Maternal and Child Health Journal

, Volume 12, Issue 4, pp 415–426 | Cite as

Maternal Work and Birth Outcome Disparities

  • Janice F. Bell
  • Frederick J. Zimmerman
  • Paula K. Diehr
Article

Abstract

Objectives: We tested relations between aspects of maternal work and birth outcomes in a national sample and in subgroups known to experience disparities. Methods: Three indices of work attributes (Status and Recognition, Physical Demands, and Exposure to Conflict) were derived by factor analysis of variables extracted from the Department of Labor’s O*Net database. The indices were linked to the National Longitudinal Survey of Youth using occupation codes for the primary jobs held by women who gave birth between 1979 and 2000 and worked during the quarter prior to birth (n = 3,386 births to n = 2,508 mothers). Multiple regression was used to model birth outcomes as functions of the work attribute indices, controlling for several measures of socioeconomic status and risk factors for adverse birth outcomes. Results: In the full sample, work-related Physical Demands were associated with lower average birthweight and increased odds of preterm birth while Status and Recognition was associated with higher average birthweight and lower odds of fetal growth restriction. In stratified models, Status and Recognition was associated with higher birth weight among women with low (versus high) income and with lower odds of preterm birth among women with low (versus high) education. Physical Demands were associated with higher rates of preterm birth among women with low (versus high) income and education and among African-American mothers (compared to Whites). Conclusions: The work environment is an important predictor of healthy births. Relations between maternal work attributes and birth outcomes differ by race/ethnicity and socioeconomic status and according to the outcome under investigation. Further research with measures of work attributes specific to maternal work experiences is recommended to confirm our findings.

Keywords

Birthweight Prematurity Fetal growth Maternal work Race/ethnicity Socioeconomic status NLSY O*Net 

Notes

Acknowledgements

Dr. Bell gratefully acknowledges funding for this work from the Agency for Healthcare Research and Quality (Grant #: T32-HS013853-01). A Certificate of Exemption was granted for this study by the University of Washington Institutional Review Board.

