The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis

  • Chenxi Cai
    Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada

    Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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  • Ben Vandermeer
    Department of Pediatrics, Faculty of Medicine and Dentistry, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada

    Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
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  • Rshmi Khurana
    Departments of Medicine and Obstetrics & Gynecology, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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  • Kara Nerenberg
    Departments of Medicine, Obstetrics & Gynecology, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Robin Featherstone
    Department of Pediatrics, Faculty of Medicine and Dentistry, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada

    Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
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  • Meghan Sebastianski
    Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
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  • Margie H. Davenport
    Corresponding author: Margie H. Davenport, PhD.
    Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada

    Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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Published:September 21, 2019DOI:


      Data: An increasing number of studies suggest that exposure to physically demanding work during pregnancy could be associated with increased risks of adverse pregnancy outcomes, but the results remain conflicted and inconclusive. The purpose of this study was to examine the influence of occupational activities during pregnancy on maternal and fetal health outcomes.


      Studies of all designs (except case studies and reviews) that contained information on the relevant population (women who engaged in paid work during pregnancy), occupational exposures (heavy lifting, prolonged standing, prolonged walking, prolonged bending, and heavy physical workload), comparator (no exposure to the listed physical work demands), and outcomes (preterm birth, low birthweight, small for gestational age, miscarriage, gestational hypertension, preeclampsia, gestational diabetes mellitus, stillbirth, and intrauterine growth restriction) were included.

      Study Appraisal and Synthesis Methods

      Five electronic databases and 3 gray literature sources were searched up to March 15, 2019.


      Eighty observational studies (N=853,149) were included. Low-to-very low certainty evidence revealed that lifting objects ≥11 kg was associated with an increased odds ratio of miscarriage (odds ratio, 1.31; 95% confidence interval, 1.08–1.58; I2=79%), and preeclampsia (odds ratio, 1.35; 95% confidence interval, 1.07–1.71; I2=0%). Lifting objects for a combined weight of ≥100 kg per day was associated with an increased odds of preterm delivery (odds ratio, 1.31; 95% confidence interval, 1.11–1.56; I2=0%) and having a low birthweight neonate (odds ratio, 2.08; 95% confidence interval, 1.06–4.11; I2=73%). Prolonged standing was associated with increased odds of preterm delivery (odds ratio, 1.11; 95% confidence interval, 1.02–1.22; I2=30%) and having a small-for-gestational-age neonate (odds ratio, 1.17; 95% confidence interval, 1.01–1.35; I2=41%). A heavy physical workload was associated with increased odds of preterm delivery (odds ratio, 1.23; 95% confidence interval, 1.07–1.41; I2=32%) and having a low birthweight neonate (odds ratio, 1.79; 95% confidence interval, 1.11–2.87; I2=87%). All other associations were not statistically significant. Dose-response analysis showed women stand for >2.5 hours per day (vs no standing) had a 10% increase in the odds of having a preterm delivery.


      Physically demanding work during pregnancy is associated with an increased risk of adverse pregnancy outcomes.

      Key words

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      Linked Article

      • Working conditions and pregnancy outcomes: an updated appraisal of the evidence
        American Journal of Obstetrics & GynecologyVol. 222Issue 3
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          Participation of women in the workforce increased greatly in the second half of the 20th century, peaking at 60% in 1999, and more recently estimated at 56.7% in 2017.1 Many employed women continue to work through their pregnancies, raising the question of the effect of occupational working conditions on pregnancy morbidities. Evidence regarding the effect of working conditions on pregnancy outcomes has been necessarily limited by the observational nature of research concerning occupational exposures.
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