Influence Of Shift Work On Pregnancy Outcomes: A Systematic Review And Meta-analysis
Bibliographic record
Abstract
Shift work including rotating shift and night shift has been suggested to be associated with risk of adverse pregnancy outcomes due to disrupted circadian rhythms and neuroendocrine adaptations which may affect fetal growth and timing of parturition. PURPOSE: To evaluate the association between shift work and pregnancy outcomes. METHODS: Five electronic databases and two grey literature sources were searched up to March 12, 2018 and the results underwent duplicate independent screening. Studies of all designs were included (except case studies), and contained information on the Population [women who engaged in paid work during pregnancy], Exposure [rotating shift work (working a pattern of days and nights) or fixed night shift (typical working day between 22:00 to 08:00)], Comparator [fixed day shift (typical working day between 8:00-18:00)], and Outcomes [preterm birth, low birthweight, small for gestational age, miscarriage, gestational hypertension and pre-eclampsia]. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, inverse variance method. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence. RESULTS: A total of 41 observational studies (N=145,671) were included. “Low” to “Very low” quality evidence from observational studies revealed that compared with fixed day shift, rotating shift was associated with an increased odds of preterm delivery (OR: 1.16, 95% CI: 1.03, 1.3, I2=34%) and having a small-for-gestational age baby (OR: 1.23, 95% CI: 1.08, 1.39, I2=11%). Fixed night shift was associated with an increase odds of preterm delivery (OR: 1.25, 95% CI: 1.05, 1.48, I2=36%), miscarriage (OR: 1.31, 95% CI: 1.09, 1.57, I2=34%) and gestational hypertension (OR: 1.22, 95% CI: 1.01, 1.48, I2=0%). When meta-analysis was restricted only to adjusted ORs, fixed night shift was associated with an increase in risk of miscarriage (OR: 1.34, 95% CI: 1.10, 1.63, I2=38%). Rotating shift or fixed night shift were not significantly associated with low birth weight or pre-eclampsia. CONCLUSIONS: Pregnant women who work with rotating shift or fixed night shift have an increased risk of adverse pregnancy outcomes. Supported by Alberta OHS Futures Research Grant and the Alberta SPOR SUPPORT Unit.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.034 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".