The effects of prenatal psychosocial work stress on adverse pregnancy outcomes: A comprehensive systematic review and meta-analysis

Abstract

OBJECTIVE: Psychosocial work stress is a predictor of adverse pregnancy outcomes. However, there is limited comprehensive and conclusive evidence available on the associations between psychosocial work stress and adverse pregnancy outcomes. This systematic review and meta-analysis paper addressed this gap by synthesizing the available evidence. METHODS: Studies were retrieved from six electronic databases that include pregnant mothers as study population, psychosocial work stress as variable exposure, and adverse pregnancy outcomes – including pregnancy loss, gestational hypertension and diabetes mellitus, preterm birth, low birth weight, and low fetal growth – as the outcomes of interest. The quality and certainty of evidence were assessed. Depending on the study characteristics, either a fixed or random effect model was employed. Heterogeneity was assessed using I 2 statistics, and further subgroup and sensitivity analysis was employed as appropriate. RESULTS: A total of 26 studies (N=1 346 686) were included. Psychosocial work stress decreased birth weight by 77.09 grams, increased the occurrence of preeclampsia by 50%, and preterm birth by 18% with moderate certainty of evidence, and increased the chance of pregnancy loss by 20% with low certainty of evidence. With a low grading scale, low birth weight and small-for-gestational-age had no significant association with psychosocial work stress. CONCLUSIONS: Psychosocial work-stress increased the risks of pre-eclampsia, preterm birth, and pregnancy loss, and decreased fetus weight. Therefore, occupational therapists, employers, policy makers, and relevant stakeholders should work together to minimize the impact of psychosocial work-stress on the mother and baby.