References

  1. 1.
    Finch, B. K. (2003). Socioeconomic gradients and low birth-weight: Empirical and policy considerations. Health Services Research, 38(6 Pt 2), 1819–1841.PubMedCrossRefGoogle Scholar
  2. 2.
    Kramer, M. S., Seguin, L., Lydon J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194–210.PubMedCrossRefGoogle Scholar
  3. 3.
    Arias, E., MacDorman, M. F., Strobino, D. M., & Guyer, B. (2003). Annual summary of vital statistics–2002. Pediatrics, 112(6 Pt 1), 1215–1230.PubMedCrossRefGoogle Scholar
  4. 4.
    Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B., & MacDorman, M. F. (2005). Annual summary of vital statistics–2003. Pediatrics, 115(3), 619–634.PubMedCrossRefGoogle Scholar
  5. 5.
    Schoendorf, K. C., Hogue, C. J., Kleinman, J. C., & Rowley, D. (1992). Mortality among infants of black as compared with white college-educated parents. The New England Journal of Medicine, 326(23), 1522–1526.PubMedCrossRefGoogle Scholar
  6. 6.
    Paneth, N. S. (1995). The problem of low birthweight. Future of Children, 5, 19–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Wadhwa, P. D., Sandman, C. A., Porto, M., Dunkel-Schetter, C., & Garite, T. J. (1993). The association between prenatal stress and infant birth weight and gestational age at birth: A prospective investigation. American Journal of Obstetrics and Gynecology, 169(4), 858–865.PubMedGoogle Scholar
  8. 8.
    Wadhwa, P. D., Culhane, J. F., Rauh, V., et al. (2001). Stress, infection and preterm birth: A biobehavioural perspective. Paediatric and Perinatal Epidemiology, 15(Suppl 2), 17–29.PubMedCrossRefGoogle Scholar
  9. 9.
    Paarlberg, K. M., Vingerhoets, A. J., Passchier, J., Dekker, G. A., & Van Geijn, H. P. (1995). Psychosocial factors and pregnancy outcome: A review with emphasis on methodological issues. Journal of Psychosomatic Research, 39(5), 563–595.PubMedCrossRefGoogle Scholar
  10. 10.
    Paarlberg, K. M., Vingerhoets, A. J., Passchier, J., Dekker, G. A., Heinen, A. G., & van Geijn, H. P. (1999). Psychosocial predictors of low birthweight: A prospective study. British Journal of Obstetrics and Gynaecology, 106(8), 834–841.PubMedGoogle Scholar
  11. 11.
    Smith, K., Downs, B., & O’Connell, M. (2001). Maternity leave and employment patterns: 1961–1995. Current population reports. U.S. Census Bureau: Washington, D.C.Google Scholar
  12. 12.
    Miller, N. H., Katz, V. L., & Cefalo, R. C. (1989). Pregnancies among physicians. A historical cohort study. The Journal of Reproductive Medicine, 34(10), 790–796.PubMedGoogle Scholar
  13. 13.
    Naeye, R. L., & Peters, E. C. (1982). Working during pregnancy: Effects on the fetus. Pediatrics, 69(6), 724–727.PubMedGoogle Scholar
  14. 14.
    McDonald, A. D., McDonald, J. C., Armstrong, B., Cherry, N. M., Nolin, A. D., & Robert, D. (1988). Prematurity and work in pregnancy. British Journal of Industrial Medicine, 45(1), 56–62.PubMedGoogle Scholar
  15. 15.
    McDonald, A. D., McDonald, J. C., Armstrong, B., et al. (1987). Occupation and pregnancy outcome. British Journal of Industrial Medicine, 44(8), 521–526.PubMedGoogle Scholar
  16. 16.
    Mamelle, N., Laumon, B., & Lazar, P. (1984). Prematurity and occupational activity during pregnancy. American Journal of Epidemiology, 119(3), 309–322.PubMedGoogle Scholar
  17. 17.
    Magann, E. F., & Nolan, T. E. (1991). Pregnancy outcome in an active-duty population. Obstetrics and Gynecology, 78(3 Pt 1), 391–393.PubMedGoogle Scholar
  18. 18.
    Armstrong, B. G., Nolin, A. D., & McDonald, A. D. (1989). Work in pregnancy and birth weight for gestational age. British Journal of Industrial Medicine, 46(3), 196–199.PubMedGoogle Scholar
  19. 19.
    Saurel-Cubizolles, M. J., & Kaminski, M. (1987). Pregnant women’s working conditions and their changes during pregnancy: A national study in France. British Journal of Industrial Medicine, 44(4), 236–243.PubMedGoogle Scholar
  20. 20.
    Saurel-Cubizolles, M. J., Kaminski, M., Llado-Arkhipoff, J., et al. (1985). Pregnancy and its outcome among hospital personnel according to occupation and working conditions. Journal of Epidemiology and Community Health, 39(2), 129–134.PubMedGoogle Scholar
  21. 21.
    Saurel-Cubizolles, M. J., Subtil, D., & Kaminski, M. (1991). Is preterm delivery still related to physical working conditions in pregnancy? Journal of Epidemiology and Community Health, 45(1), 29–34.PubMedGoogle Scholar
  22. 22.
