背景:多胎妊娠的妇女有发生早产等母体并发症的风险。危险工作条件,如体力要求高的工作和长时间不规则的工作时间,可能会增加早产的风险。
目的:这项研究的主要目的是确定某些工作条件下妊娠长达20周是否会增加多胎妊娠中早产的风险。次要目标是评估多胎妊娠的荷兰妇女的工作条件是否已根据荷兰职业医学学会的指南进行了调整。
方法:我们与ProTWIN试验一起进行了一项前瞻性队列研究,一项多中心随机对照试验,评估宫颈子宫托是否能有效预防早产。每周有偿工作时间>8小时的妇女在怀孕16至20周之间完成了有关一般健康和工作条件的问卷调查。进行了单变量和多变量逻辑回归分析,以确定与早产(妊娠32-36周)和极早产(<32周)相关的工作相关因素。我们分析了一周工作超过一半(>28小时)的参与者亚组。我们计算了报告工作相关因素不符合指南的女性比例。
结果:我们研究了383名女性,其中168人(44%)被随机分配到子宫托,142(37%)照常护理,73例(19%)未参加随机部分的研究.调整混杂变量后,工作>28小时与早产有关(n=33;78%)(调整后的比值比,3.0;95%置信区间,1.1-8.1),不规律的工作时间与早产相关(n=26,17%)(调整后的比值比,2.0;95%置信区间,1.0-4.1)和早产(n=10;24%)(调整后的比值比,2.7;95%置信区间,1.0-7.3)。在一个由213名参与者组成的小组中,每周工作>28小时,多变量分析表明,不规则的工作时间(n=16;20%)(调整后的优势比,3.5;95%置信区间,1.2-10.1)和执行任务的自由度(n=23;28%)(调整后的赔率比,3.0;95%置信区间,1.3-7.3)与早产有关。不规律的工作时间(n=9;27%)(调整后的赔率比,3.4;95%置信区间,1.0-11.1),需要体力(n=9;27%)(调整后的赔率比,5.3;95%置信区间,1.6-17.8),高身体工作量(n=7;21%)(调整后的赔率比,3.9;95%置信区间,1.1-13.9),在执行任务时没有/很少自由(n=10;30%)(调整后的赔率比,3.2;95%置信区间,1.1-9.6)与早产有关。怀孕前20周,224名(58.5%)多胎妊娠妇女继续在不符合指南的情况下工作。
结论:在我们的队列研究中,近60%的多胎妊娠妇女继续在不符合指导方针的情况下工作,以避免身体和工作压力以及长时间和不规律的工作时间。不规律的工作时间与早产和非常早产有关,长时间与早产有关。
Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth.
This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the
guidelines of the Netherlands Society of Occupational Medicine.
We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks\' gestation) and very preterm birth (<32 weeks\' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with
guidelines.
We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the
guidelines.
In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the
guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth.