Madison
- Department of Obstetrics and Gynecology, University of Wisconsin Hospitals and Clinics, Madison
| | - John E Rectenwald
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
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Kember AJ, Anderson JL, House SC, Reuter DG, Goergen CJ, Hobson SR. Impact of maternal posture on fetal physiology in human pregnancy: a narrative review. Front Physiol 2024; 15:1394707. [PMID: 38827993 PMCID: PMC11140392 DOI: 10.3389/fphys.2024.1394707] [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: 03/04/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
In numerous medical conditions, including pregnancy, gravity and posture interact to impact physiology and pathophysiology. Recent investigations, for example, pertaining to maternal sleeping posture during the third trimester and possible impact on fetal growth and stillbirth risk highlight the importance and potential clinical implications of the subject. In this review, we provide an extensive discussion of the impact of maternal posture on fetal physiology from conception to the postpartum period in human pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 242 studies from 1991 through 2021, inclusive, that met our inclusion criteria. Herein, we provide a synthesis of the resulting literature. In the first section of the review, we group the results by the impact of maternal posture at rest on the cervix, uterus, placenta, umbilical cord, amniotic fluid, and fetus. In the second section of the review, we address the impact on fetal-related outcomes of maternal posture during various maternal activities (e.g., sleep, work, exercise), medical procedures (e.g., fertility, imaging, surgery), and labor and birth. We present the published literature, highlight gaps and discrepancies, and suggest future research opportunities and clinical practice changes. In sum, we anticipate that this review will shed light on the impact of maternal posture on fetal physiology in a manner that lends utility to researchers and clinicians who are working to improve maternal, fetal, and child health.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s Hospital, Seattle, WA, United States
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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3
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Begtrup LM, Sejbaek CS, Flachs EM, Garde AH, Specht IO, Hansen J, Kolstad HA, Bonde JPE, Hammer PEC. Night work during pregnancy and small for gestational age: a Danish nationwide register-based cohort study. Occup Environ Med 2023; 80:610-616. [PMID: 37813484 DOI: 10.1136/oemed-2023-108981] [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: 05/01/2023] [Accepted: 09/02/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim was to investigate the association between night work during pregnancy and risk of having a small for gestational age (SGA) child. METHODS This cohort study had payroll data with detailed information on working hours for employees in all Danish administrative regions (primarily hospital employees) between 2007 and 2015, retrieved from the Danish Working Hour Database. Pregnancies, covariates and outcome were identified from the national birth registry. We used logistic regression to investigate the association between intensity and duration of night work during the first 32 pregnancy weeks and SGA. The adjusted model included age, body mass index, socioeconomic status and smoking. Using quantitative bias analysis and G-estimation, we explored potential healthy worker survivor bias (HWSB). RESULTS The final cohort comprised 24 548 singleton pregnancies in 19 107 women, primarily nurses and medical doctors. None of the dimensions of night work were associated with an increased risk of SGA. We found a tendency towards higher risk of SGA in pregnancies where the women stopped having night shifts during pregnancy. Using G-estimation we found an OR<1 for the association between night work and SGA if all workers continued having night work during pregnancy compared with daywork only. CONCLUSION We found no increased risk of SGA in association with night work during pregnancy among healthcare workers. G-estimation was not precise enough to estimate the observed indication of HWSB. We need better data on pregnancy discomforts and complications to be able to safely rule out HWSB.
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Affiliation(s)
- Luise Moelenberg Begtrup
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Camilla Sandal Sejbaek
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
- National Research Centre for the Working Environment, Kobenhavn, Denmark
| | - Ina Olmer Specht
- The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
- Section for General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Johnni Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Insitute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Paula Edeusa Cristina Hammer
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Okui T. Difference in risk of preterm and small-for-gestational-age birth depending on maternal occupations in Japan. BMC Res Notes 2023; 16:259. [PMID: 37798631 PMCID: PMC10557295 DOI: 10.1186/s13104-023-06539-0] [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: 03/12/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES In this study, an association between the mother's occupations with preterm and small-for-gestational-age (SGA) births was investigated using national data in Japan, and individual-level birth data from the Report of Vital Statistics: Occupational and Industrial Aspects in the 2015 fiscal year were used. Preterm and SGA birth rates were calculated for each of infant characteristics, and relative risk of each type of maternal occupations (categorized into 12 types) for the outcomes was estimated using a log binomial regression model. RESULTS Data of 997,600 singleton births were analyzed. Among maternal occupations, preterm birth rate was highest among carrying, cleaning, packaging, and related workers (5.65%) and lowest among security workers (4.24%). SGA birth rate was highest among manufacturing process workers (5.91%) and lowest among security workers (4.00%). We found significantly elevated risks for preterm birth among manufacturing process workers compared with unemployed mothers, and significantly elevated risks for SGA birth compared with unemployed mothers were observed among sales workers, service workers, and manufacturing process workers. In contrast, security workers had a significantly decreased risk for SGA birth compared with unemployed mothers.
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Affiliation(s)
- Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Fukuoka city, Japan.
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5
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van Beukering MDM, van Melick MJGJ, Duijnhoven RG, Schuit E, Liem SL, Frings-Dresen MHW, van de Wetering AJP, Spaanderman MEA, Kok M, Mol BW. Working conditions in women with multiple pregnancy-the impact on preterm birth and adherence to guidelines: a prospective cohort study. Am J Obstet Gynecol 2023; 228:734.e1-734.e16. [PMID: 36379267 DOI: 10.1016/j.ajog.2022.11.1281] [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: 06/29/2022] [Revised: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth. OBJECTIVE This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine. STUDY DESIGN We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines. RESULTS We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the guidelines. CONCLUSION In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth.
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Affiliation(s)
- Monique D M van Beukering
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marjo J G J van Melick
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sophie L Liem
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Monique H W Frings-Dresen
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health, Amsterdam, the Netherlands
| | | | - Marc E A Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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6
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Delva F, Carcasset P, Mouton P, Auguste-Virginie R, Lairez F, Sentilhes L, Brochard P, Joseph JP. Greater Risk of Pregnancy Complications for Female Surgeons: A Cross-Sectional Electronic Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:125. [PMID: 36612447 PMCID: PMC9819732 DOI: 10.3390/ijerph20010125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. METHODS We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. RESULTS Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84]. CONCLUSION Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy.
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Affiliation(s)
- Fleur Delva
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
- Centre d’Investigation Clinique 1401 Épidémiologie Clinique, Institut National de la Santé et de la Recherche, University of Bordeaux, 33076 Bordeaux, France
| | - Pierre Carcasset
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Pauline Mouton
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
| | | | - Fanny Lairez
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
| | - Loïc Sentilhes
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Patrick Brochard
- Environmental Health Platform Dedicated to Reproduction, ARTEMIS Center, Bordeaux University Hospital, 33076 Bordeaux, France
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
| | - Jean-Philippe Joseph
- Bordeaux Population Health Research Center, Inserm UMR1219, University of Bordeaux, 33076 Bordeaux, France
- Centre d’Investigation Clinique 1401 Épidémiologie Clinique, Institut National de la Santé et de la Recherche, University of Bordeaux, 33076 Bordeaux, France
- Department of General Practice, University of Bordeaux, 33076 Bordeaux, France
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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [PMID: 36532766 PMCID: PMC9753576 DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 09/10/2024] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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Affiliation(s)
- Hao-Ran Dai
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Xu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan-Sheng Ding
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Rui Cheng
- Neonatal Intensive Care Unit, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
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8
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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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10
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Richter HG, Mendez N, Halabi D, Torres-Farfan C, Spichiger C. New integrative approaches to discovery of pathophysiological mechanisms triggered by night shift work. Chronobiol Int 2021; 39:269-284. [PMID: 34727788 DOI: 10.1080/07420528.2021.1994984] [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: 10/19/2022]
Abstract
Synchronization to periodic cues such as food/water availability and light/dark cycles is crucial for living organisms' homeostasis. Both factors have been heavily influenced by human activity, with artificial light at night (ALAN) being an evolutionary challenge imposed over roughly the last century. Evidence from studies in humans and animal models shows that overt circadian misalignment, such as that imposed to about 20% of the workforce by night shift work (NSW), negatively impinges on the internal temporal order of endocrinology, physiology, metabolism, and behavior. Moreover, NSW is often associated to mistimed feeding, with both unnatural behaviors being known to increase the risk of chronic diseases, such as eating disorders, overweight, obesity, cardiovascular, metabolic (particularly type 2 diabetes mellitus) and gastrointestinal disorders, some types of cancer, as well as mental disease including sleep disturbances, cognitive disorders, and depression. Regarding deleterious effects of ALAN on reproduction, increased risk of miscarriage, preterm delivery and low birth weight have been reported in shift-worker women. These mounting lines of evidence prompt further efforts to advance our understanding of the effects of long-term NSW on health. Emerging data suggest that NSW with or without mistimed feeding modify gene expression and functional readouts in different tissues/organs, which seem to translate into persistent cardiometabolic and endocrine dysfunction. However, this research avenue still faces multiple challenges, such as functional characterization of new experimental models more closely resembling human long-term NSW and mistimed feeding in males versus females; studying further target organs; identifying molecular changes by means of deep multi-omics analyses; and exploring biomarkers of NSW with translational medicine potential. Using high-throughput and systems biology is a relatively new approach to study NSW, aimed to generate experiments addressing new biological factors, pathways, and mechanisms, going beyond the boundaries of the circadian clock molecular machinery.
