Population-based study on occupational risk factors for preeclampsia and gestational hypertension

Abstract

Haelterman E, Marcoux S, Croteau A, Dramaix M. Population-based study on occupational risk factors for preeclampsia and gestational hypertension. Scand J Work Environ Health 2007;33(4):304-317.Objectives Preeclampsia is a leading cause of maternal and perinatal morbidity. Work-related factors may influence the occurrence of this disorder. This case-control study estimated the associations between work-related physical and psychosocial factors and the risk of preeclampsia and gestational hypertension. MethodsThe eligible women consisted of a random sample of the women who delivered a singleton live birth in 1997-1999 in six regions of Quebec and worked during pregnancy. Cases of preeclampsia (N=102) and gestational hypertension (N=99) were compared with normotensive controls (N=4381). Information on occupational exposures at the onset of pregnancy was collected during phone interviews a few weeks after delivery. Detailed information was obtained on work schedule, postures, physical exertion, work organization, noise, vibration, and extreme temperature. Adjusted odds ratios (aOR) were estimated through polytomous logistic regression. ResultsWomen standing daily at least 1 hour consecutively without walking experienced a higher risk of preeclampsia [aOR 2.5, 95% confidence interval (95% CI) 1.4-4.6], as well as women climbing stairs frequently (aOR 2.3, 95% CI 1.2-4.1) and women working more than 5 consecutive days without a day-off (aOR 3.0, 95% CI 1.0-9.5). Squatting or kneeling, pushing or pulling objects, whole-body vibration, forced pace, job strain, and no control on breaks were positively, but nonsignificantly, associated with preeclampsia. The associations were weaker for gestational hypertension.Conclusions These findings suggest that being exposed to physically demanding and stressful occupational conditions at the onset of pregnancy increases the risk of preeclampsia.

Psychosocial Stress Related to the Loss of a Close Relative the Year Before or During Pregnancy and Risk of Preeclampsia

“…Because of their smaller sample sizes and lower exposure contrasts, all earlier follow-up 11,13,27 and several retrospective studies 10,12 had limited statistical power to detect a modest association of the magnitude we reported. In 3 of the 5 retrospective studies in this field, stress exposure during pregnancy was reported after delivery; 12,15,16 thus the observed associations may have been overestimated due to differential recall 12,15,16 or may be-at least partly-attributable to reverse causation. 16 In the other 2 of the 5 investigations using retrospective data, 10,14 women were assigned job stress scores based on their occupational titles, which may have led to a nondifferential misclassification of exposure and thus a likely underestimation of the association.…”

“…5 Psychosocial stress induces sympathetic arousal, activates the hypothalamic-pituitaryadrenal axis, and may thus promote endothelial dysfunction, 6 proinflammatory activity, 7,8 and blood pressure elevations. 9 Only a few studies have investigated the association between antenatal stress and preeclampsia and their findings are not conclusive, perhaps because of low statistical power, [10][11][12][13] exposure misclassification, 10,12,[14][15][16] induced in part by coping, and the risk of reverse causation. 16 Death of a close family member is considered one of the most severe sources of stress exposure, 17 especially, if the loss is unexpected or if it involves children or the spouse 17 ; it is likely to lead to a hormonal response irrespective of coping capacity.…”

Good practice in occupational health services – The influence of hazardous conditions and nuisance coexisting in the work environment and at home on the course and outcome of pregnancy

“…Inne badania nie potwierdzają jednak tych zależności. Wprawdzie nadciśnienie ciążowe i stany przedrzucawkowe występowały nieco częściej u kobiet, które pracowały w wymuszonym tempie i nie mogły decydować o przerwach w pracy, ale związek ten nie był istotny statystycznie [47].…”

Early- and late-onset preeclampsia and the DNA methylation of circadian clock and clock-controlled genes in placental and newborn tissues

“…Recent reports, studying women working night shifts (in services such as healthcare, military, protection and airway), show associations between disrupting the light-dark cycle during pregnancy and a higher risk of PTB, low birth weight, spontaneous abortion and subfertility (Knutsson, 2003;Mahoney, 2010;Waddell et al, 2012). So far, however, only a few data are available on associations between alterations of the circadian rhythm and PE (Ditisheim et al, 2013;Haelterman et al, 2007;Mozurkewich et al, 2000;Wergeland & Strand, 1997). In this regard of interest is the hormone melatonin, which is regulated by the circadian clock and synthesized by the placenta thereby protecting against excessive oxidative stress involved in the pathogenesis of PE (Chen et al, 2013;Hobson et al, 2013;Valenzuela et al, 2015).…”