Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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Women's Employment in Industries and Risk of Preeclampsia and Gestational Diabetes: A National Population Study of Republic of Korea

  • Jeong-Won Oh (Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital) ;
  • Seyoung Kim (Department of Public Health Science, Graduate School of Public Health, Seoul National University) ;
  • Jung-won Yoon (Department of Obstetrics and Gynecology, National Medical Center) ;
  • Taemi Kim (Department of Public Health, Korea University) ;
  • Myoung-Hee Kim (Center for Public Health Data Analytics, National Medical Center) ;
  • Jia Ryu (Department of Occupational Medicine, Catholic Kwandong University) ;
  • Seung-Ah Choe (Department of Public Health, Korea University)
  • Received : 2023.03.27
  • Accepted : 2023.08.02
  • Published : 2023.09.30
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Abstract

Background: Some working conditions may pose a higher physical or psychological demand to pregnant women leading to increased risks of pregnancy complications. Objectives: We assessed the association of woman's employment status and the industrial classification with obstetric complications. Methods: We conducted a national population study using the National Health Information Service database of Republic of Korea. Our analysis encompassed 1,316,310 women who experienced first-order live births in 2010-2019. We collected data on the employment status and the industrial classification of women, as well as their diagnoses of preeclampsia (PE) and gestational diabetes mellitus (GDM) classified as A1 (well controlled by diet) or A2 (requiring medication). We calculated odds ratios (aORs) of complications per employment, and each industrial classification was adjusted for individual risk factors. Results: Most (64.7%) were in employment during pregnancy. Manufacturing (16.4%) and the health and social (16.2%) work represented the most prevalent industries. The health and social work exhibited a higher risk of PE (aOR = 1.11, 95% confidence interval [CI]: 1.03-1.21), while the manufacturing industry demonstrated a higher risk of class A2 GDM (1.20, 95% CI: 1.03-1.41) than financial intermediation. When analyzing both classes of GDM, women who worked in public administration and defense/social security showed higher risk of class A1 GDM (1.04, 95% CI: 1.01, 1.07). When comparing high-risk industries with nonemployment, the health and social work showed a comparable risk of PE (1.02, 95% CI: 0.97, 1.07). Conclusion: Employment was associated with overall lower risks of obstetric complications. Health and social service work can counteract the healthy worker effect in relation to PE. This highlights the importance of further elucidating specific occupational risk factors within the high-risk industries.

Keywords

Acknowledgement

This study used the customized research database from the National Health Insurance Data Sharing Service (NHIS-2021-1-211). The conclusion of this study is not related with these institutions.

