Night work and hypertensive disorders of pregnancy: a national register-based cohort study

Hammer, Paula Ec; Flachs, Esben Meulengracht; Specht, Ina Olmer; Pinborg, Anja; Petersen, Susanne; Larsen, Ann Dyreborg; Hougaard, Karin Sørig; Hansen, Johnni; Hansen, Åse Marie; Kolstad, Henrik Albert; Garde, Anne Helene; Bonde, Jens Peter

doi:10.5271/sjweh.3728

Cited by 32 publications

(43 citation statements)

References 51 publications

(68 reference statements)

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“…In a recent published study using the same source population as in the present study, we found that women with longer spells of consecutive night shifts, and among obese women also those with long night shifts and quick returns, during the first 20 pregnancy weeks had increased risk of hypertensive disorders 22. Field studies have shown increasing hormonal dysfunction with increasing number of consecutive night shifts 37–39.…”

Section: Discussionsupporting

confidence: 69%

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Night work and sick leave during pregnancy: a national register-based within-worker cohort study

et al. 2019

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ObjectiveThe aim of our study was to investigate the acute effect of night work during pregnancy on the risk of calling in sick the following day using register-based information and the workers as their own controls.MethodsUsing the payroll-based national Danish Working Hour Database, including all public hospital employees in Denmark, we identified 9799 pregnant women with ≥1 day shift and ≥1 night shift and ≥1 day of sick leave during the first 32 pregnancy weeks from January 2007 to December 2013. We performed fixed effects logistic regression, that is, within-worker comparisons, of the risk of sick leave of any duration starting within 24 hours after night shifts of different length versus day shifts.ResultsMost of the participants were nurses (64%) or physicians (16%). We found an increased relative risk of sick leave following night shifts compared with day shifts during all pregnancy trimesters. The risk was highest for night shifts lasting >12 hours (OR 1.37, 95% CI 1.15 to 1.63 for nurses; OR 1.87, 95% CI 1.69 to 2.08 for physicians) and among women aged >35 years (OR 1.42, 95% CI 1.24 to 1.63).ConclusionAmong Danish public hospital employees night shifts during pregnancy, especially shifts longer than 12 hours, increased the risk of calling in sick the following day independent of personal factors and time-invariant confounders in all pregnancy trimesters.

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Section: Discussionsupporting

confidence: 69%

“…The study cohort was retrieved from the same source population as in a recently published study 22. In short, it comprised 42 485 women from the DWHD who gave birth at least once during from January 2007 to December 2013, giving a total of 60 482 pregnancies.…”

Section: Methodsmentioning

confidence: 99%

Night work and sick leave during pregnancy: a national register-based within-worker cohort study

et al. 2019

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“…With respect to shift work in women, shift workers may have increased rates of menstrual disruption and night shifts may be associated with increased rates of spontaneous abortion . However, whether these results are applicable to other settings remains controversial as another study showed no significant increase in miscarriage rates among shift work nurses .…”

Section: Introductionmentioning

confidence: 99%

“…2 Furthermore, evidence has been accumulating from systematic reviews, meta-analyses, and register-based prospective cohort studies about obstetric outcomes of pregnant workers. [9][10][11][12][13] With respect to shift work in women, shift workers may have increased rates of menstrual disruption and night shifts may be associated with increased rates of spontaneous abortion. 9,10,12,13 However, whether these results are applicable to other settings remains controversial as another study showed no significant increase in miscarriage rates among shift work nurses.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13] With respect to shift work in women, shift workers may have increased rates of menstrual disruption and night shifts may be associated with increased rates of spontaneous abortion. 9,10,12,13 However, whether these results are applicable to other settings remains controversial as another study showed no significant increase in miscarriage rates among shift work nurses. 14 Because research on the relationship between shift work and pregnancy outcomes is limited, the present study was conducted to provide a scientific basis for better worklife balance in pregnant women and key precautions for prenatal care.…”

Section: Introductionmentioning

confidence: 99%

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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

Suzumori

Ebara

Matsuki

et al. 2019

Birth

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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.

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Scheduling practices for pregnant emergency medicine residents

MacVane

Puissant

Fix

et al. 2022

AEM Education and Training

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Background: Night shift work is associated with adverse pathophysiologic effects on maternal and fetal well-being. Although emergency medicine (EM) residents work frequent night shifts, there is no existing guidance for residency program directors (PDs) regarding scheduling pregnant residents. Our study assessed scheduling practices for pregnant EM residents, differences based on program and PD characteristics, barriers and attitudes toward implementing a formal scheduling policy, and PDs' awareness of literature describing adverse effects of night shifts on maternal-fetal outcomes. Methods: We conducted an anonymous, web-based survey of U.S. EM residencies (N = 276). Quantitative data were summarized; chi-square analysis and logistic regression were used to assess relationships between program and PD characteristics and schedule accommodations. Qualitative description was used to analyze an openended question, organizing findings into major and minor themes.Results: Of the 167 completed surveys (response rate 61%), 67% of programs reported no formal policy for scheduling pregnant residents but made adjustments on an individual basis including block changes (85%), decreased (46%) or no night shifts (34%), and working shifts earlier in pregnancy to cover later shifts (20%). Barriers to adjustments included staffing constraints (60%), equity concerns (45%), or impact on wellness (41%) among all residents and privacy (28%). PDs endorsed scheduling adjustments as important (mean 8.1, 0-10 scale) and reported guidance from graduate medical education governance would be useful (60%). Larger program size, but not PD gender or proportion of female residents, was associated with an increased likelihood of scheduling modifications. Twenty-five percent of PDs reported little knowledge of literature regarding night shift work and pregnancy. Qualitative themes supported quantitative findings. Conclusions:Most EM residency programs do not have formal scheduling policies for pregnant residents, but most PDs support making adjustments and do so informally.More education and guidance for PDs are needed to promote the development of formal policies.

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Night work and hypertensive disorders of pregnancy: a national register-based cohort study

Cited by 32 publications

References 51 publications

Night work and sick leave during pregnancy: a national register-based within-worker cohort study

Night work and sick leave during pregnancy: a national register-based within-worker cohort study

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

Scheduling practices for pregnant emergency medicine residents

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