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Affiliation(s)
- Hans G Richter
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Natalia Mendez
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Diego Halabi
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Claudia Torres-Farfan
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Centro Interdisciplinario de Estudios del Sistema Nervioso (CISNe), Universidad Austral de Chile, Valdivia, Chile
| | - Carlos Spichiger
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
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Abderhalden-Zellweger A, Probst I, Mercier MPP, Danuser B, Krief P. Maternity Protection at Work and Safety Climate: The Perceptions of Managers and Employees in Three Healthcare Institutions in Switzerland. SCANDINAVIAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2021. [DOI: 10.16993/sjwop.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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A Roadmap for Navigating Occupational Exposures for Surgeons: A Special Consideration for the Pregnant Surgeon. Plast Reconstr Surg 2021; 147:513-523. [PMID: 33235051 DOI: 10.1097/prs.0000000000007581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
SUMMARY Surgeons are exposed to occupational hazards daily. Risks include chemical, biological, and physical hazards that place providers at risk of serious harm. Departmental policies or written guides to help pregnant surgeons navigate the hospital are lacking. In response to the scarcity in the literature, the authors have summarized current guidelines and recommendations to aid surgeons in making an informed decision. In addition, the authors present a brief narrative of the impact of these exposures during pregnancy and methods of transmission and, where relevant, include specialties that are at risk of these exposures.
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Sheppard G, Pham C, Nowacki A, Bischoff T, Snider C. Towards gender equity in emergency medicine: a position statement from the CAEP Women in Emergency Medicine committee. CAN J EMERG MED 2021; 23:455-459. [PMID: 33709250 DOI: 10.1007/s43678-021-00114-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
As of January 2019, over half of all doctors working in Canada under the age of 40 were women. Despite equal representation in the profession of medicine, women still experience harassment, discrimination, and pay inequity when compared to their male colleagues. Gender discrimination is present at all levels of medical training and negatively impacts women who want to become emergency physicians. The right to gender equity is part of the Canadian Charter of Rights and Freedoms. The World Health Organization states that "gender inequities are socially generated and, therefore, can be changed." CAEP recognizes that gender equity is important to its members and that it intersects with inequities experienced by other minority groups. This position statement from the committee for Women in Emergency Medicine (EM) is intended to support women and those who identify as women who have chosen EM as their career. Furthermore, it is meant to inform and support policy makers as they consider the unique challenges that women face in their pursuit of excellence in EM.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Chau Pham
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anna Nowacki
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Taylor Bischoff
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Snider
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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Abderhalden-Zellweger A, Probst I, Politis Mercier MP, Zenoni M, Wild P, Danuser B, Krief P. Implementation of the Swiss ordinance on maternity protection at work in companies in French-speaking Switzerland. Work 2021; 69:157-172. [PMID: 33998579 DOI: 10.3233/wor-213465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Switzerland's Ordinance on Maternity Protection at Work (OProMa) requires that companies take the necessary measures to ensure that pregnant employees can continue working without danger. OBJECTIVE To investigate the extent of compliance with OProMa within companies in French-speaking Switzerland as well as factors which facilitate and obstruct the ordinance's implementation. METHODS A stratified random telephone survey of 202 companies from the healthcare and food industry was conducted. Descriptive and correlational statistics were calculated. Responses to open questions were analysed thematically. RESULTS Only a minority of companies performed risk analyses or adapted employees' workstations, as per the legislation. OProMa was implemented more effectively in larger companies than smaller ones, in public rather than private ones, in the healthcare sector rather than the food industry, and when the person responsible for the wellbeing of pregnant employees within the company had undergone specific training on the subject. Data extrapolation suggested that only 2% of pregnant employees in French-speaking Switzerland's food industry and 12% in its healthcare sector are properly protected according to OProMa's provisions. CONCLUSIONS Maternity protection in French-speaking Switzerland's companies urgently requires improvement. In addition to the apparent need for stronger incentives and for monitoring of companies, our findings indicate a need to provide them with resources to meet OProMa's provisions.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Isabelle Probst
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Maria-Pia Politis Mercier
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Michela Zenoni
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Pascal Wild
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Research and Study Management Unit, INRS, Vandoeuvre les Nancy, France
| | - Brigitta Danuser
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Peggy Krief
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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15
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Francis F, Johnsunderraj SE, Divya KY, Raghavan D, Al-Furgani A, Bera LP, Abraham A. Ergonomic Stressors Among Pregnant Healthcare Workers: Impact on pregnancy outcomes and recommended safety practices. Sultan Qaboos Univ Med J 2021; 21:e172-e181. [PMID: 34221463 PMCID: PMC8219330 DOI: 10.18295/squmj.2021.21.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/01/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
Workplace environment can have a considerable impact on the physical, psychological and maternal health of pregnant healthcare workers. This article aimed to summarise the impact of work-related ergonomic stressors on pregnancy outcomes for healthcare workers, along with potential interventions to resolve these stressors. A narrative review analysis using the Pearl Growing Strategy was conducted between February 2019 and June 2020 to identify English-language articles published between 2000 and 2020. A total of 89 studies were identified from the SCOPUS (Elsevier, Amsterdam, Netherlands), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) databases and Google Scholar (Google LLC, Menlo Park, California, USA). The results indicated that poor work-related ergonomics had detrimental effects on pregnancy outcomes, resulting in spontaneous abortions, preterm delivery, low birth weight babies and infertility. Policymakers and employers should conduct ergonomic assessments and implement appropriate practices to ensure the safety of pregnant healthcare workers.
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Affiliation(s)
- Frincy Francis
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | | | - K. Y. Divya
- Department of Community & Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Divya Raghavan
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | - Atiya Al-Furgani
- Department of Maternal & Child Health, Sultan Qaboos University, Muscat, Oman
| | - Lily P. Bera
- Department of Maternal & Child Health, College of Nursing, All India Institute of Medical Sciences, Bhopal, India
| | - Aniamma Abraham
- Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
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Goin DE, Izano MA, Eick SM, Padula AM, DeMicco E, Woodruff TJ, Morello-Frosch R. Maternal Experience of Multiple Hardships and Fetal Growth: Extending Environmental Mixtures Methodology to Social Exposures. Epidemiology 2021; 32:18-26. [PMID: 33031217 PMCID: PMC7708528 DOI: 10.1097/ede.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women can be exposed to a multitude of hardships before and during pregnancy that may affect fetal growth, but previous approaches have not analyzed them jointly as social exposure mixtures. METHODS We evaluated the independent, mutually adjusted, and pairwise joint associations between self-reported hardships and birthweight for gestational age z-scores in the Chemicals in Our Bodies-2 prospective birth cohort (N = 510) using G-computation. We examined financial hardship, food insecurity, job strain, poor neighborhood environment, low community standing, caregiving, high burden of stressful life events, and unplanned pregnancy collected via questionnaire administered in the second trimester of pregnancy. We used propensity scores to ensure our analyses had sufficient data support and estimated absolute differences in outcomes. RESULTS Food insecurity was most strongly associated with reduced birthweight for gestational age z-scores individually, with an absolute difference of -0.16, 95% confidence interval (CI) -0.45, 0.14. We observed an unexpected increase in z-scores associated with poor perceived neighborhood environment (0.18, 95% CI -0.04, 0.41). Accounting for coexposures resulted in similar findings. The pairwise joint effects were strongest for food insecurity in combination with unplanned pregnancy (-0.45, 95% CI -0.93, 0.02) and stressful life events (-0.42, 95% CI -0.90, 0.05). Poor neighborhood environment in combination with caregiving was associated with an increase in z-scores (0.47, 95% CI -0.01, 0.95). CONCLUSIONS Our results are consistent with the hypothesis that experiencing food insecurity during pregnancy, alone and in combination with stressful life events and unplanned pregnancy, may affect fetal growth.
