Employment status, occupation associated with stillbirth, miscarriage

Employment status and certain occupations were associated with increased risks for stillbirth and miscarriage among women in South Korea, according to study results published in the Journal of Occupational Health.

“For pregnant women, toxic chemicals, radiation and extreme temperatures in the workplace can interfere with the development of the embryo or fetus, leading to pregnancy loss or fetal anomalies,” Chae-Bong Kim, of the department of preventive medicine at Korea University in Seoul, South Korea, and colleagues wrote. “In addition to physical hazards in the workplace, compared with men, women are more likely to be exposed to discrimination, work-related psychological stress and biological agents, which can increase the risk of adverse reproductive outcomes.”

Kim and colleagues retrospectively reviewed data from South Korea’s National Health Insurance Service to evaluate clinical, sociodemographic and pregnancy information for 1,825,845 women aged 20 to 49 years who were pregnant between 2010 and 2019.

The cohort was divided by employment status, with employed women further divided into 18 occupational categories. Most (90%) employed women fell into one of seven categories: manufacturing; health and social work; wholesale and retail trade; financial/insurance; real estate, renting and leasing; education; and public, social and personal service.

The primary outcomes were risk for early abortive outcomes, including miscarriage and ectopic and molar pregnancy; stillbirth; and no live birth, including early abortive outcomes and stillbirth.

There were 577,227 unemployed and 1,248,618 employed women in the cohort. Employment was associated with younger age, lower income, normal BMI, lower prevalence of anemia and no smoking history compared with unemployment.

In total, 18% of pregnancies had early abortive outcomes and 0.7% resulted in stillbirth.

Adjusted analyses revealed that women who were employed vs. unemployed had greater odds of early abortive outcomes (adjusted RR = 1.011; 95% CI, 1.004-1.018) and no live birth (aRR = 1.011; 95% CI, 1.009-1.012).

Among the seven most common occupational categories, manufacturing (aRR = 1.03; 95% CI, 1.013-1.047) and health and social work (aRR = 1.029; 95% CI, 1.012-1.046) jobs were associated with greater risk for early abortive outcomes compared with financial and insurance jobs.

Additionally, the risk for no live birth was greater among women working in manufacturing (aRR = 1.008; 95% CI, 1.004-1.012), wholesale and retail trade (aRR = 1.004; 95% CI, 1-1.008), education (aRR = 1.006; 95% CI, 1.002-1.01), health and social work (aRR = 1.015; 95% CI, 1.011-1.019) and public, social and personal service (aRR = 1.006; 95% CI, 1.001-1.011) vs. those working in finance and insurance.

Of note, women with jobs in the financial and insurance field had a greater risk for no live birth compared with unemployed women (aRR = 1.008; 95% CI, 1.004-1.012).

“The good news is that the Ministry of Employment and Labor of South Korea is now revising the Industrial Accident Compensation Insurance Act to cover all the abortive outcomes in pregnant women workers,” study author Jung-won Yoon, MD, of the department of OB/GYN at the National Medical Center in Seoul, South Korea, said in a press release. “Our study contributed to the amendment of this act, as we presented the impact of the occupational environment on adverse pregnancy outcomes.”

References:

• Do certain jobs increase a woman’s risk of pregnancy loss? www.eurekalert.org/news-releases/977335. Published Jan. 25, 2023. Accessed Jan. 31, 2023.
• Kim CB, et al. J Occup Health. 2023;doi:10.1002/1348-9585.12380.