"Will my work affect my pregnancy?" Resources for anticipating and answering patients' questions

"How Do I Prepare for This?" Patient Perspectives on Providers' Employment-related Support During Pregnancy

BACKGROUND

Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided.

METHODS

We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes.

RESULTS

People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients' individual work-related concerns.

CONCLUSIONS

Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.

The effectiveness of an intervention to reduce exposure to trace metals during or prior to pregnancy: A prospective study in urban and rural locations

Background

Prenatal exposure to trace metals can have adverse effects on health and increase the risk of developing certain diseases. This study aimed to determine the effectiveness of giving women advice to reduce their exposure to trace metals during pregnancy or prior to conception. The study also examined differences in exposure between rural and urban environments in southern France.

Methods

In this prospective study, pregnant women or those intending to conceive were recruited from two medical centers for gynecology/obstetrics (rural location: Saint-Rémy-de-Provence; urban location: Marseille). Hair samples were collected and analyzed to determine the levels of exposure to trace metals. Participants with 'risky' levels were given corresponding advice sheets on how to reduce their exposure or, for certain metals, they were encouraged to find out about potential sources of exposure. A second hair sample was collected and analyzed 3 months later.

Results

It was found that 109 women had 'risky' levels of exposure to trace metals, out of a total of 184 women (59.2 %). Cerium was the most frequently identified metal (N = 26), followed by nickel (N = 23), and titanium (N = 19). There were more women at the urban center with 'risky' levels (56/86; 65.1 %) than at the rural center (53/98; 54.1 %), but this difference was not statistically significant (p = 0.13). Advice sheets were given to 64 of the 109 participants with 'risky' levels (58.7 %), but only 21 returned for the second hair analysis. Of these, 14 were found to have reduced their exposure, which corresponds to just 12.8 % (14/109) of the participants with 'risky' levels.

Conclusions

These results indicate that it would be helpful to develop new interventions to reduce trace metal exposure during or prior to pregnancy.

Work as a social risk factor in pregnancy: A systematic review of screening practices related to working conditions and family leave among pregnant adults

BACKGROUND

Paid family leave and working conditions are components of employment quality-a key social determinant of health across the life course, particularly during pregnancy. Increased research on prenatal social risk screening has not extended to employment quality. The objective of this systematic review was to identify prenatal screening practices and interventions in health care settings that address employment and working conditions as social risk factors among pregnant adults and to describe their properties and key findings.

METHOD

We searched MEDLINE, PsychINFO, SocINDEX, EMBASE, and the SIREN Evidence and Resource Library for studies published through February 14, 2022. We selected multiple search terms related to four domains: (1) employment or working conditions; (2) screening; (3) health care settings; and (4) pregnancy or maternal health.

RESULTS

Of the 2317 unique titles and abstracts that were potentially relevant, eight articles met all inclusion criteria and focused on pregnant populations. The content of identified screening practices varied substantially, highlighting the multiple ways employment is conceptualized as a potential risk factor. Few studies included multidimensional measures of employment to assess working conditions, which may be particularly relevant during pregnancy.

CONCLUSIONS

Our review suggests that screening for employment as a social risk factor does not regularly occur in prenatal care. Although pragmatic properties of the screening tools we assessed are promising, tools seldom examine the multidimensional nature of work. Understanding the principal intent of screening for employment prenatally could provide greater opportunity to collect and interpret contextual factors that influence how both providers and patients respond to social risk.

Are antral follicle count and serum anti-Mullerian hormone level, as reliable markers of ovarian reserve, affected by UV radiation?

ObjectiveWe aimed to assess whether ovarian reserve test including serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Mullerian hormone (AMH) levels, and antral follicle count (AFC) which are ovarian reserve markers are affected by ultraviolet (UV) radiation or not.MethodsWomen between the ages of 25 and 40 who served as flight crew constituted the study population in this prospective case-control study. Age-matched women having no risk factor for low ovarian reserve were selected as control group. Participants were compared according to age, duration in profession, and ovarian reserve markers.ResultsA total of 134 patients were included: 66 participants in study group and 68 participants in control group. Serum AMH levels and AFC were found to be significantly lower while serum FSH and E2 levels were significantly higher in the study group. This difference was found to be more significant, especially in the advanced age group. When the participants were classified according to their working time, lower ovarian reserve was observed in women with longer working time.DiscussionWorking for a while in the air and being closer to the sun have negative effects on ovarian functions. Preventive measures may be taken earlier in flight crew than those in the normal population to prevent the decline of ovarian functions and possible conceiving problems.

Implementation of maternity protection legislation: Gynecologists' perceptions and practices in French-speaking Switzerland

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.

A screening questionnaire for occupational and hobby exposures during pregnancy

BACKGROUND

Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care.

AIMS

To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics.

METHODS

A cross-sectional survey assessed prenatal clinic patients at a public hospital who were currently employed and <20 weeks gestation. Questionnaires evaluated job characteristics, workplace and hobby exposures, protective equipment use and symptoms during pregnancy.