References

  1. Suzumori N, Ebara T, Matsuki T, Yamada Y, Kato S, Omori T, Saitoh S, Kamijima M, Sugiura-Ogasawara M. Effects of long working hours and shift work during pregnancy on obstetric and perinatal outcomes: a large prospective cohort study-Japan Environment and Children's Study. Birth 2020;47(1):67-79.  https://doi.org/10.1111/birt.12463
  2. Bonzini M, Coggon D, Palmer KT. Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review. Occup Environ Med 2007;64(4):228-43.  https://doi.org/10.1136/oem.2006.026872
  3. Ostlund I, Haglund B, Hanson U. Gestational diabetes and preeclampsia. Eur J Obstetrics, Gynecol Reprod Biol 2004;113(1):12-6.  https://doi.org/10.1016/j.ejogrb.2003.07.001
  4. Lain KY, Roberts JM. Contemporary concepts of the pathogenesis and management of preeclampsia. Jama 2002;287(24):3183-6.  https://doi.org/10.1001/jama.287.24.3183
  5. Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia. New Engl J of Med 2022;386(19):1817-32.  https://doi.org/10.1056/NEJMra2109523
  6. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 2018;72(1):24-43.  https://doi.org/10.1161/HYPERTENSIONAHA.117.10803
  7. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive services task force and the National Institutes of Health office of medical applications of research. Ann Intern Med 2013;159(2):123-9.  https://doi.org/10.7326/0003-4819-159-2-201307160-00661
  8. Lewandowska M, Wieckowska B, Sajdak S. Pre-pregnancy obesity, excessive gestational weight gain, and the risk of pregnancy-induced hypertension and gestational diabetes mellitus. J Clin Med 2020;9(6). 
  9. ACOG. ACOG practice bulletin No. 190: gestational diabetes mellitus. Obstetrics Gynecol 2018;131(2):e49-64.  https://doi.org/10.1097/AOG.0000000000002501
  10. Saravanan P. Gestational diabetes: opportunities for improving maternal and child health. Lancet Diabetes Endocrinol 2020;8(9):793-800.  https://doi.org/10.1016/S2213-8587(20)30161-3
  11. Spadarella E, Leso V, Fontana L, Giordano A, Iavicoli I. Occupational risk factors and hypertensive disorders in pregnancy: a systematic review. Int J Environ Res Public Health 2021;18(16). 
  12. Women in the health and care sector earn 24 per cent less than men. https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_850968/lang-en/index.htm. 
  13. Nugteren JJ, Snijder CA, Hofman A, Jaddoe VWV, Steegers EAP, Burdorf A. Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study. PLoS One 2012;7(6) e39263-e39263.  https://doi.org/10.1371/journal.pone.0039263
  14. Seong SC, Kim YY, Khang YH, Park JH, Kang H-J, Lee H, Do C-H, Song J-S, Bang JH, Ha S, Lee E-J, Shin SA. Data resource profile: the National Health Information database of the National Health Insurance service in South Korea. Int J Epidemiol 2017;46(3):799-800. 
  15. NHIS. Statistics of the national health insurance 2016. National Health Insurance Service; 2017. 
  16. Park S. Medical service utilization and out-of-pocket spending among nearpoor National Health Insurance members in South Korea. BMC Health Serv Res 2021;21(1):886. 
  17. Vital statistics - number of live births [https://kosis.kr/eng/] 
  18. National health insurance statistical Yearbook; 2015.. http://www.nhis.or.kr/menu/boardRetriveMenuSet.xx?menuId=F3321. 
  19. Choe SA, Min HS, Cho SI. Decreased risk of preeclampsia after the introduction of universal voucher scheme for antenatal care and birth services in the Republic of Korea. Matern Child Health J 2017;21(1):222-7.  https://doi.org/10.1007/s10995-016-2112-z
  20. Choe SA, Kauderer S, Eliot MN, Glazer KB, Kingsley SL, Carlson L, Awad YA, Schwartz JD, Savitz DA, Wellenius GA. Air pollution, land use, and complications of pregnancy. Sci Total Environ 2018;645:1057-64.  https://doi.org/10.1016/j.scitotenv.2018.07.237
  21. These global cities have the highest cost of living [https://www.forbes.com/sites/anthonytellez/2022/06/29/these-global-cities-have-the-highest-cost-ofliving/?sh=23a5f5072d3e] 
  22. Kim CB, Choe SA, Kim T, Kim MH, Ryu J, Oh JW, Yoon JW. Risk of adverse pregnancy outcomes by maternal occupational status: a national population-based study in South Korea. J Occup Health 2023;65(1):e12380. 
  23. Jansen PW, Tiemeier H, Verhulst FC, Burdorf A, Jaddoe VW, Hofman A, Moll HA, Verburg BO, Steegers EA, Mackenbach JP, Raat H. Employment status and the risk of pregnancy complications: the Generation R Study. Occup Environ Med 2010;67(6):387-94.  https://doi.org/10.1136/oem.2009.046300
  24. Eskenazi B, Fenster L, Sidney S. A multivariate analysis of risk factors for preeclampsia. Jama 1991;266(2):237-41.  https://doi.org/10.1001/jama.1991.03470020063033
  25. Schuring M, Burdorf L, Kunst A, Mackenbach J. The effects of ill health on entering and maintaining paid employment: evidence in European countries. J Epidemiol Community Health 2007;61(7):597-604.  https://doi.org/10.1136/jech.2006.047456
  26. Lissaker C, Hemmingsson T, Kjellberg K, Lindfors P, Selander J. Occupational stress and pregnancy-related hypertension and diabetes: results from a nationwide prospective cohort. Scand J Work Environ Health 2022;48(3):239-47.  https://doi.org/10.5271/sjweh.4004
  27. Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2020;222(3):224-38.  https://doi.org/10.1016/j.ajog.2019.08.059
  28. Vollebregt K, Van Der Wal M, Wolf H, Vrijkotte T, Boer K, Bonsel G. Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? BJOG: Int J Obstetrics Gynaecol 2008;115(5):607-15.  https://doi.org/10.1111/j.1471-0528.2008.01665.x
  29. 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;(4):304-17. 
  30. Nugteren JJ, Snijder CA, Hofman A, Jaddoe VW, Steegers EA, Burdorf A. Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study. PLoS One 2012;7(6):e39263. 
  31. Spinillo A, Capuzzo E, Colonna L, Piazzi G, Nicola S, Baltaro F. The effect of work activity in pregnancy on the risk of severe preeclampsia. Aust N Z J Obstet Gynaecol 1995;35(4):380-5.  https://doi.org/10.1111/j.1479-828X.1995.tb02146.x
  32. Cusimano MC, Baxter NN, Sutradhar R, McArthur E, Ray JG, Garg AX, Vigod S, Simpson AN. Evaluation of adverse pregnancy outcomes in physicians compared with nonphysicians. JAMA Netw Open 2022;5(5):e2213521. 
  33. Ortayli N, Ozugurlu M, Gokcay G. Female health workers: an obstetric risk group. Int J Gynaecol Obstet 1996;54(3):263-70.  https://doi.org/10.1016/0020-7292(96)02717-8
  34. Gabbe SG, Morgan MA, Power ML, Schulkin J, Williams SB. Duty hours and pregnancy outcome among residents in obstetrics and gynecology. Obstet Gynecol 2003;102(5 Pt 1):948-51.  https://doi.org/10.1097/00006250-200311000-00012
  35. Behbehani S, Tulandi T. Obstetrical complications in pregnant medical and surgical residents. J Obstet Gynaecol Can 2015;37(1):25-31.  https://doi.org/10.1016/S1701-2163(15)30359-5
  36. Skroder H, Pettersson H, Albin M, Gustavsson P, Rylander L, Norlen F, Selander J. Occupational exposure to whole-body vibrations and pregnancy complications: a nationwide cohort study in Sweden. Occup Environ Med 2020;77(10):691-8.  https://doi.org/10.1136/oemed-2020-106519
  37. Lissaker CT, Gustavsson P, Albin M, Ljungman P, Bodin T, Sjostrom M, Selander J. Occupational exposure to noise in relation to pregnancy-related hypertensive disorders and diabetes. Scand J Work Environ Health 2021;47(1):33-41.  https://doi.org/10.5271/sjweh.3913
  38. Myoga M, Tsuji M, Tanaka R, Shibata E, Askew DJ, Aiko Y, Senju A, Kawamoto T, Hachisuga T, Araki S, Kusuhara K, Morokuma S, Sanefuji M, Japan Environment and Children's Study. Impact of sleep duration during pregnancy on the risk of gestational diabetes in the Japan environmental and Children's study (JECS). BMC Pregnancy Childbirth 2019;19(1):483. 
  39. Fujiwara K, Tsukishima E, Kasai S, Masuchi A, Tsutsumi A, Kawakami N, Miyake H, Kishi R. Urinary catecholamines and salivary cortisol on workdays and days off in relation to job strain among female health care providers. Scand J Work Environ Health 2004;30(2):129-38.  https://doi.org/10.5271/sjweh.770
  40. Khatun S, Kanayama N, Hossain B, el Maradny E, Kobayashi T, Jahan S, Bhuiyan AB, Terao T. Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia. Eur J Obstetrics, Gynecol Reprod Biol 1997;74(1):103-9.  https://doi.org/10.1016/S0301-2115(97)00112-7
  41. Karteris E, Vatish M, Hillhouse EW, Grammatopoulos DK. Preeclampsia is associated with impaired regulation of the placental nitric oxide-cyclic guanosine monophosphate pathway by corticotropin-releasing hormone (CRH) and CRH-related peptides. J Clin Endocrinol Metab 2005;90(6):3680-7.  https://doi.org/10.1210/jc.2004-2210
  42. Briancon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 2015;7:25. 
  43. Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstetrics Gynecol 2019;221(6):563-76.  https://doi.org/10.1016/j.ajog.2019.06.051
  44. Coussons-Read ME, Okun ML, Nettles CD. Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Brain Behav Immun 2007;21(3):343-50.  https://doi.org/10.1016/j.bbi.2006.08.006
  45. Pregnant workers can also take parental leave... Flexible commuting hours as well [https://www.korea.kr/news/policyNewsView.do?newsId=148895764#goList]