Work and pregnancy: The role of fatigue and the “second shift” on antenatal morbidity,☆☆

Presented at the Nineteenth Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, California, January 18-23, 1999.
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Abstract

Objective: This study was undertaken to evaluate factors at home and work associated with antenatal morbidity (emergency department visits and hospitalizations) among employed pregnant women. Study Design: This prospective study of 213 women included 3 antenatal interviews at about 16, 24, and 30 weeks’ gestation with questions on health history, lifestyle, housework, working conditions, and emergency department visits and hospitalizations. Work scores and home scores were formulated from each interview. Fatigue was defined as being very tired or extremely tired at the end of a typical workday. The risk of antenatal morbidity was modeled by means of logistic regression; results are presented as adjusted odds ratios with 95% confidence intervals. Results: The risk of antenatal morbidity, which was greatest during the second trimester, was increased by stress (adjusted odds ratio, 2.45; 95% confidence interval, 1.32-4.57), fatigue (adjusted odds ratio, 3.77; 95% confidence interval, 1.98-7.18), work plus home score (adjusted odds ratio, 1.55; 95% confidence interval, 1.22-1.97), and the interaction of fatigue and work plus home score (adjusted odds ratio, 4.61; 95% confidence interval, 2.02-10.50). Conclusions: These findings suggest that maternal fatigue contributes significantly to antenatal morbidity. (Am J Obstet Gynecol 1999;181:1172-9.)

Section snippets

Study sample

Women were recruited for the study when they first registered for prenatal care at the University of Michigan Health System between March 1997 and November 1997. Women were contacted by telephone several days before their first appointment for prenatal care to introduce the study and to identify those individuals interested in participating. Women were then enrolled in person during their prenatal visit. The first interview was conducted either at that time or subsequently by telephone, at the

Results

The description of the study population is given in Table I.

. Description of study population characteristics and pregnancy outcomes

There were no significant differences between women with or without medically ordered work reduction or bed rest by age, parity, race, medical history, pregravid body mass index, gestational weight gain, smoking or alcohol habits, or cesarean birth. Women who had neither medically ordered work reduction nor bed rest were significantly better educated, had higher

Comment

These findings suggest that fatigue and stress, whether from work or home factors and particularly during the second trimester, contribute significantly to antenatal morbidity. Previous studies, particularly those conducted with women in the military,6, 7, 8, 9 have linked physically demanding work to increased antenatal morbidity. Adams et al9 reported that 23% of enlisted women had ≥1 antenatal admissions and 15% had prolonged hospitalizations that immediately preceded delivery. Ramirez et al,

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    Reprint requests: Barbara Luke, ScD, MPH, Department of Obstetrics and Gynecology, University of Michigan Medical School, 1500 E Medical Center Dr, F4866 Mott, Ann Arbor, MI 48109-0264.

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