    Teitelman, A. M., Welch, L. S., Hellenbrand, K. G., & Bracken, M. B. (1990). Effect of maternal work activity on preterm birth and low birth weight. American Journal of Epidemiology, 131(1), 104–133.PubMedGoogle Scholar
  23. 23.
    Peoples-Sheps, M. D., Siegel, E., Suchindran, C. M., Origasa, H., Ware, A., & Barakat, A. (1991). Characteristics of maternal employment during pregnancy: Effects on low birthweight. American Journal of Public Health, 81(8), 1007–1012.PubMedGoogle Scholar
  24. 24.
    Nurminen, T., Lusa, S., Ilmarinen, J., & Kurppa, K. (1989). Physical work load, fetal development and course of pregnancy. Scandinavian Journal of Work, Environment & Health, 15(6), 404–414.Google Scholar
  25. 25.
    Mamelle, N., & Munoz, F. (1987). Occupational working conditions and preterm birth: A reliable scoring system. American Journal of Epidemiology, 126(1), 150–152.PubMedGoogle Scholar
  26. 26.
    Luke, B., Mamelle, N., Keith, L., et al. (1995). The association between occupational factors and preterm birth: A United States nurses’ study. Research Committee of the Association of Women’s Health, Obstetric, and Neonatal Nurses. American Journal of Obstetrics and Gynecology, 173(3 Pt 1), 849–862.PubMedCrossRefGoogle Scholar
  27. 27.
    Launer, L. J., Villar, J., Kestler, E., & de Onis, M. (1990). The effect of maternal work on fetal growth and duration of pregnancy: A prospective study. British Journal of Obstetrics and Gynaecology, 97(1), 62–70.PubMedGoogle Scholar
  28. 28.
    Brett, K. M., Strogatz, D. S., & Savitz, D. A. (1997). Employment, job strain, and preterm delivery among women in North Carolina. American Journal of Public Health, 87(2), 199–204.PubMedGoogle Scholar
  29. 29.
    Berkowitz, G. S., Kelsey, J. L., Holford, T. R., & Berkowitz, R. L. (1983). Physical activity and the risk of spontaneous preterm delivery. The Journal of Reproductive Medicine, 28(9), 581–588.PubMedGoogle Scholar
  30. 30.
    Marcoux, S., Brisson, J., & Fabia, J. (1989). The effect of leisure time physical activity on the risk of pre-eclampsia and gestational hypertension. Journal of Epidemiology and Community Health, 43(2), 147–152.PubMedGoogle Scholar
  31. 31.
    Jarrett, J. C. 2nd, Spellacy, W. N. (1983). Jogging during pregnancy: An improved outcome? Obstetrics and Gynecology, 61(6), 705–709.PubMedGoogle Scholar
  32. 32.
    Escriba-Aguir, V., Perez-Hoyos, S., & Saurel-Cubizolles, M. J. (2001). Physical load and psychological demand at work during pregnancy and preterm birth. International Archives of Occupational and Environmental Health, 74(8), 583–588.PubMedGoogle Scholar
  33. 33.
    Ramirez, G., Grimes, R. M., Annegers, J. F., Davis, B. R., & Slater, C. H. (1990). Occupational physical activity and other risk factors for preterm birth among US Army primigravidas. American Journal of Public Health, 80(6), 728–730.PubMedCrossRefGoogle Scholar
  34. 34.
    Chen, D., Cho, S. I., Chen, C., et al. (2000). Exposure to benzene, occupational stress, and reduced birth weight. Occupational and Environmental Medicine, 57(10), 661–667.PubMedCrossRefGoogle Scholar
  35. 35.
    Grunebaum, A., Minkoff, H., & Blake, D. (1987). Pregnancy among obstetricians: A comparison of births before, during, and after residency. American Journal of Obstetrics and Gynecology, 157(1), 79–83.PubMedGoogle Scholar
  36. 36.
    Oths, K. S., Dunn, L. L., & Palmer, N. S. (2001). A prospective study of psychosocial job strain and birth outcomes. Epidemiology, 12(6), 744–746.PubMedCrossRefGoogle Scholar
  37. 37.
    Wergeland, E., & Strand, K. (1998). Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scandinavian Journal of Work, Environment & Health, 24(3), 206–212.Google Scholar
  38. 38.
    Klonoff-Cohen, H. S., Cross, J. L., & Pieper, C. F. (1996). Job stress and preeclampsia. Epidemiology, 7(3), 245–249.PubMedCrossRefGoogle Scholar
  39. 39.
    Saurel-Cubizolles, M. J., Kaminski, M., Du Mazaubrun, C., Llado, J., & Estryn-Behar, M. (1991). High blood pressure during pregnancy and working conditions among hospital personnel. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 40(1), 29–34.PubMedCrossRefGoogle Scholar
  40. 40.
    Landsbergis, P., & Hatch, M. (2000). Job stressors and gestational hypertension. Epidemiology, 11(1), 95.Google Scholar
  41. 41.
    Landsbergis, P. A., & Hatch, M. C. (1996). Psychosocial work stress and pregnancy-induced hypertension. Epidemiology, 7(4), 346–351.PubMedCrossRefGoogle Scholar
