The following is a summary of “Working conditions in women with multiple pregnancy—the impact on preterm birth and adherence to guidelines: a prospective cohort study,” published in the JUNE 2023 issue of Obstetrics and Gynecology by Beukering, et al.

Women with multiple pregnancies are at higher risk of maternal complications, including preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, may further increase these women’s risk of preterm birth. For a study, researchers sought to determine whether specific working conditions during the first 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to assess whether the working conditions of Dutch women with multiple pregnancies align with the Netherlands Society of Occupational Medicine guidelines.

The researchers conducted a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial examining the effectiveness of cervical pessaries in preventing preterm birth. Participants who worked for more than 8 hours per week completed questionnaires on 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 at 32-36 weeks and very preterm birth at less than 32 weeks. A subgroup of participants who worked for more than half of the week (more than 28 hours) was also analyzed. The proportion of women who reported work-related factors inconsistent with the guidelines was calculated.

The study included 383 women, with 168 (44%) in the pessary group, 142 (37%) in the care as usual group, and 73 (19%) not participating in the randomized part of the study. After adjusting for confounding variables, working more than 28 hours was associated with a higher risk of very preterm birth (78%) (adjusted odds ratio, 3.0; 95% CI, 1.1-8.1), while irregular working hours were associated with preterm birth (17%) (adjusted odds ratio, 2.0; 95% CI, 1.0-4.1) and very preterm birth (24%) (adjusted odds ratio, 2.7; 95% CI, 1.0-7.3). Among the subgroup of 213 participants working more than 28 hours per week, the multivariable analysis revealed that irregular working hours (20%) (adjusted odds ratio, 3.5; 95% CI, 1.2-10.1) and having little or no freedom in task performance (28%) (adjusted odds ratio, 3.0; 95% CI, 1.3-7.3) were associated with preterm birth. Irregular working hours (27%) (adjusted odds ratio, 3.4; 95% CI, 1.0-11.1), physical strength requirements (27%) (adjusted odds ratio, 5.3; 95% CI, 1.6-17.8), high physical workload (21%) (adjusted odds ratio, 3.9; 95% CI, 1.1-13.9), and lack of freedom in task performance (30%) (adjusted odds ratio, 3.2; 95% CI, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 58.5% of women with multiple pregnancies continued to work under conditions that did not align with the guidelines to avoid physical and job strain and long and irregular working hours.

In the cohort study, a significant proportion of women with multiple pregnancies worked under conditions not in accordance with the guidelines, which could increase the risk of preterm birth. Irregular working hours and long working hours were associated with preterm and very preterm birth. It highlighted the need for better adherence to guidelines and interventions to improve working conditions for pregnant women with multiple pregnancies.

Source: ajog.org/article/S0002-9378(22)02169-X/fulltext