Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician–gynecologists

Abstract

Objective

While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN).

Methods

A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models.

Results

The survey was distributed to 556 anesthesiology and 662 obstetrics–gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician–gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001).

Conclusions

ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

Keywords:

• Abortion
• spontaneous
• occupational exposure
• pregnancy complications
• pregnancy outcome

Author contributions

Natalie R. Barnett, MD: conceptualize study and study design, drafting and editing of the study surveys, acquisition and interpretation of data for analysis, drafting and editing of manuscript, critical revision of manuscript, and approval of final submitted manuscript. Renuka M. George, MD: conceptualize study and study design, drafting and editing of the study surveys, acquisition of data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Katherine H. Hatter, MD: conceptualize study design, drafting and editing of study surveys, acquisition of data for analysis, drafting of manuscript, and approval of final submitted manuscript. Norah R. Janosy, MD: acquire data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Samantha J. Vizzini MD: acquire data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Shubhangi Singh, MBBS: acquire data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Rebecca E. Lee, MD: acquire data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Bethany J. Wolf, PhD: conceptualize statistical study design and methods, drafting and editing of manuscript, statistical analysis, and approval of final submitted manuscript. Camila Cabrera, MD: acquire data for analysis, critical revision of manuscript, and approval of final submitted manuscript. Amy L. Duhachek-Stapelman, MD: acquire data for analysis, drafting and editing of manuscript, and approval of final submitted manuscript. Daniel Katz, MD: conceptualize study and study design, drafting and editing of the study surveys, acquisition and interpretation of data for analysis, drafting and editing of manuscript, critical revision of manuscript, and approval of final submitted manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this survey study are available upon request from the corresponding author, NRB. The data are not publicly available due to the sensitive nature of the study and concerns for the privacy of research participants.

Additional information

Funding

None.