Association of Maternal Work with Adverse Perinatal Outcome

By Arafa, Mostafa A.; Amine, Taher et al. | Canadian Journal of Public Health, May/June 2007 | Go to article overview

Association of Maternal Work with Adverse Perinatal Outcome


Arafa, Mostafa A., Amine, Taher, Fattah, Moataz Abdel, Canadian Journal of Public Health


ABSTRACT

Objective: To investigate the relationship between maternal work and pregnancy outcome.

Methods: Over a 4-month period from October 2004 through February 2005, 2,419 women were interviewed shortly after delivery in the three main public and Health Insurance hospitals in Alexandria, Egypt. Of these, 730 (30.2%) were working and 1,689 (69.8%) were not working prior to delivery. A detailed description of working status was analyzed, along with a risk profile which was compared between the two groups.

Results: There was no significant association between different work characteristics and perinatal outcomes except for that between working posture, stress and delivery of smallfor- gestational-age (SGA) babies. There was an excess rate of SGA and perinatal death among the non-working group, while preterm delivery was significantly increased among those who worked throughout the whole pregnancy. After adjusting for confounders, the risk of preterm delivery was no longer significant (OR = 1.2, 95% CI = 0.96-1.7). On the other hand, working status had a beneficial effect on SGA and perinatal death (OR = 0.41, 95% CI = 0.26-0.64 and OR = 0.26, 95% CI = 0.14-0.48, respectively).

Conclusion: These results cast doubt on the risk of adverse pregnancy outcome for women who work during pregnancy. Work per se does not constitute a health risk factor and may even have a positive social impact on pregnancy. Further research on this topic in our region is recommended.

MeSH terms: Maternal work; adverse pregnancy outcome; developing countries; strenuous work

The potential impact of employment on pregnancy is an important issue that merits assessment, given the increasing numbers of women entering the labour force and continuing employment throughout pregnancy. Guidelines in some European countries and the United States suggest that pregnant women should avoid prolonged standing and heavy lifting in the workplace during the second and third trimesters of pregnancy.1,2 Much attention is paid by obstetricians to the diet and environment of the pregnant woman in prenatal care, but it is possible that her work also may affect pregnancy outcome. In the workplace, women may encounter specific hazards of radiation or chemicals. More widespread are the problems of fatigue and boredom, which need careful assessment in relation to the outcome of pregnancy. These factors should be measured more precisely, thus allowing the physician to advise pregnant women better about the safe duration of work.3 Physical exertion in the workplace during pregnancy may be predictive of adverse reproductive outcome. Many studies have suggested that strenuous physical activity, including in the workplace during pregnancy, is associated with reduced infant birthweight, shorter gestation period, intrauterine growth retardation, spontaneous abortion, and some congenital malformations.4-10 These types of associations, however, have not been observed in other studies.11-14 Moreover, only a few such studies have been conducted in developing countries.15-18

As the Egyptian population grows, the size of the labour force grows even faster with an increased participation of women in the workforce. Much of women's work in Egypt remains unrecognized, as informal activities, unpaid work, and activities for domestic consumption are not included. In accordance to the Population Census, which captures female work in formal activities only, the participation rate of females in the total labour force increased from 10% in 1986 to 12.9% in 2000 and to 15.4% in 2001.19,20 To the authors' knowledge after review of the literature, this work was the first undertaken in Egypt to investigate the association between maternal work and adverse perinatal outcomes.

MATERIAL AND METHODS

The data for the current study were collected from three public hospitals in the City of Alexandria, the second capital of Egypt: El-Shatby Maternity Hospital (the Main University Hospital) and Gamal Abdel-Nasser and Karmouz Hospitals (the Main Health Insurance Hospital). …

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