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      Shift Work Effects and Pregnancy Outcome: A Historical Cohort Study

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          Abstract

          Objective: Employed mothers face considerable amount of hazards. Especially shift work can impact pregnant women by affecting some hormones. This study was conducted to assess the adverse effects of shift work on pregnancy outcomes.

          Materials and methods: This historical cohort study was conducted in 2017 in order to assess the effect of shift work on pregnancy outcomes. The subjects were consecutively selected from pregnant women, which referred to Al Zahra and Shahid Beheshti hospitals, Isfahan, Iran for their pregnancy care. The effect of shift work on pregnancy and labor complications (low birth weight, small for gestational age, pre-eclampsia and eclampsia, intra-uterine growth retardation, spontaneous abortion, preterm delivery, excessive bleeding during labor, and type of labor) was assessed. The effect was adjusted for occupation and number of children as well. Data were analyzed by SPSS (ver. 17) usingT-test, chi-Square test and logistic regression analysis.

          Results: Totally, 429 pregnant women entered the study. There was not a statistically significant difference between morning and shift workers regarding age. It was found that shift work probably increases the incidence of small for gestational age, pre-eclampsia and eclampsia, intra-uterine growth retardation, spontaneous abortion, and preterm delivery, but after adjustment for job and number of children the effect was observed only on preterm delivery.

          Conclusion: Working in a rapid cycling schedule of shift work may cause an increase in the incidence of preterm delivery in pregnant mothers.

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          Most cited references18

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          Health disorders of shift workers.

          The effects of shift work on physiological function through disruption of circadian rhythms are well described. However, shift work can also be associated with specific pathological disorders. This article reviews the evidence for a relationship between specific medical disorders and working at night or on shift systems. The strongest evidence exists for an association with peptic ulcer disease, coronary heart disease and compromised pregnancy outcome.
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            Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review.

            Occupational activities are suspected of having an adverse impact on outcomes of pregnancy. To assess the evidence relating three major adverse outcomes (preterm delivery, low birthweight (LBW) and pre-eclampsia/gestational hypertension) to five common occupational exposures (prolonged working hours, shift work, lifting, standing and heavy physical workload). A systematic search of Medline and Embase (1966-December 2005) using combinations of keywords and medical subject heading terms was conducted. For each relevant paper, standard details were abstracted that were then used to summarise the design features of studies, to rate their methodological quality (completeness of reporting and potential for important bias or confounding) and to provide estimates of effect. For studies with similar definitions of exposure and outcome, pooled estimates of relative risk (RR) in meta-analysis were calculated. 53 reports were identified-35 on preterm delivery, 34 on birth weight and 9 on pre-eclampsia or gestational hypertension. These included 21 cohort investigations. For pre-term delivery, extensive evidence relating to each of the exposures of interest was found. Findings were generally consistent and tended to rule out a more than moderate effect size (RR >1.4). The larger and most complete studies were less positive, and pooled estimates of risk pointed to only modest or null effects. For small-for-gestational age, the position was similar, but the evidence base was more limited. For pre-eclampsia and gestational hypertension, it was too small to allow firm conclusions. The balance of evidence is not sufficiently compelling to justify mandatory restrictions on any of the activities considered in this review. However, given some uncertainties in the evidence base and the apparent absence of important beneficial effects, it may be prudent to advise against long working hours, prolonged standing and heavy physical work, particularly late in pregnancy. Our review identifies several priorities for future investigation.
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              Shift work and pregnancy outcomes: a systematic review with meta-analysis of currently available epidemiological studies.

              Varying work schedules are suspected of increasing risks to pregnant women and to fetal wellbeing. In particular, maternal hormonal disturbance arising from sleep deprivation or circadian rhythm disruption might impair fetal growth or lead to complications of pregnancy. Two independent meta-analyses (from 2000 to 2007) reported a small adverse effect of shift work on the risk of preterm delivery (PTD). However, these reviews were based on few high-quality studies. To provide an updated review of the associations of shift work with PTD, low birthweight (LBW), small-for-gestational-age (SGA) infants and pre-eclampsia. We conducted a systematic search of MEDLINE using combinations of keywords and MeSH terms. For each relevant paper we abstracted standard details, used to summarise design features and rate methodological quality. We calculated pooled estimates of relative risk (RR) in random-effect meta-analyses. We retrieved 23 relevant studies. The pooled estimate of RR for PTD was 1.16 (95% CI 1.00-1.33, 16 studies), but when five reports of poorer methodological quality were excluded, the estimated RR decreased to 1.03 (95% CI 0.93-1.14). We also observed increased RRs for LBW (RR 1.27, 95% CI 0.93-1.74) and for SGA (RR 1.12, 95% CI 1.03-1.22), which varied little by study quality. Little evidence was found on pre-eclampsia. These findings suggest that overall, any risk of PTD, LBW, or SGA arising from shift work in pregnancy is small. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
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                Author and article information

                Journal
                J Family Reprod Health
                J Family Reprod Health
                JFRH
                Journal of Family & Reproductive Health
                Tehran University of Medical Sciences (Tehran, Iran )
                1735-8949
                1735-9392
                June 2018
                : 12
                : 2
                : 84-88
                Affiliations
                [1 ]Industrial Disease Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                [2 ]Isfahan University of Medical Sciences, Isfahan, Iran
                [3 ]Health and Environment, Department of Management Planning and Environmental Education, Tehran University, Tehran, Iran
                Author notes
                Correspondence: Maryam Bahaloo, Occupational Medicine Clinic, Shahid Rahnemoun Hospital, Farrokhi Ave., Yazd, Iran. Email: drbahaloo@ 123456gmail.com
                Article
                JFRH-12-84
                6391306
                30820211
                9616966c-e1a5-465a-ae51-489dd5d17659
                Copyright © Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : June 2018
                : June 2018
                : June 2018
                Categories
                Original Article

                pregnancy,shift work,working women,pregnancy complications

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