RESULTS

Of 69 participants (96% response rate), 46% were predominantly Spanish-speaking. Primary occupations were caregiver (16%), cleaner (14%) and administrative assistant (14%). Overall, 93% were exposed to a workplace hazard, with most participants reporting physical stressors (82%) or organic solvent exposure (78%). Most women (74%) used some personal protective equipment. Nearly half (54%) reported at least one non-pregnancy symptom, and 52% were referred for follow-up with an occupational medicine practitioner. Household and hobby-related chemical exposures were common in our sample (91%). We observed moderate consistency between job task and chemical use responses: 67-99% of intentionally redundant questions were fully or partially matched. Closed- compared to open-ended activity questions identified a higher proportion of physical stressors (82% versus 12%) and cleaning product (76% versus 30%) exposures.

CONCLUSIONS

A self-administered questionnaire is an effective screening tool for identifying women with occupational and hobby-related exposures during pregnancy. Consistent incorporation of exposure assessment into prenatal care can improve clinical communications and early interventions for at-risk pregnant women.

Reproductive toxic agents in work environments and related cases in Korea

There has been a growing concern and subsequent interest surrounding numerous reproductive toxic agents found in various working and non-working environments. Meanwhile, there have been many efforts in medical fields such as toxicology and epidemiology applying experimental studies to elucidate reproductive toxic agents' characterization and health effects. However, there remains insufficient research data and inadequate evidence in humans. Adverse reproductive outcomes vary from transient, moderate health effects to severely detrimental consequences, such as permanent infertility or childhood cancer of one's offspring. Furthermore, upon exposure to toxic agents, the latent period before reproductive health effects are observed is relatively short compared to other occupational diseases (e.g., occupational cancer); instant action is required once exposure to reproductive toxic agents is detected. Therefore, it is very important for workers and healthcare professionals to know about the reproductive toxic agents they are likely to be exposed to. In this review, we discuss the general epidemiology of reproductive health in Korea, and the information regarding these reproductive toxic agents.

Urinary metabolites of polycyclic aromatic hydrocarbons in pregnant women and their association with a biomarker of oxidative stress

Exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy may pose adverse health risk to both the mothers and babies. In the present study, 188 pregnant women of different trimesters were recruited in Guangzhou, south China, and nine hydroxyl PAHs (OH-PAHs) and a biomarker of DNA oxidative damage, 8-hydroxy-2'-deoxyguanosine (8-OHdG), were determined in their urine samples. All OH-PAHs except for 4-hydroxyphenanthrene and 6-hydroxychrysene were found in > 90% samples, with total concentration in the range of 0.52 to 42.9 μg/g creatinine. In general, concentration levels of OH-PAHs in pregnant women were lower than those in general population in the same research area but with higher levels in working women than in housewives. The mean daily intakes of PAHs from dietary estimated by urinary OH-PAHs were 0.021, 0.004, 0.047, and 0.030 μg/kg_bw/day for naphthalene, fluorene, phenanthrene, and pyrene, respectively, which were much lower than the reference doses (20, 30, and 40 μg/kg_bw/day for naphthalene, pyrene, and fluorene, respectively) derived from chronic oral exposure data by the United States Environmental Protection Agency. The low exposure levels of PAHs may be attributed to the traditional dietary taboo of Chinese pregnant women, which is to minimize the consumption of "toxic" food. The concentrations of 8-OHdG (4.67-49.4 μg/g creatinine) were significantly positively correlated with concentrations of several OH-PAHs, such as metabolites of naphthalene, fluorene, and phenanthrene (r = 0.3-0.6). In addition, the concentrations of 8-OHdG were higher in working women than in housewives when exposed to the same levels of PAHs, partly indicating the possible relation between work-related pressure for working women and the oxidative stress.

The Perinatal Condition Around Birth and Cardiovascular Risk Factors in the Japanese General Population: The Suita Study

Aim: To investigate the relationship between perinatal condition around birth and cardiovascular risk in later life.

Methods: Retrospective data were examined from 1241 city dwellers (521 men, 720 women; age 41–69 years) who had undergone medical examination at a single institution including blood tests and physical measurements from 2007 to 2008. The questionnaire was conducted to determine how perinatal factors affect their lives later. We also selected and studied a total of 28 individuals (12 men and 16 women) specifically about the conformity rate of the breastfeeding method between participants' memories and what was written in the maternal and child health handbooks.

Results: The conformity rate of the breastfeeding method between a self-questionnaire and his/her maternal and child health handbook was well correlated (r = 0.73; p < 0.025). Among the data in women who were born at home, HbA1C levels (5.36 ± 0.03 vs. 5.25 ± 0.05 mg/dL, p = 0.03) and low-density lipoprotein cholesterol (136.0 ± 1.4 vs. 129.3 ± 2.5 mg/dL, p = 0.04) were higher than women who were born at the hospital. Women raised by formula showed higher low-density lipoprotein cholesterol levels than women fed breast milk or a mixture of breast milk and formula (150.2 ± 4.8 vs. 138.7 ± 3.7, 142.5 ± 2.6 mg/dL, p = 0.04). Fasting blood glucose levels at an adult time in men and women born through breech presentation were higher than those by the cephalic presentation (123.2 ± 7.8 vs. 106.8 ± 1.2 mg/dL, p = 0.03).

Conclusion: The study proposed that some perinatal conditions around birth such as delivery place, presenting part, and lactation affected especially Japanese women's cardiovascular risks between ages 41 and 69 years.