Pregnancy: occupational aspects of management: concise guidance

Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician-gynecologists

OBJECTIVE

While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN).

METHODS

A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models.

RESULTS

The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001).

CONCLUSIONS

ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

Do current policies reflect current evidence on the relationship between occupational risks and preterm birth, and are they consistent? A policy content analysis

OBJECTIVES

Preterm birth is a leading cause of neonatal mortality and the second-leading cause of death among children under five worldwide. Recent systematic reviews have demonstrated an increased risk of preterm birth in women exposed to workplace physical and psychosocial risks during pregnancy. The extent to which this evidence is reflected in policy remains unclear. This study aimed to determine the extent to which current policies reflect the current evidence regarding the association between occupational risks and preterm birth.

STUDY DESIGN

Policy content analysis.

METHODS

This study used a three-step search strategy: searching electronic databases (Embase and Scopus), policy databases (Overton, Dimension, and Google Advanced), and websites of global and national agencies/organisations focused on occupational or women's health policies. Data were analysed through descriptive and interpretive content analyses. Eligible documents were publicly available in full text, published from 2000 onwards by credible sources, and written in English.

RESULTS

Thirteen eligible policy documents were identified. Of these, eight concluded that the evidence for the relationship between occupational risks and preterm birth was inconclusive. The remaining five documents report that occupational risks may be associated with an increased risk of preterm birth. Nine documents offered recommendations to address this risk. These included four recommending job redesign, two information/education, and three a combination of job redesign, job transfer, information/education, and changes to workplace policy. Three were developed by a multidisciplinary stakeholder group, six by a multidisciplinary clinical group, and four by unidisciplinary clinicians.

CONCLUSIONS

Most current policies partially reflect the current evidence on the relationship between occupational risks and preterm birth. Development of most policy documents did not use rigorous methods and did not involve multidisciplinary stakeholder groups. There is an urgent need for the development of evidence-based policies grounded in robust research methods.

A few thoughts on workplace safety

In an industry known for its workplace hazards, such as the management and manipulation of animals that could bite, kick or cause considerable damage simply because of their size, combined with long working hours, lifting of heavy loads and the general mental stress, it is perhaps surprising that the veterinary industry is not also known for its safety culture and structures. One would expect that where such hazards and risks have been identified, there would be many and varied levels of education on risk and hazard management, a comprehensive set of tools with which to mitigate these risks as well as discussion and debriefing of significant adverse events to ensure they do not occur again. One would also assume that there would be a strong sense of safety culture in the workplace and that personnel would expect each other to ensure that the health and safety of themselves and their colleagues was a number one priority. Yet, is this the case in the veterinary industry? A request was made by the Association of Veterinary Anaesthetists (AVA) to provide 'safety guidelines' for use in general practice, particularly pertaining to pregnancy. The AVA set up a task force to address these concerns and to determine if guidelines could be created. This article is offered as a starting point for considering safety in the veterinary industry in a broad sense, with the hope that in the future there may be development of such guidelines. It is hoped that this article also provides the stimulus for further research in this area.

Impact of maternal posture on fetal physiology in human pregnancy: a narrative review

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.

Associations of Night Shift Status During Pregnancy With Small for Gestational Age and Preterm Births

BACKGROUND

Shift work, including night shift work, during pregnancy has been associated with adverse birth outcomes such as small for gestational age (SGA) infants and preterm births. This study, conducted in South Korea using the Korean CHildren's ENvironmental health Study (Ko-CHENS) cohort, aimed to investigate the association between shift work and night shift status during pregnancy and adverse birth outcomes.

METHODS

The Korean Ko-CHENS is a nationwide prospective birth cohort study of children's environmental diseases, conducted by the Ministry of Environment and the National Institute of Environmental Research. This study included pregnant women recruited from 2015 to 2020 for Ko-CHENS Core Cohorts, and 4,944 out of a total of 5,213 pregnant women were selected as final subjects. A logistic regression model was used to identify the risk factors affecting SGA births, preterm births, and low-birth-weight infants, and the odds ratio (OR) was adjusted. This was confirmed by calculating ORs. Maternal age, infant sex, maternal educational status, body mass index, smoking status, alcohol consumption status, parity, gestational diabetes mellitus, preeclampsia, and abortion history were used as adjusted variables.