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Affiliation(s)
- Dana E. Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | | | - Stephanie M. Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Erin DeMicco
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management & School of Public Health, University of California, Berkeley
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Pregnancy and work stress: investigation of factors relating stress level of pregnant working women in Indonesia. GACETA SANITARIA 2021; 35 Suppl 1:S38-S41. [PMID: 33832622 DOI: 10.1016/j.gaceta.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors related to the stress levels among pregnant women in Indonesia. METHOD The study was used cross sectional design. The participants were 92 pregnant women who worked at a footwear manufacturer at Banten, Indonesia. Half of the participants worked less than 40h per week and the other half worked 40h or more per week. A test instrument to measure stress in pregnant women was developed and conducted in this study. Dependent and independent factors were analyzed by the chi-square test. RESULTS Our results showed that 59.78% of respondents had their gestational age was more than 31 weeks; 53.00% of workers experienced moderate stress; and as many 53.26% of respondents experienced a high workload. CONCLUSIONS Our conclusion confirmed gestational age, workload, and working time related with work stress level of pregnant women significantly.
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18
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Yaw AM, McLane-Svoboda AK, Hoffmann HM. Shiftwork and Light at Night Negatively Impact Molecular and Endocrine Timekeeping in the Female Reproductive Axis in Humans and Rodents. Int J Mol Sci 2020; 22:E324. [PMID: 33396885 PMCID: PMC7795361 DOI: 10.3390/ijms22010324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 01/17/2023] Open
Abstract
Shiftwork, including work that takes place at night (nightshift) and/or rotates between day and nightshifts, plays an important role in our society, but is associated with decreased health, including reproductive dysfunction. One key factor in shiftwork, exposure to light at night, has been identified as a likely contributor to the underlying health risks associated with shiftwork. Light at night disrupts the behavioral and molecular circadian timekeeping system, which is important for coordinated timing of physiological processes, causing mistimed hormone release and impaired physiological functions. This review focuses on the impact of shiftwork on reproductive function and pregnancy in women and laboratory rodents and potential underlying molecular mechanisms. We summarize the negative impact of shiftwork on female fertility and compare these findings to studies in rodent models of light shifts. Light-shift rodent models recapitulate several aspects of reproductive dysfunction found in shift workers, and their comparison with human studies can enable a deeper understanding of physiological and hormonal responses to light shifts and the underlying molecular mechanisms that may lead to reproductive disruption in human shift workers. The contributions of human and rodent studies are essential to identify the origins of impaired fertility in women employed in shiftwork.
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Affiliation(s)
| | | | - Hanne M. Hoffmann
- Department of Animal Science and the Reproductive and Developmental Science Program, Michigan State University, East Lansing, MI 48824, USA
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Nasiri K, Moodie EEM, Abenhaim HA. To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort. Am J Epidemiol 2020; 189:1360-1368. [PMID: 32285132 DOI: 10.1093/aje/kwaa054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Abstract
Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011-2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.
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Bagci S, Sabir H, Müller A, Reiter RJ. Effects of altered photoperiod due to COVID-19 lockdown on pregnant women and their fetuses. Chronobiol Int 2020; 37:961-973. [PMID: 32519912 DOI: 10.1080/07420528.2020.1772809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Maternal circadian rhythms provide highly important input into the entrainment and programming of fetal and newborn circadian rhythms. The light-dark cycle is an important regulator of the internal biological clock. Even though pregnant women spend a greater part of the day at home during the latter stages of pregnancy, natural light exposure is crucial for the fetus. The current recommended COVID-19 lockdown might dramatically alter normal environmental lighting conditions of pregnant women, resulting in exposure to extremely low levels of natural daylight and high-intensity artificial light sources during both day and night. This article summarizes the potential effects on pregnant woman and their fetuses due to prolonged exposure to altered photoperiod and as consequence altered circadian system, known as chronodisruption, that may result from the COVID-19 lockdown.
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Affiliation(s)
- S Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - H Sabir
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - A Müller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - R J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio , San Antonio, Texas, USA
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Abderhalden-Zellweger A, Probst I, Politis Mercier MP, Danuser B, Wild P, Krief P. Implementation of maternity protection legislation: Gynecologists' perceptions and practices in French-speaking Switzerland. PLoS One 2020; 15:e0231858. [PMID: 32353865 PMCID: PMC7192633 DOI: 10.1371/journal.pone.0231858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 04/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background In several countries, maternity protection legislations (MPL) confer an essential role to gynecologist-obstetricians (OBGYNs) for the protection of pregnant workers and their future children from occupational exposures. This study explores OBGYNs’ practices and difficulties in implementing MPL in the French-speaking part of Switzerland. Methods An online survey was sent to 333 OBGYNs. Data analysis included: 1) descriptive and correlational statistics and 2) hierarchical cluster analysis to identify patterns of practices. Results OBGYNs evoked several problems in MPL implementation: absence of risk analysis in the companies, difficult collaboration with employers, lack of competencies in the field of occupational health. Preventive leave was underused, with sick leave being prescribed instead. Training had a positive effect on OBGYNs’ knowledge and implementation of MPL. Hierarchical cluster analysis highlighted three main types of practices: 1) practice in line with legislation; 2) practice on a case-by-case basis; 3) limited practice. OBGYNs with good knowledge of MPL more consistently applied its provisions. Conclusion The implementation of MPL appears challenging for OBGYNs. Collaboration with occupational physicians and training might help OBGYNs to better take on their role in maternity protection. MPL in itself could be improved.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Epalinges, Switzerland
- * E-mail:
| | - Isabelle Probst
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Maria-Pia Politis Mercier
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Brigitta Danuser
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Epalinges, Switzerland
| | - Pascal Wild
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Epalinges, Switzerland
- INRS Research and Studies Management, Vandoeuvre les Nancy, France
| | - Peggy Krief
- Occupational Health and Environment Department (OHED), Center for Primary Care and Public Health (Unisanté), Epalinges, Switzerland
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Accommodating pregnancy and parental leave for the emergency physician: An update. CAN J EMERG MED 2020; 22:277-279. [PMID: 32188527 DOI: 10.1017/cem.2019.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Croteau A. Occupational lifting and adverse pregnancy outcome: a systematic review and meta-analysis. Occup Environ Med 2020; 77:496-505. [DOI: 10.1136/oemed-2019-106334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022]
Abstract
This systematic review was conducted to help clarify the effect of lifting at work on pregnancy outcome, by focusing on specific exposure categories. A search in Medline and Embase identified 51 articles reporting association of spontaneous abortion (SA), preterm delivery (PTD) or small-for-gestational-age (SGA) infant with exposure to occupational lifting. A global validity score was assigned to each study and six potential sources of bias were considered in sensitivity analyses. For each exposure–outcome combination, a summary risk estimate (RE) was obtained from all studies and from a subset of studies with high validity score, this latter summary RE was selected as a final result. Statistical heterogeneity was measured with I2 and Q tests and the possibility of a publication bias was also assessed. For each meta-analysis, the strength of evidence was established from explicit criteria. Heavy (or ≥10 kg) loads often (or ≥10x/day) lifted were associated with increased risks of SA (summary RE=1.31, 95% CI 1.17 to 1.47) and PTD (summary RE=1.24, 95% CI 1.07 to 1.43), with good strength of evidence. No association was identified with SGA, nor with lower exposure levels and SA or PTD. These results are reassuring for lower levels of exposure; however, observed associations can guide health professionals’ recommendations aimed at the prevention of SA and PTD for pregnant women who frequently lift (or ≥10x/day) heavy (or ≥10 kg) loads at work.Résumé
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Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2020; 222:224-238. [PMID: 31550447 DOI: 10.1016/j.ajog.2019.08.059] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Data: An increasing number of studies suggest that exposure to physically demanding work during pregnancy could be associated with increased risks of adverse pregnancy outcomes, but the results remain conflicted and inconclusive. The purpose of this study was to examine the influence of occupational activities during pregnancy on maternal and fetal health outcomes. STUDY Studies of all designs (except case studies and reviews) that contained information on the relevant population (women who engaged in paid work during pregnancy), occupational exposures (heavy lifting, prolonged standing, prolonged walking, prolonged bending, and heavy physical workload), comparator (no exposure to the listed physical work demands), and outcomes (preterm birth, low birthweight, small for gestational age, miscarriage, gestational hypertension, preeclampsia, gestational diabetes mellitus, stillbirth, and intrauterine growth restriction) were included. STUDY APPRAISAL AND SYNTHESIS METHODS Five electronic databases and 3 gray literature sources were searched up to March 15, 2019. RESULTS Eighty observational studies (N=853,149) were included. Low-to-very low certainty evidence revealed that lifting objects ≥11 kg was associated with an increased odds ratio of miscarriage (odds ratio, 1.31; 95% confidence interval, 1.08-1.58; I2=79%), and preeclampsia (odds ratio, 1.35; 95% confidence interval, 1.07-1.71; I2=0%). Lifting objects for a combined weight of ≥100 kg per day was associated with an increased odds of preterm delivery (odds ratio, 1.31; 95% confidence interval, 1.11-1.56; I2=0%) and having a low birthweight neonate (odds ratio, 2.08; 95% confidence interval, 1.06-4.11; I2=73%). Prolonged standing was associated with increased odds of preterm delivery (odds ratio, 1.11; 95% confidence interval, 1.02-1.22; I2=30%) and having a small-for-gestational-age neonate (odds ratio, 1.17; 95% confidence interval, 1.01-1.35; I2=41%). A heavy physical workload was associated with increased odds of preterm delivery (odds ratio, 1.23; 95% confidence interval, 1.07-1.41; I2=32%) and having a low birthweight neonate (odds ratio, 1.79; 95% confidence interval, 1.11-2.87; I2=87%). All other associations were not statistically significant. Dose-response analysis showed women stand for >2.5 hours per day (vs no standing) had a 10% increase in the odds of having a preterm delivery. CONCLUSION Physically demanding work during pregnancy is associated with an increased risk of adverse pregnancy outcomes.
