Occupational determinants of adverse pregnancy outcomes : work in healthcare and exposure to welding fumes and metal dust

The goal of this thesis is to (i) systematically review all epidemiologic studies reporting on the relationship between occupational exposures and adverse pregnancy outcomes among nurses and physicians, (ii) compare the risk of adverse pregnancy outcomes between singleton newborns of nurses, midwives, and physicians and those of women in other occupations (reference groups) and (iii) investigate the risk of adverse pregnancy outcomes among parents exposed to welding fumes or metal dust. Data were obtained from all epidemiologic studies reporting on the relation between occupational exposures and adverse pregnancy outcomes among nurses and physicians, the 1990–2006 Finnish Medical Birth Register, and the Finnish Prenatal Environment and Health Study (FPEHS). Occupational exposure to anaesthetic gases was associated with spontaneous abortion and congenital malformation among nurses and physicians. Chemotherapy agents were associated with spontaneous abortion among nurses. There was moderate to substantial heterogeneity in the studied relations. In the FHCPS, singleton newborns of nurses have increased risk of low birth weight, post-term delivery, and small-for-gestational-age compared to those of teachers (reference group). Maternal employment as a midwife was not related to adverse pregnancy outcomes. The risk of high birth weight and post-term delivery were lower among singleton newborns of the physicians compared to those of other upper-level employees (reference group), but the risk of SGA and LGA did not differ between the newborns of physicians and those of the reference group. In the FPEHS, paternal exposure to welding fumes only was related to small-for-gestational-age. Maternal exposure to metal dust only was related to low birth weight and pre-term delivery and the joint effect of welding fumes and metal dust was related to small-for-gestational age. In conclusion, maternal employment as a nurses and parental occupational exposure to welding fumes or metal dust may increase the risk of adverse pregnancy outcomes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo