Work and Pregnancy

1
Work and Pregnancy
Tanja Vrijkotte
Amsterdam Born Children and their Development

• Municipal Health Services Amsterdam AMC
  Social Medicine
• Dr. Marcel van der Wal Prof. Dr. Gouke Bonsel
  
• Ir. Manon van Eijsden Dr. Tanja Vrijkotte

2
The Problem

• Evidence
• - physical work load SGA (OR 1.2 1.4)
• work stress LBW

3
The Problem

• Evidence
• - physical work load SGA (OR 1.2 1.4)
• work stress LBW
• Amsterdam
• - SGA LBW gt, in particular among ethnic
  groups

4
The Problem

• Evidence
• - physical work load SGA (OR 1.2 1.4)
• work stress LBW
• Amsterdam
• - SGA LBW gt, in particular among ethnic
  groups
• Ethnic background

Work Profile
Birth Weight SGA
Other Factors
5
This Study

• Evidence
• physical work load SGA (OR 1.2 1.4)
• work stress BW
• Amsterdam
• - SGA LBW gt, in particular among ethnic groups
• Ethnic background

work profile
BW SGA
other factors

• PROSPECTIVE ABCD - COHORT - STUDY

Birth Weight
Work Profile
6
Design ABCD-study
Amsterdam Born Children and their Development

• General Design
• Prospective Cohort Study
• All Amsterdam pregnant women 1/1/2003-1/3/2004
• Prenatal biomedical psychosocial determinants
• Outcome at birth and later
• special attention for ethnicity

7
Design ABCD-study
Amsterdam Born Children and their Development

• General Design
• Prospective Cohort Study
• All Amsterdam pregnant women 1/1/2003-1/3/2004
• Prenatal biomedical psychosocial determinants
• Outcome at birth and later
• special attention for ethnicity

• Specific Design
• Self reported questionnaire at 14th week
  pregnancy
• Outcome - Birth weight
• - Gestational age

8
Pregnancy Questionnaire

• 4 WORK FACTORS
• Weekly working hours
• - 8-23
• - 24-31
• - 32 or more
• Weekly hours standing and/or walking
• - lt 10
• - 10-19
• - 20 or more
• Physical work load
• Job strain

In several languages!
9
Physical work load

• 7 Questions
• for example never some- often always
• times
• Do you need to carry heavy loads?
• Do you need to bend or reach?
• Does your work require strenuous physical
  activity?
• score 1 2 3 4

Sum score physical work load 0-7 low
8-20 moderate 21-28 high
10
Work stress

• International validated questionnaire
• Job Strain Model from Karasek

11 questions about job demands Do you work
under time pressure? Does your work need a lot
of concentration? 11 questions about job control
Do you have influence on planning your
tasks? Can you take a break if you want?
high moderate low
high
job demands
moderate
low
high moderate low
job control
11
Numbers ABCD-cohort

• 12.377 pregnant women invited for ABCD research
  (GBA)
• 8.267 questionnaire data available (67
  response)
• 6.941 Analysis sample
• exclusions - twins
• - preterm delivery
• - maternal age lt 20 year
• - pre-existense of hypertension or diabetes
  mellitus

35
65
12
Statistical Analysis
Univariaat

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Birth weight

13
Statistical Analysis
Univariaat Model 1
Maternal age Parity Pregnancy duration Maternal
length Maternal BMI Gender

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Birth weight

• Birth weight

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Statistical Analysis
Univariaat Model 1 Model 2
Maternal age Parity Pregnancy duration Maternal
length Maternal BMI Gender
Model 1 smoking maternal education marital
status parenting stress

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Risk factors
• weekly working hours
• hours standing walking
• physical work load
• job strain

• Birth weight

• Birth weight

• Birth weight

15
Birth Weight impact of Work
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Birth Weight impact of Work
17
Birth Weight impact of Work
18
Interaction Job Strain and Working Hours
Working hours
?143 gram
Birth Weight (gram)
Low Moderate High
19
Work Factors in Ethnic Groups
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Conclusions

• High impact of work on birth weight

21
Conclusions

• High impact of work on birth weight
• 32 Working hours high work stress
• 140 gram Birth Weight

22
Conclusions

• High impact of work on birth weight
• 32 Working hours high work stress
• 140 gram Birth Weight like smoking!

23
Conclusions

• High impact of work on birth weight
• 32 Working Hours High Work stress
• 140 gram Birth Weight like smoking!
• Plus smoking
• 300 gram Birth Weight

24
Conclusions

• High impact of work on birth weight
• 32 Working Hours High Work stress
• 140 gram Birth Weight like smoking!
• Plus smoking
• 300 gram Birth Weight
• Adverse work conditions more prevalent in ethnic
  workers

25
Preventive measures

• Should pregnant women with high work stress work
  less than 32 hours a week?
• Reduce work stress (also quit smoking!)
• Extra care for non-Western employees
• - higher risk
• - higher response (data not shown)

26
Thanks to
Municipal health Services Amsterdam Dr. Marcel
van der Wal Ir. Manon van Eijsden AMC Social
Medicine/Public Health Epidemiology Prof. Dr.
Gouke Bonsel AMC Netherlands Center for
Occupational Diseases Dr. T. Brand Amsterdam 8267
pregnant women and their care givers
27
Interaction Job Strain and Ethnicity