Klebanoff M A, Shiono P H, Rhoads G G
Division of Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892.
N Engl J Med. 1990 Oct 11;323(15):1040-5. doi: 10.1056/NEJM199010113231506.
Physically demanding, highly stressful work during pregnancy has been reported to cause a variety of adverse outcomes. It has been difficult, however, to separate the effects of work from those of socioeconomic status.
By means of a national questionnaire-based survey, we studied the outcomes of pregnancy during residency for 4412 women who graduated from medical school in 1985 and for the wives of 4236 of their male classmates, who served as controls.
The rate of response to our survey was 87 percent (4412 of 5079) for the women residents and 85 percent (4236 of 4968) for the wives of the male residents. There were no significant differences in the proportion of pregnancies ending in miscarriage (13.8 percent for residents vs. 11.8 percent for their classmates' wives, P = 0.12), ectopic gestations (0.5 percent vs. 0.8 percent, P = 0.69), and stillbirths (0.2 percent vs. 0.5 percent, P = 0.20). There were 989 women residents and 1238 residents' wives whose first pregnancy during residency resulted in the live birth of a singleton infant. Although during each trimester the women residents worked many more hours than the wives of the male residents, the frequency of preterm births (less than 37 weeks' gestation) was similar: 6.5 percent for residents and 6.0 percent for residents' wives (odds ratio = 1.1; 95 percent confidence interval, 0.7 to 1.5). Infants who were small for gestational age (with birth weights less than the 10th percentile for gestational age) were born to 5.3 percent of the residents and 5.8 percent of the residents' wives (odds ratio = 0.9; 95 percent confidence interval, 0.6 to 1.3). Adjustment for factors that differed between the women residents and the wives of male residents resulted in odds ratios of 1.2 (95 percent confidence interval, 0.8 to 1.7) for preterm delivery and 0.9 (95 percent confidence interval, 0.6 to 1.3) for the delivery of an infant who was small for gestational age. However, the women residents more frequently reported having had preterm labor (11 percent vs. 6 percent), but not preterm delivery (6.5 percent vs. 6.0 percent); preeclampsia was also more common among the women residents (8.8 percent vs. 3.5 percent).
These results suggest that working long hours in a stressful occupation has little effect on the outcome of pregnancy in an otherwise healthy population of high socioeconomic status.
据报道，孕期从事体力要求高、压力大的工作会导致多种不良后果。然而，很难将工作的影响与社会经济地位的影响区分开来。
通过一项基于全国问卷调查的研究，我们对1985年医学院毕业的4412名女性住院医师以及作为对照的4236名男性住院医师的妻子孕期情况进行了研究。
女性住院医师的调查回复率为87%（5079人中的4412人），男性住院医师妻子的调查回复率为85%（4968人中的4236人）。流产（住院医师为13.8%，其同学妻子为11.8%，P = 0.12）、异位妊娠（0.5%对0.8%，P = 0.69）和死产（0.2%对0.5%，P = 0.20）的妊娠比例无显著差异。有989名女性住院医师和1238名住院医师的妻子在住院实习期间首次怀孕并产下单胎活婴。尽管在每个孕期，女性住院医师的工作时间都比男性住院医师的妻子多很多，但早产（孕周小于37周）的发生率相似：住院医师为6.5%，住院医师的妻子为6.0%（优势比 = 1.1；95%置信区间，0.7至1.5）。孕周小的婴儿（出生体重低于孕周的第10百分位数）在5.3%的住院医师和5.8%的住院医师妻子中出生（优势比 = 0.9；95%置信区间，0.6至1.3）。对女性住院医师和男性住院医师妻子之间不同的因素进行调整后，早产的优势比为1.2（95%置信区间，0.8至1.7），孕周小的婴儿出生的优势比为0.9（95%置信区间，0.6至1.3）。然而，女性住院医师更频繁地报告有早产迹象（11%对6%），但早产分娩情况并非如此（6.5%对6.0%）；子痫前期在女性住院医师中也更常见（8.8%对3.5%）。
这些结果表明，在社会经济地位较高的健康人群中，从事压力大的职业且长时间工作对妊娠结局影响不大。