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The ARTEMIS Center: An Environmental Health Prevention Platform Dedicated to Reproduction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030694. [PMID: 31973110 PMCID: PMC7038129 DOI: 10.3390/ijerph17030694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 11/17/2022]
Abstract
In France, a new approach is being developed through the ARTEMIS Center, which is a prevention platform for environmental health dedicated to reproduction. The objective is to describe the clinical management of patients in the ARTEMIS center. Couples with a condition affecting reproduction are referred to the ARTEMIS center. Management includes a medical consultation and a standardized interview. Current exposure is assessed by a questionnaire that includes exposure circumstances to reproductive risk factor and on the basis of which it is possible to implement preventive action in clinical practice without prejudging the role of such exposure in the onset of disease. From 16 February 2016 to 2 May 2019, 779 patients were seen in the ARTEMIS center. On the day of the consultation, 88.3% men and 72.2% women were employed. Among employed men, 61.5% had at least one instance of occupational exposure to a reproductive risk factor, and among employed women, 57.8%. The main nonprofessional circumstances of exposure identified were proximity of the residence to an agricultural area (35.3%) and domestic pesticide exposure (79.7%). The preventive actions implemented by the ARTEMIS center are targeted to the individual practices of patients. However, patient care also allows their physicians to become familiarized with environmental health.
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Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:563-576. [PMID: 31276631 DOI: 10.1016/j.ajog.2019.06.051] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUD An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse pregnancy outcomes, but the results remain conflicting and inconclusive. OBJECTIVE To examine the influences of shift work and longer working hours during pregnancy on maternal and fetal health outcomes. DATA SOURCES Five electronic databases and 3 gray literature sources were searched up to March 15, 2019. METHODS OF STUDY SELECTION Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy); exposure (rotating shift work [shifts change according to a set schedule], fixed night shift [typical working period is between 11:00 pm and 11:00 am] or longer working hours [>40 hours per week]);comparator (fixed day shift [typical working period is between 8:00 am and 6:00 pm] or standard working hours [≤40 hours per week]); and outcomes (preterm delivery, low birthweight [birthweight <2500 g], small for gestational age, miscarriage, gestational hypertension, preeclampsia, intrauterine growth restriction, stillbirth, and gestational diabetes mellitus). TABULATION, INTEGRATION, AND RESULTS From 3305 unique citations, 62 observational studies (196,989 women) were included. "Low" to "very low" certainty evidence from these studies revealed that working rotating shifts was associated with an increased odds of preterm delivery (odds ratio, 1.13; 95% confidence interval, 1.00-1.28, I2 = 31%), an infant small for gestational age (odds ratio, 1.18, 95% confidence interval, 1.01-1.38, I2 = 0%), preeclampsia (odds ratio, 1.75, 95% confidence interval, 1.01-3.01, I2 = 75%), and gestational hypertension (odds ratio, 1.19, 95% confidence interval, 1.10-1.29, I2 = 0%), compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased odds of preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; I2 = 36%) and miscarriage (odds ratio, 1.23; 95% confidence interval, 1.03-1.47; I2 = 37%). Compared with standard hours, working longer hours was associated with an increased odds of miscarriage (odds ratio, 1.38; 95% confidence interval, 1.08-1.77; I2 = 73%), preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; I2 = 30%), an infant of low birthweight (odds ratio, 1.43; 95% confidence interval, 1.11-1.84; I2 = 0%), or an infant small for gestational age (odds ratio, 1.16, 95% confidence interval, 1.00-1.36, I2 = 57%). Dose-response analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the odds of having a preterm delivery. CONCLUSION Pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.
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Reproductive health problems among female shift workers: A qualitative study in Iran. J Gynecol Obstet Hum Reprod 2019; 49:101653. [PMID: 31760178 DOI: 10.1016/j.jogoh.2019.101653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/22/2019] [Accepted: 11/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Shift work (i.e. working between 18:00 and 07:00) is associated with sleeplessness and fatigue and hence, can cause female shift workers different health problems. This study aimed to explore reproductive health problems among female shift workers. MATERIALS AND METHODS This qualitative study was conducted in Amol and Babol cities, Iran, on 19 female shift workers with previous history of pregnancy and breastfeeding. Participants were selected purposively and with maximum variation respecting their age, work experience, educational level, and financial and employment status. Face-to-face semi-structured interviews were held for data collection and conventional qualitative content analysis was employed for data analysis. RESULTS Female shift workers' reproductive health problems were categorized into fourteen subcategories and the five main categories of conflict between pregnancy and shift work, breastfeeding-related challenges, impaired sexual relationships, childbearing limitations, and gynecological problems. CONCLUSION Impaired sexual problems are the most significant reproductive health problem among female shift workers. Their reproductive health can be promoted through periodical reproductive health assessments by midwives, reproductive health specialists, psychologists, and gynecologists.
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Nehme PA, Amaral F, Lowden A, Skene DJ, Cipolla-Neto J, Moreno CRC. Reduced melatonin synthesis in pregnant night workers: Metabolic implications for offspring. Med Hypotheses 2019; 132:109353. [PMID: 31421432 DOI: 10.1016/j.mehy.2019.109353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
Several novel animal studies have shown that intrauterine metabolic programming can be modified in the event of reduced melatonin synthesis during pregnancy, leading to glucose intolerance and insulin resistance in the offspring. It is therefore postulated that female night workers when pregnant may expose the offspring to unwanted health threats. This may be explained by the fact that melatonin is essential for regulating energy metabolism and can influence reproductive activity. Moreover, the circadian misalignment caused by shift work affects fertility and the fetus, increasing the risk of miscarriage, premature birth and low birth weight, phenomena observed in night workers. Thus, we hypothesize that light-induced melatonin suppression as a result of night work may alter intrauterine metabolic programming in pregnant women, potentially leading to metabolic disorders in their offspring.
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Affiliation(s)
- P A Nehme
- School of Public Health, University of São Paulo, Brazil
| | - F Amaral
- Department of Physiology, Federal University of São Paulo, Brazil
| | - A Lowden
- Stress Research Institute, University of Stockholm, Sweden
| | - D J Skene
- Faculty of Health and Medical Sciences, University of Surrey, UK
| | - J Cipolla-Neto
- Department of Physiology and Biophysics Neurobiology Lab, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - C R C Moreno
- School of Public Health, University of São Paulo, Brazil; Stress Research Institute, University of Stockholm, Sweden.
