(930) Working 9–5: Adverse Perinatal Outcomes by Employment Status in a National Cohort over 11 years

Social determinants of health are widely recognized to influence health outcomes. Our objectives were to analyze the rates of adverse perinatal outcomes and assess the influence of employment status in pregnancy.

Study Design:

Using data from the Irish National Perinatal Reporting System, key perinatal indicators including stillbirth (death of a fetus weighing ≥500 grams), early neonatal mortality (ENM, death of a liveborn infant during the first week of life) and adjusted perinatal mortality (APM, stillbirths and early neonatal deaths excluding causative congenital anomalies) were assessed in a large retrospective cohort from 2012 to 2022. Outcome rates were analyzed according to maternal employment status: employed outside the home, unemployed, or homemaker. Logistic regression analysis was used to adjust for changes over time.

Results:

A total of 694,234 pregnancies were analyzed, representing 100% of births in Ireland over 11 years. Stillbirths occurred in 2,606 pregnancies (0.004%) and early neonatal deaths occurred in 1,385 pregnancies (0.002%). Employment data were available for 679,820 (97.9%) women, with 526,885 women employed outside the home (76%). 5% of women were unemployed and 17% worked as homemakers (n=31,860, n=121,075 respectively). Rates of adverse outcomes were higher in the unemployed and homemaker groups than the employed group (Figure 1). Homemakers had the highest rates of ENM and APM, over unemployed (p=0.0302, p=0.0431 respectively) and employed mothers (p< 0.0001 in both). There was no evidence of a difference in the stillbirth rates with greater variability (p >0.05).

Conclusion:
Women working in the home were more likely to experience adverse perinatal outcomes when compared to those working outside the home or those unemployed. Potential contributing factors include logistical barriers such as childcare, transportation and scheduling, in addition to socio-economic factors. This study highlights the need for further investigation of underlying factors of maternal employment status that may contribute to the adverse pregnancy outcomes in full-time mothers.