  42. 42.
    Marcoux, S., Berube, S., Brisson, C., & Mondor, M. (1999). Job strain and pregnancy-induced hypertension. Epidemiology, 10(4), 376–382.PubMedCrossRefGoogle Scholar
  43. 43.
    Ahlborg, G. Jr., Bodin, L., & Hogstedt, C. (1990). Heavy lifting during pregnancy—a hazard to the fetus? A prospective study. International Journal of Epidemiology, 19(1), 90–97.PubMedCrossRefGoogle Scholar
  44. 44.
    Hartikainen-Sorri, A. L., & Sorri, M. (1989). Occupational and socio-medical factors in preterm birth. Obstetrics and Gynecology, 74(1), 13–16.PubMedGoogle Scholar
  45. 45.
    Hickey, C. A., Cliver, S. P., Mulvihill, F. X., McNeal, S. F., Hoffman, H. J., & Goldenberg, R. L. (1995). Employment-related stress and preterm delivery: A contextual examination. Public Health Reports, 110(4), 410–418.PubMedGoogle Scholar
  46. 46.
    Homer, C. J., James, S. A., & Siegel, E. (1990). Work-related psychosocial stress and risk of preterm, low birthweight delivery. American Journal of Public Health, 80(2), 173–177.PubMedGoogle Scholar
  47. 47.
    Marbury, M. C. (1992). Relationship of ergonomic stressors to birthweight and gestational age. Scandinavian Journal of Work, Environment & Health, 18(2), 73–83.Google Scholar
  48. 48.
    Rabkin, C. S., Anderson, H. R., Bland, J. M., Brooke, O. G., Chamberlain, G., & Peacock, J. L. (1990). Maternal activity and birth weight: A prospective, population-based study. American Journal of Epidemiology, 131(3), 522–531.PubMedGoogle Scholar
  49. 49.
    Zuckerman, B. S., Frank, D. A., Hingson, R., Morelock, S., & Kayne, H. L. (1986). Impact of maternal work outside the home during pregnancy on neonatal outcome. Pediatrics, 77(4), 459–464.PubMedGoogle Scholar
  50. 50.
    Meyer, B. A., & Daling, J. R. (1985). Activity level of mother’s usual occupation and low infant birth weight. Journal of Occupational Medicine, 27(11), 841–847.PubMedCrossRefGoogle Scholar
  51. 51.
    Klebanoff, M. A., Shiono, P. H., & Rhoads, G. G. (1990). Outcomes of pregnancy in a national sample of resident physicians. The New England Journal of Medicine, 323(15), 1040–1045.PubMedCrossRefGoogle Scholar
  52. 52.
    Moss, N., & Carver, K. (1993). Pregnant women at work: Sociodemographic perspectives. American Journal of Industrial Medicine, 23(4), 541–557.PubMedCrossRefGoogle Scholar
  53. 53.
    Savitz, D. A., Blackmore, C. A., & Thorp, J. M. (1991). Epidemiologic characteristics of preterm delivery: Etiologic heterogeneity. American Journal of Obstetrics and Gynecology, 164(2), 467–471.PubMedGoogle Scholar
  54. 54.
    Wen, S. W., Goldenberg, R. L., Cutter, G. R., Hoffman, H. J., & Cliver, S. P. (1990). Intrauterine growth retardation and preterm delivery: Prenatal risk factors in an indigent population. American Journal of Obstetrics and Gynecology, 162(1), 213–218.PubMedGoogle Scholar
  55. 55.
    NLS Handbook (2000). ed. Labor. 2000, Washington: Bureau of Labor Statistics.Google Scholar
  56. 56.
    NLSY1979 Child and Young Adult Data Users Guide (2002). Bureau of Labor Statistics: Washington.Google Scholar
  57. 57.
    Zimmerman, F. J., Christakis, D. A., & Vander Stoep A. (2004). Tinker, tailor, soldier, patient: Work attributes and depression disparities among young adults. Social Science & Medicine, 58(10), 1889–1901.CrossRefGoogle Scholar
  58. 58.
    Stengel, B., Saurel-Cubizolles, M. J., & Kaminski, M. (1987). Healthy worker effect and pregnancy: Role of adverse obstetric history and social characteristics. Journal of Epidemiology and Community Health, 41(4), 312–320.PubMedCrossRefGoogle Scholar
  59. 59.
    Joffe, M. (1985). Biases in research on reproduction and women’s work. International Journal of Epidemiology, 14(1), 118–123.PubMedCrossRefGoogle Scholar
  60. 60.
    Kleinbaum, D. G., Kupper, L. L., & Muller, K. E. (1992). Variable reduction and factor analysis. In Applied regression analysis (2nd ed.). PWS-Kent Publishing Company: Boston. 595–641.Google Scholar
  61. 61.
    Wilcox, A. J. (2001). On the importance–and the unimportance–of birthweight. International Journal of Epidemiology, 30(6), 1233–1241.PubMedCrossRefGoogle Scholar
  62. 62.
    Alexander, G. R., Himes, J. H., Kaufman, R. B., Mor, J., & Kogan, M. A. (1996). A United States national reference for fetal growth. Obstetrics and Gynecology, 87(2), 163–168.PubMedCrossRefGoogle Scholar
  63. 63.