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van Beukering M, Velu A, van den Berg L, Kok M, Mol BW, Frings-Dresen M, de Leeuw R, van der Post J, Peute L. Usability and Usefulness of a Mobile Health App for Pregnancy-Related Work Advice: Mixed-Methods Approach. JMIR Mhealth Uhealth 2019; 7:e11442. [PMID: 31094353 PMCID: PMC6532337 DOI: 10.2196/11442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/14/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023] Open
Abstract
Background Pregnant women are often unaware of the potential risks that working conditions can cause to them and their unborn child. A mobile health (mHealth) app, the Pregnancy and Work (P and W) app, developed by a multidisciplinary team and based on an evidence-based guideline for occupational physicians, aims to provide advice on work adjustment during pregnancy. Objective This study evaluates the usability of the mHealth P and W app and the perceived usefulness of the work advice, the main goal of the app, by potential end users. Methods A total of 12 working pregnant women participated in think aloud usability sessions and performed 9 tasks. All think aloud sessions were recorded, transcribed, and coanalyzed. The usability problems were rated for their severity in accordance with Nielsen severity scale. The completion rates and time taken for completion of tasks were registered. In addition, participants were questioned on demographics and user characteristics and were asked to evaluate the value of the app by filling in the Intrinsic Motivation Inventory (IMI) score and the System Usability Scale (SUS) questionnaire. Results In total, 82 usability problems with a severity ≥1 were identified, of which 40 had severity ≥3. The main usability problems concerned the interpretation of terminology used in the app’s questionnaires and difficulties in finding and understanding the work advice. Furthermore, 10 out of 12 participants were able to open the work advice page in the app. Only 7 out of these 10 participants understood and intended to follow the work advice. The overall mean IMI score was relatively high (5 out of 7), indicating that the participants did indeed value the use of the app. This IMI score corresponded to the overall mean SUS score (68 out of 100) and the mean grade given to the P and W app (7 out of 10). Conclusions This think aloud usability study showed that the information provided in the P and W app was considered valuable by the end users, working pregnant women, and it meets their needs; however, usability issues severely impacted the perceived usefulness of the work advice given in the app.
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Affiliation(s)
- Monique van Beukering
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adeline Velu
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Liesbeth van den Berg
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Monique Frings-Dresen
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joris van der Post
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Peute
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Selander J, Rylander L, Albin M, Rosenhall U, Lewné M, Gustavsson P. Full-time exposure to occupational noise during pregnancy was associated with reduced birth weight in a nationwide cohort study of Swedish women. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 651:1137-1143. [PMID: 30360245 DOI: 10.1016/j.scitotenv.2018.09.212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/30/2018] [Accepted: 09/16/2018] [Indexed: 06/08/2023]
Abstract
Noise is a common exposure in the occupational work environment. Earlier studies of occupational noise and pregnancy outcome are few and show mixed results. To investigate if objectively assessed exposure to occupational noise during pregnancy is associated with reduced intrauterine growth and/or preterm birth a nationwide cohort study of 857,010 single births was initiated. Individual information on occupation and risk factors was retrieved from prenatal care interviews at pregnancy week 10. Occupational noise was classified into three exposure categories <75, 75-85, >85 dBA by a job exposure matrix. Odds ratios were adjusted for BMI, smoking, parity, education, physically strenuous work and low job control. Exposure to high (>85 dBA) levels of occupational noise throughout the pregnancy (full time workers) was associated with an increased risk of the child being born small for gestational age, OR 1.44 (95% CI 1.01 to 2.03) compared to noise exposure <75 dBA. A similar increase was seen for low birth weight OR 1.36 (95% CI 1.03 to 1.80) for high levels of noise. No clear association was seen for preterm birth. No consistent effects on birth outcome was observed in women who had worked part-time or were on leave of absence >21 days (median). In summary, full-time exposure to high levels of noise during pregnancy was associated with a slightly reduced fetal growth but not with preterm birth. The effect of intermediate occupational noise exposure (75-85 dBA) showed a small, but statistically increased risk for all studied birth outcomes. The study strengthens the evidence that pregnant women should not be long-term exposed to high levels >85 dBA of occupational noise during pregnancy. Intermediate exposure should be studied further.
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Affiliation(s)
- Jenny Selander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Ulf Rosenhall
- Unit of Audiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Habilitation & Health, Audiology Department, Region Västra Götaland, Sweden
| | - Marie Lewné
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Gatford KL, Kennaway DJ, Liu H, Kleemann DO, Kuchel TR, Varcoe TJ. Simulated shift work disrupts maternal circadian rhythms and metabolism, and increases gestation length in sheep. J Physiol 2019; 597:1889-1904. [PMID: 30671970 DOI: 10.1113/jp277186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/03/2019] [Indexed: 12/19/2022] Open
Abstract
KEY POINTS Shift work impairs metabolic health, although its effects during pregnancy are not well understood We evaluated the effects of a simulated shift work protocol for one-third, two-thirds or all of pregnancy on maternal and pregnancy outcomes in sheep. Simulated shift work changed the timing of activity, disrupted hormonal and cellular rhythms, and impaired maternal glucose tolerance during early pregnancy. Gestation length was increased in twin pregnancies, whereas singleton lambs were lighter at a given gestational age if mothers were subjected to shift work conditions in the first one-third of pregnancy. Exposure to rotating night and day shifts, even if only in early pregnancy, may adversely affect maternal metabolic and pregnancy outcomes. ABSTRACT Shift workers are at increased risk of developing type 2 diabetes and obesity; however, the impact during pregnancy on maternal metabolism is unknown. Using a large animal model, we assessed the impact of simulated shift work (SSW) exposure during pregnancy on maternal circadian rhythms, glucose tolerance and pregnancy outcomes. Following mating, ewes were randomly allocated to a control photoperiod (CON 12 h light, 12 h dark) or to SSW, where the timing of light exposure and food presentation was reversed twice each week for one-third, two-thirds or all of pregnancy. Maternal behaviour followed SSW cycles with increased activity during light exposure and feeding. Melatonin rhythms resynchronized within 2 days of the photoperiod shift, whereas peripheral circadian rhythms were arrhythmic. SSW impaired glucose tolerance (+29%, P = 0.019) and increased glucose-stimulated insulin secretion (+32%, P = 0.018) in ewes with a singleton fetus in early but not late gestation. SSW exposure did not alter rates of miscarriage or stillbirth, although it extended gestation length in twin pregnancies (+2.4 days, P = 0.032). Relative to gestational age, birth weight was lower in singleton progeny of SSW than CON ewes (-476 g, P = 0.016). These results have implications for the large number of women currently engaged in shift work, and further studies are required to determine progeny health impacts.
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Affiliation(s)
- Kathryn L Gatford
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - David J Kennaway
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Hong Liu
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - David O Kleemann
- Turretfield Research Centre, South Australian Research and Development Institute, Rosedale, SA, Australia
| | - Timothy R Kuchel
- Preclinical Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains, SA, Australia
| | - Tamara J Varcoe
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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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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Mendez N, Torres-Farfan C, Salazar E, Bascur P, Bastidas C, Vergara K, Spichiger C, Halabi D, Vio CP, Richter HG. Fetal Programming of Renal Dysfunction and High Blood Pressure by Chronodisruption. Front Endocrinol (Lausanne) 2019; 10:362. [PMID: 31244775 PMCID: PMC6563621 DOI: 10.3389/fendo.2019.00362] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
Abstract
Adverse prenatal conditions are known to impose significant trade-offs impinging on health and disease balance during adult life. Among several deleterious factors associated with complicated pregnancy, alteration of the gestational photoperiod remains largely unknown. Previously, we reported that prenatal manipulation of the photoperiod has adverse effects on the mother, fetus, and adult offspring; including cardiac hypertrophy. Here, we investigated whether chronic photoperiod shifting (CPS) during gestation may program adult renal function and blood pressure regulation. To this end, pregnant rats were subjected to CPS throughout pregnancy to evaluate the renal effects on the fetus and adult offspring. In the kidney at 18 days of gestation, both clock and clock-controlled gene expression did not display a daily pattern, although there were recurrent weaves of transcriptional activity along the 24 h in the control group. Using DNA microarray, significant differential expression was found for 1,703 transcripts in CPS relative to control fetal kidney (835 up-regulated and 868 down-regulated). Functional genomics assessment revealed alteration of diverse gene networks in the CPS fetal kidney, including regulation of transcription, aldosterone-regulated Na+ reabsorption and connective tissue differentiation. In adult offspring at 90 days of age, circulating proinflammatory cytokines IL-1β and IL-6 were increased under CPS conditions. In these individuals, CPS did not modify kidney clock gene expression but had effects on different genes with specific functions in the nephron. Next, we evaluated several renal markers and the response of blood pressure to 4%NaCl in the diet for 4 weeks (i.e., at 150 days of age). CPS animals displayed elevated systolic blood pressure in basal conditions that remained elevated in response to 4%NaCl, relative to control conditions. At this age, CPS modified the expression of Nhe3, Ncc, Atp1a1, Nr3c1 (glucocorticoid receptor), and Nr3c2 (mineralocorticoid receptor); while Nkcc, Col3A1, and Opn were modified in the CPS 4%+NaCl group. Furthermore, CPS decreased protein expression of Kallikrein and COX-2, both involved in sodium handling. In conclusion, gestational chronodisruption programs kidney dysfunction at different levels, conceivably underlying the prehypertensive phenotype observed in the adult CPS offspring.