RESULTS

No statistically significant differences were observed in the birth outcomes or maternal working patterns. There were no significant differences in the adjusted odds ratios (aORs) of SGA and preterm births between the non-worker, day worker, and shift worker. However, there was a significant difference in the aORs of SGA between non-workers and night shift workers. (aORs [95% confidence interval], 2.643 [1.193-5.859]).

CONCLUSION

Working during pregnancy did not increase the risk of SGA or preterm birth, and night shift work did not increase the risk of preterm birth. However, night-shift work increases the risk of SGA.

Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study

BACKGROUND

Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial.

OBJECTIVE

This study aims to verify the feasibility and usability of the Job Adjustment mobile app.

METHODS

A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale.

RESULTS

The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01).

CONCLUSIONS

The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.

Physical exposures in the work environment during pregnancy - a challenge for risk assessment

Pregnant women have been preforming work-related activities during pregnancy since time immemorial, from the traditional hunter-gatherer or forager society to today’s modern world. But ever since our society has been industrialized, exposure patterns for pregnant women have changed dramatically, and they keep changing. This change is due partly to exposure changes overall in the labor market and partly the changes in the gender balance in different occupations.

To some extent, women have been protected from the most hazardous occupations, since these mainly have been held by men (1). But active strategies within Europe to move towards a gender-balanced work force have increased the number of women seeking employment in hazardous work environments. One example is heavy truck and lorry drivers, who are predicted to be 40% female by 2030 (2). Today, the labor participation rate for women is high, with a total of 67% in Europe and 74–80% in Scandinavian countries (3), leading to a workforce that eventually has as many exposed women as men.

A gender-balanced work force across occupations brings diversity and thus benefits to the work site (4). But it also introduces a challenge, especially in exposed blue-collar occupations. So far, much emphasis has been given to chemical and particles exposure. This is a very important and crucial area for the risk assessment for pregnant workers (5, 6) but not the only hazard present in occupational settings. Too little attention has been paid to physical factors in the work environment during pregnancy in association with health effects, even though physical factors are more prevalent than chemical and particles exposure in occupational settings. The exception is physical load, about which several original articles and reviews have been published (7–9). But physical exposure is a broad concept and also includes exposure to temperature, whole-body vibration, and noise.

Among the physical exposures in occupational settings, physically strenuous work has been the most studied. This area includes work postures, heavy lifting, standing/walking, sedentary work as well as a cardiovascular strain from physical labor. Recent reviews show an overall modest effect for physically strenuous work during pregnancy as well as pregnancy complications and adverse birth outcomes (10). In summary, the evidence so far concludes that pregnant workers should avoid occasional heavy lifting and lifting >10 kg in general (9). Heat in residential settings during pregnancy has been extensively studied (11), and some studies have also focused on occupational settings. An association between heat exposure and heat stress in relation to pregnancy complications as well as birth outcomes has been reported (12). But the evidence is not strong enough to recommend specific temperature levels in occupational settings for pregnant workers.

Only a few studies have investigated noise and whole-body vibration and its effect on pregnant workers. In both areas, reviews have shown inconclusive results (13, 14) and, since then, only a handful studies have been published, including only one large scale cohort study divided into five manuscripts (15–19). The evidence so far suggests that working full-time (8 hours) in weighted average of >80dBA occupational noise and >0.5m/s2 whole-body vibration is associated with an increased risk of pregnancy complications and negative birth outcomes. But since these findings come from one cohort, they need to be confirmed in other high quality cohort studies where levels of exposure can be assessed.

An important review on the evidence so far regarding physical exposures during pregnancy and preterm birth is on the way; the method and protocols have already been published (20), but a review is only as good as its included studies, and we need more high-quality original studies in this research area. Overall, more prospective cohort studies with objectively assessed exposures are needed to be able to identify a safe level for occupational physical exposures during pregnancy. So far, the current evidence on physical load is predominantly based on self-reported physical load, and future studies should focus on high quality objective exposure assessment to increase the level of evidence within this part of the research field.

To be able to progress, future studies also need detailed information on absence from work. In many countries, absence from work due to pregnancy benefit, sick leave and parental leave is common during pregnancy. In Sweden, 7 out of 10 women apply for leave of absence benefits at some point during pregnancy [21). In contrast to chemical exposures, that can bioaccumulate, physical exposures predominately affect the working mother during pregnancy. Hence, to correctly assess occupational exposure to physical factors during pregnancy in relation to health effects in the mother and child, absence from work needs to be addressed properly. Associations can otherwise be missed due to misclassification of exposure. This have been shown in a large-scale cohort study from Sweden, where associations only were found in full time workers with low leave of absence during pregnancy [16-18).

Leave of absence data is also needed to assess the potential beneficial effect that leave of absence can have on the pregnant worker. This was shown in Skröder et al 2021, where pregnant women highly exposed to whole-body vibration only had an increased risk of preterm birth if they had few days of leave of absence during pregnancy. With increased levels of leave of absence from work, women highly exposed to whole-body vibration at work had the same risk of delivering preterm as the general working population. In high levels of leave of absence data, women highly exposed to whole-body vibration had a lower risk of preterm birth then the general population with the same level of absence from work, indicating a healthy worker effect [16). Leave of absence during pregnancy can also be seen as an intermediate measure, since early health effects can lead to an increased level of sick leave, parental leave or pregnancy benefit. An association between exposure at the workplace and level of absence from work have been seen in a recent Danish study and in a recent review [22, 23).

High quality environmental epidemiological studies have been of use when assessing the effect of occupational exposure during pregnancy to chemical and particle exposure on pregnancy complications and birth outcomes. But for physical exposures, the exposures and levels differ substantially between environmental and occupational settings and some of the mechanisms. This is true for the mechanism between noise and health, where occupational and residential exposure to noise both are associated with a stress mechanism, but were only the residential exposure contribute to sleep disturbance and related health effects [13). An exposome approach is needed to identify and assess all the potential risk factors for pregnant women [24). In the exposome concept, multiple exposures in a life course perspective are assessed, with a focus on vulnerable stages, such as pregnancy. It is important to adjust for other co-exposures in the work environment, such as chemical and particle exposure, psychosocial exposures, shift work and other physical exposures when assessing the relationship between occupational exposure to one physical factor and the outcome. These exposures are partly correlated with each other [15-19). Few previous studies have been able to adjust for other occupational exposures at work when investigating individual occupational exposures. Very few studies examined the interaction of occupational exposure and how they jointly contribute to the risk of health effects in the mother and child, even though most of these exposures correlate in the work place [25). Some of the existing birth cohort studies can be regarded as hidden treasures for occupational data, with detailed information on occupational environment of the parents that many times have not been used [26). We need to be able to produce valid exposure-response curves and thereby ensure a safe work environment for the pregnant worker and her child. But also, to avoid excluding women from the labor market during pregnancy unnecessary. An unnecessary exclusion from the labor market can hinder female workers career advancement to the next level of their career and lead to lower salaries, and in the end lower pensions compared to men. So, a well-balance discussion based on high quality evidence can provide a safe and non-discriminatory work environment for pregnant women.

Regarding chemical and particle exposure, an equal low level of exposure for both men and women in reproductive ages can reduce reproductive effects successfully. In physical exposures, there is less need to reduce exposure levels for all, unless these are associated with other health outcomes. It is mainly women of reproductive age who need to be protected, preferably early on since at least whole-body vibration is suspected to be associated with miscarriages. A better system to identify and inform pregnant workers already at the time of their prenatal care registration (usually in gestational week 10) is needed. Overall, there remains a significant knowledge gap regarding the effect of physical occupational exposures during pregnancy and health effects among children. More high-quality cohort studies with objectively assessed exposure that have access to leave-of-absence-during-pregnancy data are needed to increase the level of knowledge in this important area so researchers can generate accurate exposure–response functions and provide correct and well-balanced advice to occupational health services, employers, and pregnant workers.

