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Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis

Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis
Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis
OBJECTIVES: We assessed the evidence relating preterm delivery (PTD), low birth weight, small for gestational age (SGA), pre-eclampsia and gestational hypertension to five occupational exposures (working hours, shift work, lifting, standing and physical workload). We conducted a systematic search in Medline and Embase (1966 to 2011), updating a previous search with a further 6 years of observations.

METHODS: As before, combinations of keywords and medical subject headings were used. Each relevant paper was assessed for completeness of reporting and potential for important bias or confounding, and its effect estimates abstracted. Where similar definitions of exposure and outcome existed we calculated pooled estimates of relative risk (RR) in meta-analysis.

RESULTS: Analysis was based on 86 reports (32 cohort investigations, 57 with usable data on PTD, 54 on birth weight and 11 on pre-eclampsia/gestational hypertension); 33 reports were new to this review. For PTD, findings across a substantial evidence base were generally consistent, effectively ruling out large effects (eg, RR>1.2). Larger and higher quality studies were less positive, while meta-estimates of risk were smaller than in previous analyses and best estimates pointed to modest or null effects (RR 1.04 to 1.18). For SGA, the position was similar but meta-estimates were even closer to the null (eight of nine RRs ? 1.07). For pre-eclampsia/gestational hypertension the evidence base remains insufficient.

CONCLUSIONS: The balance of evidence is against large effects for the associations investigated. As the evidence base has grown, estimates of risk in relation to these outcomes have become smaller.
1351-0711
213-222
Palmer, Keith T.
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Bonzini, Matteo
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Harris, E. Clare
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Linaker, Catherine
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Bonde, Jens Peter
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Palmer, Keith T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Bonzini, Matteo
764e0306-7727-4c67-947b-1c4ccc8d08d7
Harris, E. Clare
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Linaker, Catherine
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Bonde, Jens Peter
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Palmer, Keith T., Bonzini, Matteo, Harris, E. Clare, Linaker, Catherine and Bonde, Jens Peter (2013) Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis. Occupational & Environmental Medicine, 70 (4), 213-222. (doi:10.1136/oemed-2012-101032). (PMID:23343859)

Record type: Article

Abstract

OBJECTIVES: We assessed the evidence relating preterm delivery (PTD), low birth weight, small for gestational age (SGA), pre-eclampsia and gestational hypertension to five occupational exposures (working hours, shift work, lifting, standing and physical workload). We conducted a systematic search in Medline and Embase (1966 to 2011), updating a previous search with a further 6 years of observations.

METHODS: As before, combinations of keywords and medical subject headings were used. Each relevant paper was assessed for completeness of reporting and potential for important bias or confounding, and its effect estimates abstracted. Where similar definitions of exposure and outcome existed we calculated pooled estimates of relative risk (RR) in meta-analysis.

RESULTS: Analysis was based on 86 reports (32 cohort investigations, 57 with usable data on PTD, 54 on birth weight and 11 on pre-eclampsia/gestational hypertension); 33 reports were new to this review. For PTD, findings across a substantial evidence base were generally consistent, effectively ruling out large effects (eg, RR>1.2). Larger and higher quality studies were less positive, while meta-estimates of risk were smaller than in previous analyses and best estimates pointed to modest or null effects (RR 1.04 to 1.18). For SGA, the position was similar but meta-estimates were even closer to the null (eight of nine RRs ? 1.07). For pre-eclampsia/gestational hypertension the evidence base remains insufficient.

CONCLUSIONS: The balance of evidence is against large effects for the associations investigated. As the evidence base has grown, estimates of risk in relation to these outcomes have become smaller.

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e-pub ahead of print date: 23 January 2013
Published date: April 2013
Organisations: Faculty of Medicine

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Local EPrints ID: 353168
URI: http://eprints.soton.ac.uk/id/eprint/353168
ISSN: 1351-0711
PURE UUID: 36b9bdaf-24a8-47e0-9b15-31bab057cd23
ORCID for E. Clare Harris: ORCID iD orcid.org/0000-0001-8037-566X
ORCID for Catherine Linaker: ORCID iD orcid.org/0000-0003-1091-9283

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Date deposited: 31 May 2013 11:57
Last modified: 18 Feb 2021 16:42

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Contributors

Author: Keith T. Palmer
Author: Matteo Bonzini
Author: E. Clare Harris ORCID iD
Author: Jens Peter Bonde

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