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Affiliation(s)
- Natalia Mendez
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Claudia Torres-Farfan
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
- Centro Interdisciplinario de Estudios del Sistema Nervioso, Universidad Austral de Chile, Valdivia, Chile
| | - Esteban Salazar
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Pía Bascur
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Carla Bastidas
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Karina Vergara
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos Spichiger
- Faculty of Sciences, Institute of Biochemistry and Microbiology, Universidad Austral de Chile, Valdivia, Chile
| | - Diego Halabi
- Faculty of Medicine, School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos P. Vio
- Center of Aging and Regeneration CARE, Department of Physiology, Pontificia Universidad Católica de Chile, Valdivia, Chile
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Santiago, Chile
| | - Hans G. Richter
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology, and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
- *Correspondence: Hans G. Richter
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Sletten J, Cornelissen G, Assmus J, Kiserud T, Albrechtsen S, Kessler J. Maternal exercise, season and sex modify the daily fetal heart rate rhythm. Acta Physiol (Oxf) 2018; 224:e13093. [PMID: 29754451 DOI: 10.1111/apha.13093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Abstract
AIM The knowledge on biological rhythms is rapidly expanding. We aimed to define the longitudinal development of the daily (24-hour) fetal heart rate rhythm in an unrestricted, out-of-hospital setting and to examine the effects of maternal physical activity, season and fetal sex. METHODS We recruited 48 women with low-risk singleton pregnancies. Using a portable monitor for continuous fetal electrocardiography, fetal heart rate recordings were obtained around gestational weeks 24, 28, 32 and 36. Daily rhythms in fetal heart rate and fetal heart rate variation were detected by cosinor analysis; developmental trends were calculated by population-mean cosinor and multilevel analysis. RESULTS For the fetal heart rate and fetal heart rate variation, a significant daily rhythm was present in 122/123 (99.2%) and 116/121 (95.9%) of the individual recordings respectively. The rhythms were best described by combining cosine waves with periods of 24 and 8 hours. With increasing gestational age, the magnitude of the fetal heart rate rhythm increased, and the peak of the fetal heart rate variation rhythm shifted from a mean of 14:25 (24 weeks) to 20:52 (36 weeks). With advancing gestation, the rhythm-adjusted mean value of the fetal heart rate decreased linearly in females (P < .001) and nonlinearly in males (quadratic function, P = .001). At 32 and 36 weeks, interindividual rhythm diversity was found in male fetuses during higher maternal physical activity and during the summer season. CONCLUSION The dynamic development of the daily fetal heart rate rhythm during the second half of pregnancy is modified by fetal sex, maternal physical activity and season.
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Affiliation(s)
- J Sletten
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - G Cornelissen
- Department of Integrative Biology and Physiology, Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
| | - J Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - T Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - S Albrechtsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - J Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Salazar ER, Richter HG, Spichiger C, Mendez N, Halabi D, Vergara K, Alonso IP, Corvalán FA, Azpeleta C, Seron-Ferre M, Torres-Farfan C. Gestational chronodisruption leads to persistent changes in the rat fetal and adult adrenal clock and function. J Physiol 2018; 596:5839-5857. [PMID: 30118176 DOI: 10.1113/jp276083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Here we explored the developmental impact of gestational chronodisruption (chronic photoperiod shift, CPS) on adult and fetal adrenal biorhythms and function. We found that gestational chronodisruption altered fetal and adult adrenal function, at the molecular, morphological and physiological levels. The differences between control and CPS offspring suggest desynchronization of the adrenal circadian clock and steroidogenic pathway, leading to abnormal stress responses and metabolic adaptation, potentially increasing the risk of developing chronic diseases. ABSTRACT Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Indeed, an abnormal photoperiod during gestation alters fetal development, inducing long-term effects on the offspring. Accordingly, we carried out a longitudinal study in rats, exploring the impact of gestational chronodisruption on the adrenal biorhythms and function of the offspring. Adult rats (90 days old) gestated under chronic photoperiod shift (CPS) decrease the time spent in the open arm zone of an elevated plus maze to 62% and increase the rearing time to 170%. CPS adults maintained individual daily changes in corticosterone, but their acrophases were distributed from 12.00 h to 06.00 h. CPS offspring maintained clock gene expression and oscillation, nevertheless no daily rhythm was observed in genes involved in the regulation and synthesis of steroids. Consistent with adult adrenal gland being programmed during fetal life, blunted daily rhythms of corticosterone, core clock gene machinery, and steroidogenic genes were observed in CPS fetal adrenal glands. Comparisons of the global transcriptome of CPS versus control fetal adrenal gland revealed that 1078 genes were differentially expressed (641 down-regulated and 437 up-regulated). In silico analysis revealed significant changes in Lipid Metabolism, Small Molecule Biochemistry, Cellular Development and the Inflammatory Response pathway (z score: 48-20). Altogether, the present results demonstrate that gestational chronodisruption changed fetal and adult adrenal function. This could translate to long-term abnormal stress responses and metabolic adaptation, increasing the risk of developing chronic diseases.
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Affiliation(s)
- E R Salazar
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - H G Richter
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - C Spichiger
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - N Mendez
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - D Halabi
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - K Vergara
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - I P Alonso
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - F A Corvalán
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - C Azpeleta
- Department of Basic Biomedical Sciences, Faculty of Biomedical Sciences and Health, European University of Madrid, Villaviciosa de Odón, Spain
| | - M Seron-Ferre
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C Torres-Farfan
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Centro Interdisciplinario de Estudios del Sistema Nervioso (CISNe), Universidad Austral de Chile, Valdivia, Chile
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Developmental Programming of Capuchin Monkey Adrenal Dysfunction by Gestational Chronodisruption. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9183053. [PMID: 30186871 PMCID: PMC6109991 DOI: 10.1155/2018/9183053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/14/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022]
Abstract
In the capuchin monkey (Cebus apella), a new-world nonhuman primate, maternal exposure to constant light during last third of gestation induces precocious maturation of the fetal adrenal and increased plasma cortisol in the newborn. Here, we further explored the effects of this challenge on the developmental programming of adrenal function in newborn and infant capuchin monkeys. We measured (i) plasma dehydroepiandrosterone sulphate (DHAS) and cortisol response to ACTH in infants with suppressed endogenous ACTH, (ii) plasma DHAS and cortisol response to ACTH in vitro, and (iii) adrenal weight and expression level of key factors in steroid synthesis (StAR and 3β-HSD). In one-month-old infants from mothers subjected to constant light, plasma levels of cortisol and cortisol response to ACTH were twofold higher, whereas plasma levels of DHAS and DHAS response to ACTH were markedly reduced, compared to control conditions. At 10 months of age, DHAS levels were still lower but closer to control animals, whereas cortisol response to ACTH was similar in both experimental groups. A compensatory response was detected at the adrenal level, consisting of a 30% increase in adrenal weight and about 50% reduction of both StAR and 3β-HSD mRNA and protein expression and the magnitude of DHAS and cortisol response to ACTH in vitro. Hence, at birth and at 10 months of age, there were differential effects in DHAS, cortisol production, and their response to ACTH. However, by 10 months of age, these subsided, leading to a normal cortisol response to ACTH. These compensatory mechanisms may help to overcome the adrenal alterations induced during pregnancy to restore normal cortisol concentrations in the growing infant.