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Full-time exposure to occupational noise during pregnancy was associated with reduced birth weight in a nationwide cohort study of Swedish women. Sci Total Environ. 2019;651:1137-1143. https://doi.org/10.1016/j.scitotenv.2018.09.212 19. Lissåker CT, Gustavsson P, Albin M, Ljungman P, Bodin T, Sjöström M. et al. Occupational exposure to noise in relation to pregnancy-related hypertensive disorders and diabetes. Scand J Work Environ Health. 2021;47(1):33-41. https://doi.org/10.5271/sjweh.3913 20. Adane HA, Iles R, Boyle JA, Collie A. Maternal occupational risk factors and preterm birth: Protocol for a systematic review and meta-analysis. PLoS One. 2023;18(7):e0283752. https://doi.org/10.1371/journal.pone.0283752 21. Försäkringskassan. Gravidas socialförsäkringsskydd - Jämlik, ekonomisk trygghet? [Pregnant women`s social security protection - Equal, financial security?] 2022: https://www.forsakringskassan.se/download/18.7fc616c01814e179a9f81c/1662473039324/gravidas-socialforsakringsskydd-socialforsakringsrapport-2022-2.pdf. 22. Hansen ML, Thulstrup AM, Juhl M, Kristensen JK, Ramlau-Hansen CH. Occupational exposures and sick leave during pregnancy: results from a Danish cohort study. Scandinavian Journal of Work Environment & Health. 2015;41(4):397-406. https://doi.org/10.5271/sjweh.3507 23. Henrotin JB, Gulisano F, Sick leave during pregnancy and occupational factors: a systematic review. Occup Med. 2022;72(8):550-558.https://doi.org/10.1093/occmed/kqac090 24. Handakas E, Robinson O, Laine JE. The exposome approach to study children`s health. Curr Op Environ Sci Health. 2023;32. https://doi.org/10.1016/j.coesh.2023.100455 25. Nurminen T, Kurppa K. Occupational noise exposure and course of pregnancy. 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Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/025, September 2022) - Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth

Aim This revised guideline was coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). It aims to improve the prediction, prevention, and management of preterm birth, based on evidence from the current literature, the experience of members of the guidelines commission, and the viewpoint of self-help organizations. Methods The members of the contributing professional societies and organizations developed recommendations and statements based on international literature. The recommendations and statements were presented and adopted using a formal process (structured consensus conferences with neutral moderation, written Delphi vote). Recommendations Part 1 of this short version of the guideline presents statements and recommendations on the epidemiology, etiology, prediction, and primary and secondary prevention of preterm birth.

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

OBJECTIVE

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

DESIGN

Scoping review.

DATA SOURCES

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

ELIGIBILITY CRITERIA

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

DATA EXTRACTION AND SYNTHESIS

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

RESULTS

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

CONCLUSIONS

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

Investigation of gender differences in stillbirths in Italian regions at the turn of the nineteenth century

Data quality issues have hindered the analysis of the determinants of stillbirths in the years following Italian unification. By exploiting panel data techniques to take into account the possible effect of stillbirth misreporting, this paper investigates the relationship between seasonal agricultural workload and the number of male and female stillbirths in the Italian regions at the turn of the twentieth century (1883–1913). We found that although stillbirth rates were lower for females, agricultural workload seasonality had a more substantial effect for them. We suggest that this finding may be rationalised through the adaptive sex ratio adjustment hypothesis.

Integrated Proteomics and Metabolomics Analysis in Pregnant Rat Hippocampus After Circadian Rhythm Inversion

To investigate the changes in proteins, metabolites, and related mechanisms in the hypothalamus of pregnant rats after circadian rhythm inversion during the whole pregnancy cycle. A total of 12 Wistar female rats aged 7 weeks were randomly divided into control (six rats) and experimental (six rats) groups at the beginning of pregnancy. The control group followed a 12-h light and dark cycle (6 a.m. to 6 p.m. light, 6 p.m. to 6 a.m. dark the next day), and the experimental group followed a completely inverted circadian rhythm (6 p.m. to 6 a.m. light the next day, 6 a.m. to 6 p.m. dark). Postpartum data were collected until 7–24 h after delivery, and hypothalamus samples were collected in two groups for quantitative proteomic and metabolism analyses. The differential proteins and metabolites of the two groups were screened by univariate combined with multivariate statistical analyses, and the differential proteins and metabolites enriched pathways were annotated with relevant databases to analyze the potential mechanisms after circadian rhythm inversion. A comparison of postpartum data showed that circadian rhythm inversion can affect the number of offspring and the average weight of offspring in pregnant rats. Compared with the control group, the expression of 20 proteins and 37 metabolites was significantly changed in the experimental group. The integrated analysis between proteins and metabolites found that RGD1562758 and lysophosphatidylcholine acyltransferase 1 (LPCAT1) proteins were closely associated with carbon metabolism (choline, NAD+, L-glutamine, theobromine, D-fructose, and pyruvate) and glycerophospholipid metabolism (choline, NAD+, L-glutamine, phosphatidylcholine, theobromine, D-fructose, pyruvate, and arachidonate). Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that the differential metabolites enriched in adenosine triphosphate (ATP)–binding cassette (ABC) transporters. Our study suggested that circadian rhythm inversion in pregnant rats may affect the numbers, the average weight of offspring, and the expressions of proteins and metabolism in the hypothalamus, which may provide a comprehensive overview of the molecular profile of circadian rhythm inversion in pregnant groups.