    Petersen, D. J., & Alexander, G. R. (1992). Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care. Public Health Reports, 107(6), 701–706.PubMedGoogle Scholar
  64. 64.
    Deaton, A. (1997). The analysis of household surveys. Baltimore: Johns Hopkins University Press.CrossRefGoogle Scholar
  65. 65.
    Greene, W. H. (2000). Econometric analysis (4th ed.). Upper Saddle River: Prentice-Hall.Google Scholar
  66. 66.
    Kennedy, P. (1998). A guide to econometrics. Cambridge: MIT Press.Google Scholar
  67. 67.
    Culhane, J. F., Rauh, V., McCollum, K. F., Elo, I. T., & Hogan, V. (2002). Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women. American Journal of Obstetrics and Gynecology, 187(5), 1272–1276.PubMedCrossRefGoogle Scholar
  68. 68.
    Culhane, J. F., Rauh, V., McCollum, K. F., Hogan, V. K., Agnew, K., & Wadhwa, P. D. (2001). Maternal stress is associated with bacterial vaginosis in human pregnancy. Maternal and Child Health Journal, 5(2), 127–134.PubMedCrossRefGoogle Scholar
  69. 69.
    Omer, H., & Everly, G. S. Jr. (1988). Psychological factors in preterm labor: Critical review and theoretical synthesis. The American Journal of Psychiatry, 145(12), 1507–1513.PubMedGoogle Scholar
  70. 70.
    Marmot, M. G. R. G., Shipley, M., & Hamilton, P. J. (1978). Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology and Community Health, 32, 244–249.PubMedGoogle Scholar
  71. 71.
    Redelmeier, D. A., & Singh, S. M. (2001). Survival in Academy Award-winning actors and actresses. Annals of Internal Medicine, 134(10), 955–962.PubMedGoogle Scholar
  72. 72.
    Colie, C. F. (1993). Preterm labor and delivery in working women. Seminars in Perinatology, 17(1), 37–44.PubMedGoogle Scholar
  73. 73.
    Krieger, N., & Sidney, S. (1996). Racial discrimination and blood pressure: The CARDIA Study of young black and white adults. American Journal of Public Health, 86(10), 1370–1378.PubMedGoogle Scholar
  74. 74.
    Mannetje, A., & Kromhout, H. (2003). The use of occupation and industry classifications in general population studies. International Journal of Epidemiology, 32(3), 419–428.PubMedCrossRefGoogle Scholar
  75. 75.
    Brandt, L. P., & Nielsen, C. V. (1992). Job stress and adverse outcome of pregnancy: A causal link or recall bias? American Journal of Epidemiology, 135(3), 302–311.PubMedGoogle Scholar
  76. 76.
    Olson, J. E., Shu, X. O., Ross, J. A., Pendergrass, T., & Robison, L. L. (1997). Medical record validation of maternally reported birth characteristics and pregnancy-related events: A report from the Children’s Cancer Group. American Journal of Epidemiology, 145(1), 58–67.PubMedGoogle Scholar
  77. 77.
    Buka, S. L., Goldstein, J. M., Spartos, E., & Tsuang, M. T. (2004). The retrospective measurement of prenatal and perinatal events: Accuracy of maternal recall. Schizophrenia Research, 71(2–3), 417–426.PubMedCrossRefGoogle Scholar
  78. 78.
    Tomeo, C. A., Rich-Edwards, J. W., Michels, K. B., et al. (1999). Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology, 10(6), 774–777.PubMedCrossRefGoogle Scholar
  79. 79.
    National Center for Health Statistics. (2005). Health, United States 2005, with Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: U.S. Government Printing Office.Google Scholar
  80. 80.
    Reagan, P. B., & Salsberry, P. J. (2005). Race and ethnic differences in determinants of preterm birth in the USA: broadening the social context. Social Science & Medicine, 60(10), 2217–2228.Google Scholar
  81. 81.
    Colen, C. G., Geronimus, A. T., Bound, J., & James, S. A. (2006). Maternal upward socioeconomic mobility and black-white disparities in infant birthweight. American Journal of Public Health, 96(11), 2032–2039.PubMedCrossRefGoogle Scholar
  82. 82.
    Center for Human Resource Research. (1999). The National Longitudinal Surveys NLSY79 User’s Guide. Ohio State University: U.S. Dept. of Labor.Google Scholar
  83. 83.
    Korn, E. L., & Graubard, B. I. (1999). Analysis of health surveys. New York: John Wiley & Sons, Inc.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Janice F. Bell
    • 1
    • 2
  • Frederick J. Zimmerman
    • 1
    • 2
    • 3
  • Paula K. Diehr
    • 1
    • 4
  1. 1.Health ServicesUniversity of WashingtonSeattleUSA
  2. 2.Child Health InstituteUniversity of WashingtonSeattleUSA
  3. 3.Maternal and Child Health ProgramUniversity of WashingtonSeattleUSA
  4. 4.Department of BiostatisticsUniversity of WashingtonSeattleUSA

Personalised recommendations