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Probst I, Zellweger A, Politis Mercier MP, Danuser B, Krief P. Implementation, mechanisms and effects of maternity protection legislation: a realist narrative review of the literature. Int Arch Occup Environ Health 2018; 91:901-922. [DOI: 10.1007/s00420-018-1339-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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Association of Birthweight With Maternal Trajectories of Effort-Reward Imbalance and Demand-Control Across Pregnancy. J Occup Environ Med 2018; 59:169-176. [PMID: 28002356 DOI: 10.1097/jom.0000000000000932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We assessed longitudinal patterns of effort-reward imbalance (ERI) and demand-control (DC) scores in pregnancy, and their association with newborn birthweight (BW). METHODS Sixty-one women were surveyed four times across pregnancy using the ERI and DC questionnaires. Trajectories of change in ERI and DC scores across pregnancy were constructed using growth mixture modeling, and their associations with BW were examined with generalized linear regression. RESULTS Declining ERI (diminishing effort with stable/increasing reward) was associated with higher BW (408 g; P = 0.015), and was robust to other work factors. DC trajectory was not significantly associated with BW. CONCLUSIONS Declining ERI may reflect improved work psychosocial climate across pregnancy, or a conscious reduction in effort. The ERI model may represent more flexible work characteristics, whereas job control may be less amenable to short-term alteration. Surveys in more diverse pregnant working populations could be recommended.
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Longitudinal Assessment of Effort-Reward Imbalance and Job Strain Across Pregnancy: A Preliminary Study. Matern Child Health J 2017; 20:1366-74. [PMID: 26948376 DOI: 10.1007/s10995-016-1933-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess longitudinal changes in occupational effort-reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy. METHODS A pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models. RESULTS ERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (b = 8.8; p < 0.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment. CONCLUSIONS Self-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes.
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Man GCW, Zhang T, Chen X, Wang J, Wu F, Liu Y, Wang CC, Cheong Y, Li TC. The regulations and role of circadian clock and melatonin in uterine receptivity and pregnancy-An immunological perspective. Am J Reprod Immunol 2017; 78. [DOI: 10.1111/aji.12715] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/04/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gene Chi Wai Man
- Department of Orthopaedics and Traumatology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Tao Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Jianzhang Wang
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Fangrong Wu
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
- Li Ka Shing Institute of Health Sciences; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
- School of Biomedical Sciences; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
| | - Ying Cheong
- Human Development and Health; Princess Anne Hospital; University of Southampton Faculty of Medicine; Southampton UK
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology; Faculty of Medicine; The Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong SAR
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Physical and Organizational Job Stressors in Pregnancy and Associations With Primary Cesarean Deliveries. J Occup Environ Med 2017; 59:571-577. [DOI: 10.1097/jom.0000000000001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua. Vaccine 2017; 35:3056-3063. [PMID: 28465095 PMCID: PMC5439533 DOI: 10.1016/j.vaccine.2017.04.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 01/12/2023]
Abstract
Background: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua. Methods: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM). Results: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75–0.99 and aOR: 0.66; 95% CI: 0.45–0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64–0.97). Conclusions: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.
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Lee LJ, Symanski E, Lupo PJ, Tinker SC, Razzaghi H, Chan W, Hoyt AT, Canfield MA. Role of maternal occupational physical activity and psychosocial stressors on adverse birth outcomes. Occup Environ Med 2017; 74:192-199. [PMID: 27919059 PMCID: PMC5394923 DOI: 10.1136/oemed-2016-103715] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association of an array of estimated maternal occupational physical activities and psychosocial stressors during pregnancy with odds for preterm birth (PTB) and small-for-gestational age (SGA). METHODS Data for infants born without major birth defects delivered from 1997 to 2009 whose mothers reported working at least 1 month during pregnancy were obtained from the National Birth Defects Prevention Study. We linked occupational codes to the US Department of Labor's Occupational Information Network, which provides estimates of exposure for multiple domains of physical activity and psychosocial stressors by occupational categories. We conducted factor analysis using principal components extraction with 17 occupational activities and calculated factor scores. ORs for PTB and SGA across quartiles of factor scores in each trimester were computed using logistic regression. RESULTS Factor analysis grouped occupational domains into 4 groups based on factor loadings. These groups were 'occupational physical activity', 'interpersonal stressor', 'automated work' and 'job responsibility'. High levels of 'occupational physical activity' were significantly associated with SGA (adjusted OR (AOR) for highest quartile compared with lowest quartile of factor score: 1.36; 95% CIs 1.02 to 1.82; p for trend=0.001) and were also positively associated with PTB (AOR: 1.24; 95% CI 0.93 to 1.64; p for trend=0.01). No clear results were observed across domains of psychosocial stressors. CONCLUSIONS Our findings expand understanding of associations between occupational physical activity and psychosocial stressors and PTB and SGA and suggest that additional research is needed to further examine these relationships.
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Affiliation(s)
- Laura J Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, USA
- Southwest Center for Occupational and Environmental Health, Houston, Texas, USA
| | - Elaine Symanski
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, USA
- Southwest Center for Occupational and Environmental Health, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology–Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilda Razzaghi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wenyaw Chan
- Department of Biostatistics, UTHealth School of Public Health, Houston, Texas, USA
| | - Adrienne T Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
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Mendez N, Halabi D, Spichiger C, Salazar ER, Vergara K, Alonso-Vasquez P, Carmona P, Sarmiento JM, Richter HG, Seron-Ferre M, Torres-Farfan C. Gestational Chronodisruption Impairs Circadian Physiology in Rat Male Offspring, Increasing the Risk of Chronic Disease. Endocrinology 2016; 157:4654-4668. [PMID: 27802074 DOI: 10.1210/en.2016-1282] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic exposure to light at night, as in shift work, alters biological clocks (chronodisruption), negatively impacting pregnancy outcome in humans. Actually the interaction of maternal and fetal circadian systems could be a key factor determining a fitting health in adults. We propose that chronic photoperiod shift (CPS) during pregnancy alter maternal circadian rhythms and impair circadian physiology in the adult offspring, increasing health risks. Pregnant rats were exposed to normal photoperiod (12 h light, 12 h dark) or to CPS until 85% of gestation. The effects of gestational CPS were evaluated on the mother and adult offspring. In the mother we measured rhythms of heart rate, body temperature, and activity through gestation and daily rhythms of plasma variables (melatonin, corticosterone, aldosterone, and markers of renal function) at 18 days of gestation. In adult offspring, we measured rhythms of the clock gene expression in the suprachiasmatic nucleus (SCN), locomotor activity, body temperature, heart rate, blood pressure, plasma variables, glucose tolerance, and corticosterone response to ACTH. CPS altered all maternal circadian rhythms, lengthened gestation, and increased newborn weight. The adult CPS offspring presented normal rhythms of clock gene expression in the SCN, locomotor activity, and body temperature. However, the daily rhythm of plasma melatonin was absent, and corticosterone, aldosterone, renal markers, blood pressure, and heart rate rhythms were altered. Moreover, CPS offspring presented decreased glucose tolerance and an abnormal corticosterone response to ACTH. Altogether these data show that gestational CPS induced long-term effects on the offspring circadian system, wherein a normal SCN coexists with altered endocrine, cardiovascular, and metabolic function.
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Affiliation(s)
- Natalia Mendez
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Diego Halabi
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Carlos Spichiger
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Esteban R Salazar
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Karina Vergara
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Pamela Alonso-Vasquez
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Pamela Carmona
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Jose M Sarmiento
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Hans G Richter
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Maria Seron-Ferre
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
| | - Claudia Torres-Farfan
- Laboratory of Developmental Chronobiology (N.M., D.H., C.S., E.R.S., K.V., P.A.-V., H.G.R., C.T.-F.), Institute of Anatomy, Histology, and Pathology and Institute of Physiology (P.C., J.M.S.), Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile; and Laboratorio de Cronobiología (M.S.-F.), Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, 6640750 Santiago, Chile
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Guendelman S, Gemmill A, MacDonald LA. Biomechanical and organisational stressors and associations with employment withdrawal among pregnant workers: evidence and implications. ERGONOMICS 2016; 59:1613-1624. [PMID: 27119569 DOI: 10.1080/00140139.2016.1157627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
The distribution of exposure to biomechanical and organisational job stressors (BOJS) and associations with employment withdrawal (antenatal leave, unemployment) was examined in a case-control study of 1114 pregnant workers in California. We performed descriptive and multivariate logistic and multinomial regression analyses. At pregnancy onset, 57% were exposed to one or more biomechanical stressors, including frequent bending, heavy lifting and prolonged standing. One-third were simultaneously exposed to BOJS. Exposure to biomechanical stressors declined as pregnancy progressed and cessation often (41%) coincided with employment withdrawal (antenatal leave and unemployment). In multivariate modelling, whether we adjusted for or considered organisational stressors as coincident exposures, results showed that pregnant workers exposed to biomechanical stressors had increased employment withdrawal compared to the unexposed. Work schedule accommodations moderate this association. Paid antenatal leave, available to few US women, was an important strategy for mitigating exposure to BOJS. Implications for science and policy are discussed. Practitioner Summary: This case-control study showed that exposure to biomechanical stressors decline throughout pregnancy. Antenatal leave was an important strategy used for mitigating exposure among sampled California women with access to paid benefits. Employment withdrawal among workers exposed to BJOS may be reduced by proactive administrative and engineering efforts applied early in pregnancy.