Biomechanical and organisational constraints of pregnant women at work: definition of exposure levels using a consensus method (Delphi)

OBJECTIVES

To identify the biomechanical and organisational constraints that influence pregnancy outcomes and define the exposure levels at which the risks for pregnancy become significant.

SETTING AND PARTICIPANTS

We applied a consensus method (Delphi) consisting of a literature review followed by expert opinions on exposure levels. The group of experts was made up of 12 people from different medical specialities and working in various structures in France.

OUTCOME MEASURES

The studied variables were: (1) exposure: night work/shift work, weekly hours at work, lifting of heavy loads, prolonged standing and multiple exposure and (2) pregnancy outcomes: prematurity, low birth weight and spontaneous miscarriages.

RESULTS

The consensus method resulted in the following recommendations. The time spent working must not exceed 40 hours/week; in the absence of a consensus on the level of exposure, night and/or shift work must be avoided; prolonged standing must not exceed 3 hours/day; lifting must be limited to carrying loads <11 kg, with a daily load <100 kg; multiple exposure must be avoided, in particular: vibration, night work/shift work, time spent working exceeding 40 hours/week, prolonged standing and lifting of heavy loads.

CONCLUSIONS

These results could help the occupational physician to address the question of whether an exposed employee should remain at work, considering her individual characteristics (medical history, family situation, socioeconomic level, etc) in consultation with pregnancy specialists (obstetricians, midwives).

Shift and night work during pregnancy and preterm birth-a cohort study of Swedish health care employees

BACKGROUND

Previous studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of PTB in relation to detailed, registry-based data on working hours.

METHODS

In a register-based prospective cohort study, we identified 4970 singleton births with information on PTB from the Swedish Medical Birth Register of health care employees in Stockholm. Day-by-day information on working hours 2008-16 was obtained from a computerized employee register. Odds ratios (ORs) of PTB according to work hour characteristics were analysed by logistic regression adjusted for mother's age, stature, body mass index (BMI), parity, smoking habits, education, profession and country of birth.

RESULTS

There was an increased risk of PTB among those who frequently worked night shifts (>25 times) [OR, 1.62; 95% confidence interval (CI), 1.03-2.53] and who ever worked ≥3 consecutive night shifts (OR, 1.43; 95% CI, 1.03-1.99) during the first trimester. Frequently (> 8 times) working 3 or more consecutive nights, and frequently (>18 times) having quick returns from night shifts (<28 h) during the first trimester showed 3-4 fold increased risk of PTB. Moreover, working frequent (>20 times) long shifts (≥10 h) (OR 1.63; 95% CI, 1.07-2.49) during the first trimester and working any Week >40 h (OR 2.05; 95% CI, 1.31-3.22) during the third trimester were associated with PTB.

CONCLUSIONS

In this cohort of Swedish health care employees with registry-based data on working hours, night work, especially working frequent consecutive nights, and quick returns from night shifts during the first trimester were associated with increased risk of PTB among pregnant women.

Associations between work environment, health status and sick leave among pregnant employees

Aims: To study the associations between and timing of psychosocial and physical work factors and health status on sick leave among Danish pregnant employees. Methods: A total of 910 pregnant women completed a questionnaire in gestational weeks 12 (baseline) and 27 (follow-up). Information about psychosocial and physical work factors and health status was obtained at baseline. Associations with sick leave ⩾14 days were estimated using logistic regression. Further, the impact of timing and duration of exposure on sick leave were examined. Results: A total of 133 women (14.6%) reported ⩾14 days of sick leave at follow-up (27 weeks of gestation). Work-related risk factors for sick leave were high work pace, low influence, low recognition, low job satisfaction, conflict in work−family balance, standing/walking, heavy lifting, and shift work/night shift. Health-related risk factors were burnout, stress, possibility of depression, low work ability, previous sick leave, and poor self-rated health. Being exposed to work-related risk factors during the first 27 weeks of pregnancy or at follow-up increased the risk of sick leave compared with those not exposed at any time or only exposed at baseline. Poor health status increased the risk if women were exposed in the first 27 weeks of pregnancy; however, high possibility of depression was also a risk factor when experienced in early pregnancy. Conclusions: Psychosocial and physical work-related risk factors and poor health status were associated with more sick leave in pregnant employees. Early adjustment of work-related risk factors at the workplace is needed to reduce sick leave.

