Physically demanding work and preterm delivery: a systematic review and meta-analysis

  • M. D. M. van BeukeringEmail author
  • M. J. G. J. van Melick
  • B. W. Mol
  • M. H. W. Frings-Dresen
  • C. T. J. Hulshof
Review Article



Physically demanding work may increase the risk of preterm delivery (PTD), defined as delivery before 37 weeks. We assessed the available evidence.


A systematic search in Medline, Embase and Nioshtic for the period 1990 to June 2012 for observational and intervention studies on physically demanding work (prolonged standing, heavy lifting, physical exertion, occupational fatigue and demanding posture) and PTD. Selected studies were assessed for their risk of bias and pooled using a random effects model. Results of case–control and cohort studies were reported separately in subgroups.


We found 10 studies with low risk of bias and seven studies with moderate risk of bias. Standing and walking at work during pregnancy for more than 3 h per day was associated with an increased risk for PTD [OR 1.3 (95 % CI 1.1–1.6)], just as lifting and carrying >5 kg [OR 1.3 (95 % CI 1.05–1.6)] or lifting and carrying in the third trimester of the pregnancy [OR 1.3 (95 % CI 1.01–1.8)]. Jobs that required physical effort or physical exertion were associated with an increased risk of PTD [OR 1.4 (95 % CI 1.19–1.66)]. Working during pregnancy in jobs with a combination of two or more physical tasks, physical effort or occupational fatigue was also associated with an increased risk of PTD [OR 1.5 (95 % CI 1.1–2.0)].


Physically demanding work during pregnancy is associated with an increased risk of PTD, especially in jobs with a combination of tasks with physical effort. In general, only small to moderate elevations of risks were found.


Physically demanding work Preterm delivery Pregnancy outcome Occupational exposure 



The authors wish to thank Dr. J. H. A. M. Verbeek (Finnish Institute of Occupational Health, Kuopio, Finland) for his help with the meta-analysis.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. D. M. van Beukering
    • 1
    Email author
  • M. J. G. J. van Melick
    • 2
  • B. W. Mol
    • 3
  • M. H. W. Frings-Dresen
    • 4
  • C. T. J. Hulshof
    • 4
  1. 1.Department of Occupational Health and Safety ServiceDNV GLArnhemThe Netherlands
  2. 2.Department of Obstetrics and GynecologyMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Department of Obstetrics and Gynecology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Academic Medical Center, Coronel Institute of Occupational HealthUniversity of AmsterdamAmsterdamThe Netherlands

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