Bonzini Matteo, Coggon David, Palmer Keith T
Department of Occupational Health, University of Milan, Foundation IRCCS Ospedale Maggiore, Milan, Italy.
Occup Environ Med. 2007 Apr;64(4):228-43. doi: 10.1136/oem.2006.026872. Epub 2006 Nov 9.
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.
职业活动被怀疑会对妊娠结局产生不利影响。
评估与三种主要不良结局（早产、低出生体重和先兆子痫/妊娠期高血压）相关的五种常见职业暴露（长时间工作、轮班工作、提举重物、站立和繁重体力劳动）的证据。
利用关键词和医学主题词的组合，对Medline和Embase（1966年至2005年12月）进行系统检索。对于每篇相关论文，提取标准细节，然后用于总结研究的设计特征，评估其方法学质量（报告的完整性以及存在重要偏倚或混杂因素的可能性）并提供效应估计值。对于暴露和结局定义相似的研究，在荟萃分析中计算相对风险（RR）的合并估计值。
共识别出53篇报告——35篇关于早产，34篇关于出生体重，9篇关于先兆子痫或妊娠期高血压。其中包括21项队列研究。对于早产，发现了与每种感兴趣的暴露相关的大量证据。研究结果总体一致，倾向于排除大于中度的效应量（RR>1.4）。规模较大且最完整的研究结果不太乐观，风险合并估计值仅显示出适度或无效应。对于小于胎龄儿，情况类似，但证据基础较为有限。对于先兆子痫和妊娠期高血压，证据量过少，无法得出确凿结论。
证据的平衡不足以令人信服地证明对本综述中考虑的任何活动进行强制性限制是合理的。然而，鉴于证据基础存在一些不确定性，且明显没有重要的有益影响，建议避免长时间工作、长时间站立和繁重体力劳动，尤其是在妊娠晚期，这可能是谨慎之举。我们的综述确定了未来调查的几个重点。