Effects of long working hours and shift work during pregnancy on obstetric and perinatal outcomes: A large prospective cohort study-Japan Environment and Children's Study

BACKGROUND

The work patterns of pregnant women may be related to adverse obstetric and perinatal outcomes. This study aimed to clarify the effects of weekly working time according to frequencies of night shifts during pregnancy on adverse outcomes in Japan.

METHODS

The Japan Environment and Children's Study, a prospective cohort study, was conducted in 15 regions nationwide in Japan. The study population included pregnant women with singleton pregnancies (n = 99 744). The mothers' working hours and frequencies of night shifts during the first and the second/third trimesters were assessed using a self-administered questionnaire. Outcome data were collected from medical transcripts.

RESULTS

Compared with nonworking women, women who worked during pregnancy had significantly increased adjusted odds ratios (aORs) of threatened miscarriage (maximum aOR: 1.47, 95% confidence interval [95% CI]: 1.26-1.73) and of threatened preterm labor (maximum aOR: 1.63, 95% CI: 1.41-1.87). Increased aORs were observed for hypertensive disorders of pregnancy (maximum aOR: 2.02, 95% CI: 1.39-2.93) in women working ≥36 hours per week with night shifts, for vacuum/forceps delivery (maximum aOR: 1.34, 95% CI: 1.22-1.48) at ≥36 hours with or without night shifts, and for small-for-gestational-age babies (aOR: 1.32, 95% CI: 1.10-1.59) at ≥46 hours with night shifts. In contrast, lower aORs were observed for gestational diabetes and meconium-stained amniotic fluid in women working without night shifts.

CONCLUSIONS

Work during pregnancy slightly increased the risks of threatened miscarriage and threatened preterm labor. Long working hours increased the risks of hypertensive disorders of pregnancy, vacuum/forceps delivery, and small-for-gestational-age babies.

The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis

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.

Reducing the Risk of Preterm Birth by Ambulatory Risk Factor Management

BACKGROUND

The preterm birth rate in Germany has remained unchanged at 8-9% since 2009. Preterm birth is the most common cause of neonatal morbidity and mortality. In the absence of a causal treatment, it is important to lower the risk of preterm birth by preventive measures in prenatal outpatient care.

METHODS

This review is based on pertinent publications from the years 2000-2019 that were retrieved by a selective search in PubMed.

RESULTS

The clinical risk factors for preterm birth-known mainly from retrospective cohort studies-include previous preterm birth (adjusted odds ratio [aOR]: 3.6), multiple pregnancy (relative risk [RR]: 7.7), nicotine consumption (aOR: 1.7), and a short uterine cervix, i.e., <25 mm in the second trimester (aOR: 6.9). In women with a short cervix, vaginally administered progesterone significantly lowers the preterm birth rate (22.5% vs. 14.1% for birth before 33 weeks of gestation, RR: 0.62; 95% confidence interval [0.47; 0.81]). Nicotine abstinence is associated with a lower pre- term birth rate as well (aOR: 0.91; [0.88; 0,.94]), while working more than 40 hours per week (aOR: 1.25; [1,.01; 1,.54]) and heavy lifting during pregnancy (hazard ratio [HR]: 1.43; [1.13; 1.80]) are associated with a higher preterm birth rate. Avoidance of physical exertion, or bed rest, in the face of impending preterm birth does not lower the preterm birth rate, but it does increase the risk of complications, such as thromboembolism.

CONCLUSION

The meticulous assessment and elimination of treatable risk factors at the outset of ambulatory prenatal care can help lower the preterm birth rate. Further velopment of causally directed treat- ments (e.g., changes of relevant environmental and epigenetic factors).

The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis

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.

Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). Recommendations Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.

Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces

OBJECTIVES

The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women.

METHODS

Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument.

RESULTS

A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04).

CONCLUSION

The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods.

PROSPERO REGISTRATION NUMBER

CRD42018084802.

Combined exposure to lifting and psychosocial strain at work and adverse pregnancy outcomes-A study in the Danish National Birth Cohort

Background

Previous studies have investigated physical and psychosocial job exposures separately in relation to foetal growth. We therefore investigated if occupational lifting and psychosocial job strain interact to affect foetal growth and gestational length. We hypothesised that heavy lifting and high job strain would increase the risk of impacted foetal growth (small or large for gestational age) and preterm birth.

