University of Southampton, Faculty of Medicine, Academic Unit of Human Development and Health, Southampton, and Kings College London, Women's Academic Health Centre, St. Thomas' Hospital, London, United Kingdom.
Obstet Gynecol. 2014 Jul;124(1):99-110. doi: 10.1097/AOG.0000000000000321.
To determine whether an association exists between shift work and early reproductive outcomes.
MEDLINE, Embase, and Web of Science were searched. Additional sources included Google Scholar, the Cochrane Library, online publications of national colleges, the ClinicalTrials.gov, and references of retrieved papers.
Included studies compared female shift workers (work outside 8:00 AM to 6:00 PM) with nonshift workers with menstrual disruption (cycles less than 25 days or greater than 31 days), infertility (time-to-pregnancy exceeding 12 months), or early spontaneous pregnancy loss (less than 25 weeks).
TABULATION, INTEGRATION, AND RESULTS: Two reviewers extracted adjusted and raw data. Random effect models were used to pool data weighting for the inverse of variance. Assessments of heterogeneity, bias, and subgroup analyses were performed. Sixteen independent cohorts from 15 studies (123,403 women) were subject to analysis. Shift workers had increased rates of menstrual disruption (16.05% [2,207/13,749] compared with 13.05% [7,561/57,932] [n=71.681, odds ratio {OR} 1.22, 95% confidence interval {CI} 1.15-1.29, I 0%]) and infertility (11.3% [529/4,668] compared with 9.9% [2,354/23,811] [OR 1.80, 95% CI 1.01-3.20, I 94%]) but not early spontaneous pregnancy loss (11.84% [939/7,931] compared with 12.11% [1,898/15,673] [n=23,604, OR 0.96, 95% CI 0.88-1.05, I 0%]). Night shifts were associated with increased early spontaneous pregnancy loss (n=13,018, OR 1.29, 95% CI 1.11-1.50, I 0%). Confounder adjustment led to persistent relationships between shift work and menstrual disruption (adjusted OR 1.15, 95% CI 1.01-1.31, I 70%) but not infertility (adjusted OR 1.11 95% CI 0.86-1.44, I 61%). The association between night shifts and early spontaneous pregnancy loss remained (adjusted OR 1.41 95% CI 1.22-1.63, I 0%).
This review provides evidence for an association between performing shift work and early reproductive outcomes, consistent with later pregnancy findings. However, there is currently insufficient evidence for clinicians to advise restricting shift work in women of reproductive age.
确定轮班工作与早期生殖结局之间是否存在关联。
检索 MEDLINE、Embase 和 Web of Science。其他来源包括 Google Scholar、Cochrane 图书馆、国家学院的在线出版物、ClinicalTrials.gov 以及检索到的论文参考文献。
纳入的研究将轮班工作的女性（工作时间在上午 8:00 至下午 6:00 以外）与月经紊乱（周期少于 25 天或超过 31 天）、不孕（妊娠时间超过 12 个月）或早期自然流产（少于 25 周）的非轮班工作女性进行比较。
数据的提取、综合和结果：两位评审员提取了调整后和原始数据。使用随机效应模型对数据进行加权，权重为方差的倒数。进行了异质性、偏倚和亚组分析评估。15 项研究中的 16 项独立队列（123403 名女性）进行了分析。轮班工作者的月经紊乱发生率较高（16.05%[2,227/13749]，而 13.05%[7,561/57932]，n=71681，比值比{OR}1.22，95%置信区间{CI}1.15-1.29，I 0%）和不孕（11.3%[529/4668]，而 9.9%[2,354/23811]，n=23604，OR 1.80，95%CI 1.01-3.20，I 94%），但早期自然流产发生率没有增加（11.84%[939/7931]，而 12.11%[1,898/15673]，n=23，604，OR 0.96，95%CI 0.88-1.05，I 0%）。夜班与早期自然流产增加有关（n=13018，OR 1.29，95%CI 1.11-1.50，I 0%）。调整混杂因素后，轮班工作与月经紊乱之间仍存在关联（调整后 OR 1.15，95%CI 1.01-1.31，I 70%），但与不孕无关（调整后 OR 1.11，95%CI 0.86-1.44，I 61%）。夜班与早期自然流产之间的关联仍然存在（调整后 OR 1.41，95%CI 1.22-1.63，I 0%）。
本综述提供了轮班工作与早期生殖结局之间存在关联的证据，与后期妊娠研究结果一致。然而，目前还没有足够的证据让临床医生建议限制育龄妇女的轮班工作。