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Affiliation(s)
- Sylvia Guendelman
- a Division of Community Health and Human Development, School of Public Health , University of California Berkeley , Berkeley , CA , USA
| | - Alison Gemmill
- b Department of Demography , University of California Berkeley , Berkeley , CA , USA
| | - Leslie A MacDonald
- c National Institute for Occupational Safety and Health , Cincinnati , OH , USA
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Vigoureux S, Blondel B, Ringa V, Saurel-Cubizolles MJ. Occupational, social and medical characteristics of early prenatal leave in France. Eur J Public Health 2016; 26:1022-1027. [PMID: 27259720 DOI: 10.1093/eurpub/ckw072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In France, most women of childbearing age work. The prenatal leave law in France protects women during pregnancy and their employment. We aimed to describe how long before delivery women stopped working and analyse the association between occupational, social and medical factors and early prenatal leave (before 24 weeks' gestation). METHODS The sample was extracted from the 2010 French National Perinatal Survey. Women were interviewed in French maternity units during a 1-week period. We focused on all women with a singleton live birth who were working during pregnancy (n = 10 149). Women were interviewed between delivery and discharge to collect information on employment, date of leave, sociodemographic and medical characteristics. RESULTS Among women who worked during pregnancy, 27.5% reported early occupational leave (before 24 weeks' gestation). Early occupational leave was more frequent among women with unstable jobs (fixed-term vs. non-fixed-term contract: adjusted odds ratio aOR = 1.60 [95% confidence interval 1.40-1.84]) and with less-qualified occupational categories (manual workers vs. managers and upper-intellectual positions: aOR = 2.96 [2.30-3.82]), even after adjusting for sociodemographic and other employment characteristics. Women with a pathological or at risk pregnancy left work earlier than other women. After stratification on type of pregnancy there was still a higher rate of early leave for women with less qualified occupational group. CONCLUSION In France, social vulnerability of pregnant women, linked to low sociodemographic situation or low occupational categories, is associated with early leave during pregnancy, even after stratification on type of pregnancy.
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Affiliation(s)
- Solène Vigoureux
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
| | - Virginie Ringa
- INSERM UMR 1018, CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health Team, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Kremlin-Bicêtre F-94276, France.,Institut National d'Etudes Démographiques (INED), F-75020 Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
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47
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Lee LJ, Symanski E, Lupo PJ, Tinker SC, Razzaghi H, Pompeii LA, Hoyt AT, Canfield MA, Chan W. Data linkage between the National Birth Defects Prevention Study and the Occupational Information Network (O*NET) to assess workplace physical activity, sedentary behaviors, and emotional stressors during pregnancy. Am J Ind Med 2016; 59:137-49. [PMID: 26681357 PMCID: PMC4888062 DOI: 10.1002/ajim.22548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Knowledge of the prevalence of work-related physical activities, sedentary behaviors, and emotional stressors among pregnant women is limited, and the extent to which these exposures vary by maternal characteristics remains unclear. METHODS Data on mothers of 6,817 infants without major birth defects, with estimated delivery during 1997 through 2009 who worked during pregnancy were obtained from the National Birth Defects Prevention Study. Information on multiple domains of occupational exposures was gathered by linking mother's primary job to the Occupational Information Network Version 9.0. RESULTS The most frequent estimated physical activity associated with jobs during pregnancy was standing. Of 6,337 mothers, 31.0% reported jobs associated with standing for ≥75% of their time. There was significant variability in estimated occupational exposures by maternal age, race/ethnicity, and educational level. CONCLUSIONS Our findings augment existing literature on occupational physical activities, sedentary behaviors, emotional stressors, and occupational health disparities during pregnancy.
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Affiliation(s)
- Laura J. Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Southwest Center for Occupational and Environmental Health, Houston, Texas
| | - Elaine Symanski
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Southwest Center for Occupational and Environmental Health, Houston, Texas
| | - Philip J. Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilda Razzaghi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Pompeii
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Southwest Center for Occupational and Environmental Health, Houston, Texas
| | - Adrienne T. Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Wenyaw Chan
- Department of Biostatistics, University of Texas School of Public Health, Houston, Texas
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Spichiger C, Torres-Farfan C, Galdames HA, Mendez N, Alonso-Vazquez P, Richter HG. Gestation under chronic constant light leads to extensive gene expression changes in the fetal rat liver. Physiol Genomics 2015; 47:621-33. [DOI: 10.1152/physiolgenomics.00023.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Recent reports account for altered metabolism in adult offspring from pregnancy subjected to abnormal photoperiod, suggesting fetal programming of liver physiology. To generate a pipeline of subsequent mechanistic experiments addressing strong candidate genes, here we investigated the effects of constant gestational light on the fetal liver transcriptome. At 10 days of gestation, dams were randomized in two groups ( n = 7 each): constant light (LL) and normal photoperiod (12 h light/12 h dark; LD). At 18 days of gestation, RNA was isolated from the fetal liver and subjected to DNA microarray (Affymetrix platform for 28,000 genes). Selected differential mRNAs were validated by quantitative PCR (qPCR), while integrated transcriptional changes were analyzed with Ingenuity Pathway Analysis and other bioinformatics tools. Comparison of LL relative to LD fetal liver led to the following findings. Significant differential expression was found for 3,431 transcripts (1,960 upregulated and 1,471 downregulated), with 393 of them displaying ≥ 1.5-fold change. We validated 27 selected transcripts by qPCR, which displayed fold-change values highly correlated with microarray ( r2 = 0.91). Different markers of nonalcoholic fatty liver disease were either upregulated (e.g., Ndn and Pnpla3) or downregulated (e.g., Gnmt, Bhmt1/2, Sult1a1, Mpo, and Mat1a). Diverse pathways were altered, including hematopoiesis, coagulation cascade, complement system, and carbohydrate and lipid metabolism. The microRNAs 7a-1, 431, 146a, and 153 were upregulated, while the abundant hepatic miRNA 122 was downregulated. Constant gestational light induced extensive modification of the fetal liver transcriptome. A number of differentially expressed transcripts belong to fundamental functional pathways, potentially contributing to long-term liver disease.
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Affiliation(s)
- Carlos Spichiger
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Claudia Torres-Farfan
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Hugo A. Galdames
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Natalia Mendez
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Pamela Alonso-Vazquez
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Hans G. Richter
- Laboratory of Developmental Chronobiology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
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Retrait préventif du travail, exposition aux contraintes psychosociales au travail et symptômes dépressifs majeurs. Rev Epidemiol Sante Publique 2015; 63:355-67. [DOI: 10.1016/j.respe.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/06/2015] [Accepted: 09/11/2015] [Indexed: 11/20/2022] Open
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50
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Messing K. Pain and Prejudice: Does Collecting Information From the Standpoint of Exposed Workers Improve Scientific Examination of Work-Related Musculoskeletal Disorders? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:465-82. [PMID: 26272913 DOI: 10.1177/0020731415595337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The meaning, feasibility, and importance of scientific objectivity have been debated among public health scientists. The debate is particularly relevant to occupational health, because of frequent opposition between employer and worker interests. This article suggests that the concept of standpoint (J. Eakin) may be more useful than that of objectivity in framing discussion of work-related musculoskeletal disorders. Studies done from a "worker" standpoint can, for example, investigate and characterize environmental risk factors for work-related musculoskeletal disorders, while studies from an "employer" standpoint may concentrate on identifying individual workers likely to report work-related musculoskeletal disorders or those for whom consequences of work-related musculoskeletal disorders are more severe. Within "worker" standpoints, a distinction between "high-prestige worker" and "lower-prestige worker" standpoints can be identified in the current scientific debate about the health costs and benefits of prolonged standing vs prolonged sitting at work. Contact with workers, particularly lower-prestige workers, is critical to developing and sustaining a worker-based standpoint among researchers in occupational health. This contact can be facilitated by formal collaborations between universities and unions or other community groups.
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Affiliation(s)
- Karen Messing
- CINBIOSE, Université du Québec à Montréal, Montréal, Quebec, Canada
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