Methods

The cohort included 47,582 pregnancies from the Danish National Birth Cohort (1996–2002), where the woman was pregnant at 22 gestational weeks (GW), expected one child and worked ≥30 hours/week. Information on occupational lifting and psychosocial job strain was derived from an interview (16±3.0 GW). Data to calculate small and large for gestational age (SGA/LGA) and gestational length was retrieved from the Medical Birth Register. Interaction between lifting and job strain (Karasek’s model) was analysed by multinomial logistic regression.

Results

Overall, the adjusted regression analysis showed statistically significant interaction between lifting and job strain for SGA and LGA. For each additional 250 kg lifted/day, high strain women (high Demand/low Control) had increased odds of giving birth to a LGA-child (OR = 1.15; 95% CI 1.06–1.26), whereas women in the active group (high Demand/high Control) had increased odds of giving birth to a SGA child (OR = 1.12; 95% CI 1.03–1.23). When women lifting ≤1000 kg/day were excluded in the sensitivity analyses the interaction between lifting and job strain became insignificant. No interaction of lifting and job strain was found for gestational length.

Conclusions

The main findings may give some support to our hypothesis, as lifting in combination high with job strain increased the risk of giving birth to a LGA child. This finding was, however, not supported in the sensitivity analysis and no association of the interaction was found relative to gestational length.

Protection of pregnant women at work in Switzerland: practices, obstacles and resources. A mixed-methods study protocol

INTRODUCTION

Like most industrialised countries, Switzerland has introduced legislation to protect the health of pregnant workers and their unborn children from workplace exposure. This legislation provides for a risk assessment, adaptations to workplaces and, if the danger is not eliminated, preventive leave (prescribed by a gynaecologist). This study's first objective is to analyse the degree to which companies, gynaecologists and midwives implement the law. Its second objective is to understand the obstacles and resources of this implementation, with a focus on how relevant stakeholders perceive protective measures and their involvement with them.

METHODS AND ANALYSIS

Data will be collected using mixed methods: (1) online questionnaires for gynaecologists and midwives; telephone questionnaires with company human resources (HR) managers in the healthcare and food production sectors; (2a) case studies of 6-8 companies in each sector, including interviews with stakeholders such as women workers, HR managers and occupational health physicians; (2b) two focus groups, one involving occupational physicians and hygienists, one involving labour inspectors.Quantitative data will be analysed statistically using STATA software V.15. Qualitative data will be transcribed and thematically analysed using MaxQDA software.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of the Canton Vaud (CER-VD) has certified that this research study protocol falls outside of the field of application of the Swiss Federal Act on Research Involving Humans.The publications and recommendations resulting from this study will form the starting point for future improvements to the protection of pregnant women at work and their unborn children.This study started in February 2017 and will continue until January 2020.

Role of maternal occupational physical activity and psychosocial stressors on adverse birth outcomes

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.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.

Survey of occupational hazards in Minnesota veterinary practices in 2012

OBJECTIVE

To identify the scope of occupational hazards encountered by veterinary personnel and compare hazard exposures between veterinarians and technicians working in small and large animal practices.

DESIGN

Cross-sectional survey.

POPULATION

Licensed veterinarians and veterinary staff in Minnesota.

PROCEDURES

A survey of Minnesota veterinary personnel was conducted between February 1 and December 1, 2012. Adult veterinary personnel working in clinical practice for > 12 months were eligible to participate. Information was collected on various workplace hazards as well as on workplace safety culture.

RESULTS

831 eligible people responded, representing approximately 10% of Minnesota veterinary personnel. A greater proportion of veterinarians (93%; 368/394) reported having received preexposure rabies vaccinations than did veterinary technicians (54%; 198/365). During their career, 226 (27%) respondents had acquired at least 1 zoonotic infection and 636 (77%) had been injured by a needle or other sharps. Recapping of needles was reported by 87% of respondents; the most common reason reported by veterinarians (41%; 142/345) and veterinary technicians (71%; 238/333) was being trained to do so at school or work. Recent feelings of depression were reported by 204 (25%) respondents. A greater proportion of technicians (42%; 155/365) than veterinarians (21%; 81/394) indicated working in an environment in which employees experienced some form of workplace abuse.

CONCLUSIONS AND CLINICAL RELEVANCE

Veterinary personnel in Minnesota were exposed to several work-related hazards. Practice staff should assess workplace hazards, implement controls, and incorporate instruction on occupational health into employee training.