Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Occup Environ Med. 2011 Mar;68(3):197-204. doi: 10.1136/oem.2009.046516. Epub 2010 Dec 20.
To investigate the influence of maternal working conditions on fertility and pregnancy outcomes.
8880 women were enrolled in a large prospective birth cohort during early (76%), mid (21%) or late pregnancy (3%) (61% participation). Complete questionnaire information was available for 6302 women (71% response). Outcomes were prolonged time to pregnancy (TTP) (> 6 months), preterm birth (< 37 weeks) and decreased birth weight (< 3000 g). Self-reported exposure to chemical agents was based on a limited list of chemicals. Physical load questions concerned manual materials handling, prolonged sitting and long periods of standing. A job-exposure matrix (JEM) linked reported job title to workplace chemical exposure within jobs according to expert judgement. Associations between maternal occupational exposure and fertility and pregnancy outcomes, adjusted for age, education, minority, parity, smoking and alcohol use, were studied using logistic regression analysis.
Women in jobs with regular handling of loads ≥ 5 kg had better fertility and pregnancy outcomes. No self-reported exposure to chemicals was associated with any outcomes and self-assessments had very low reliability compared with JEM-based assessments. JEM-based maternal occupational exposure to phthalates was associated with prolonged TTP (OR 2.16, 95% CI 1.02 to 4.57) and exposure to pesticides was associated with decreased birth weight (OR 2.42, 95% CI 1.10 to 5.34). The population attributable fractions were small at 0.7% for phthalates and 0.7% for pesticides.
This birth cohort study presents evidence of health-based selection into the workforce and adverse effects of maternal occupational exposure to phthalates and pesticides on fertility and pregnancy outcomes.
研究产妇工作条件对生育和妊娠结局的影响。
在妊娠早期（76%）、中期（21%）或晚期（3%）（61%的参与率），有 8880 名妇女参加了一个大型前瞻性生育队列研究。共有 6302 名妇女（71%的回应率）提供了完整的问卷信息。结局包括妊娠时间延长（TTP）（>6 个月）、早产（<37 周）和出生体重下降（<3000g）。自我报告的接触化学物质是基于有限的化学物质清单。体力负荷问题涉及手动搬运材料、长时间坐着和长时间站立。职业暴露矩阵（JEM）根据专家判断，将报告的工作职位与工作场所的化学暴露联系起来。使用逻辑回归分析，研究了产妇职业暴露与生育和妊娠结局之间的关系，调整了年龄、教育程度、少数民族、产次、吸烟和饮酒等因素。
经常搬运负荷≥5kg的女性生育和妊娠结局更好。没有自我报告的接触化学物质与任何结局有关，与基于 JEM 的评估相比，自我评估的可靠性非常低。基于 JEM 的母体职业性邻苯二甲酸酯暴露与 TTP 延长（OR 2.16，95%CI 1.02-4.57）和接触农药与出生体重下降（OR 2.42，95%CI 1.10-5.34）有关。邻苯二甲酸酯和农药的人群归因分数分别为 0.7%和 0.7%，很小。
这项队列研究提供了基于健康的劳动力选择和母体职业性邻苯二甲酸酯和农药暴露对生育和妊娠结局的不良影响的证据。
