Makowiec-Dabrowska T, Radwan-Włodarczyk Z, Koszada-Włodarczyk W, Siedlecka J, Wilczyński J
Zakładu Fizjologii Pracy in Ergonomii Instytutu Medycyny Pracy im. Lodzi.
Med Pr. 1997;48(3):239-59.
The authors present a review of the literature on adverse effects of chemical and physical factors in the work environment on the course and outcome of pregnancy together with the results of their own study. The objective of the study was to identify the magnitude and frequency of exposures to chemical and physical factors at workposts where pregnant women were employed and to asses to what extent the existing exposure increased the risk for complications in pregnancy outcome The study involved the collection of information on factors with potential adverse effect on the course and outcome of pregnancy in employed women who were hospitalised in the Polish Mother Memorial Hospital in Lódź during the years 1992-94. The study was carried out in the group of 526 women with abnormal pregnancy outcome (N), including preterm birth (PB)--256; low birth weight < 2500 g (LBW)--232; small for gestational age (SGA)--196; asphyxia (APG)--116; and congenital malformations (M)--71. The control group (C) was composed of 683 women. As the reports on the work environment indicated working conditions in the group of women with abnormal pregnancy outcome were worse than in the control group; the presence of potentially harmful factors in the work environment were reported 57% of women in group N and 51.2% of women in group C. The increase in the risk of abnormal pregnancy outcome was relatively law (OR = 1.26). Taken into account the duration of exposure to these factors (period of employment under conditions of exposure to physical and/or chemical factors) it was revealed that pregnancy is at risk if women continue to work under such work conditions by the end of the second trimester. In this group of women odd ratio for abnormal pregnancy outcome accounted for 1.80 and it was statistically significant. The employment in the period preceding pregnancy and during the first trimester enhanced the risk insignificantly. A similar situation was observed if the risk of abnormal pregnancy outcome was assessed separately for exposure to chemical factors and to physical factors. A conclusion of great practical importance can be then drawn: expecting mothers should be prevented from working under harmful work conditions after the first trimester of gestation. Therefore, doctors attending occupationally working pregnant women should be obliged to make very careful inquiries about their working conditions. Logistic regression analysis helped to reveal and adverse effect of physical factors only in regard to newborns' body weight, but if failed to show negative effect of chemical factors on pregnancy outcome. On the other hand, the analysis highlighted a significant influence on certain social situations, lifestyles and mothers' health status on pregnancy outcome; a positive effect of higher education in the case of preterm birth and asphyxia; and a negative effect of mother's single status, smoking during pregnancy and the poor health condition during pregnancy on the incidence of congenital malformations.
作者对工作环境中化学和物理因素对妊娠过程及结局的不良影响的文献进行了综述，并给出了他们自己的研究结果。该研究的目的是确定孕妇工作岗位上化学和物理因素的暴露程度和频率，并评估现有暴露在多大程度上增加了妊娠结局并发症的风险。该研究涉及收集1992 - 1994年期间在罗兹的波兰母亲纪念医院住院的职业女性中对妊娠过程及结局有潜在不良影响因素的信息。该研究在526名妊娠结局异常的女性群体中进行（N组），包括早产（PB）——256例；低出生体重<2500克（LBW）——232例；小于胎龄儿（SGA）——196例；窒息（APG）——116例；以及先天性畸形（M）——71例。对照组（C组）由683名女性组成。由于工作环境报告显示，妊娠结局异常的女性群体的工作条件比对照组更差；N组57%的女性和C组51.2%的女性报告工作环境中存在潜在有害因素。妊娠结局异常风险的增加相对较低（OR = 1.26）。考虑到这些因素的暴露持续时间（在物理和/或化学因素暴露条件下的工作时间），结果显示，如果女性在妊娠中期结束时仍在这种工作条件下继续工作，妊娠就会面临风险。在这组女性中，妊娠结局异常的比值比为1.80，且具有统计学意义。妊娠前及妊娠早期的工作增加风险不显著。如果分别评估化学因素和物理因素暴露导致妊娠结局异常的风险，也观察到类似情况。由此可以得出一个具有重要实际意义的结论：应防止准妈妈在妊娠首三个月后在有害工作条件下工作。因此，诊治职业工作孕妇的医生有义务非常仔细地询问她们的工作条件。逻辑回归分析仅揭示了物理因素对新生儿体重的不良影响，但未显示化学因素对妊娠结局有负面影响。另一方面，该分析突出了某些社会状况、生活方式和母亲健康状况对妊娠结局的显著影响；高等教育对早产和窒息有积极影响；母亲的单身状态、孕期吸烟和孕期健康状况不佳对先天性畸形的发生率有负面影响。
