Healthcare Workers at Increased Risk of Some Adverse Maternal Outcomes

SAN FRANCISCO — Pregnant healthcare workers had increased risk for several adverse maternal outcomes compared to nonhealthcare workers, a retrospective cohort study found.

Ana Collins-Smith, MD, of the University of Texas Medical Branch in Galveston, reported that among 34,099 healthcare workers, there was an increased incidence of:

• Diet-controlled gestational diabetes mellitus (GDM): 12.88% for healthcare workers vs 9.95% for nonhealthcare workers (n=about 1.5 million), RR 1.2587 (P<0.001)
• Oral hypoglycemic agent-controlled GDM: 1.56% vs 1.02%, RR 1.5239 (P<0.001)
• Insulin-controlled GDM: 2.88% vs 1.73%, RR 1.6332 ( P<0.001)
• Gestational hypertension: 3.04% vs 2.73%, RR 1.0865 (P<0.001)
• Pre-eclampsia with severe features: 5.95% vs 4.23%, RR 1.3765 (P<0.001)
• Chronic hypertension: 10% vs 5.7%, RR 1.7657 (P<0.001)

However, healthcare workers actually had decreased incidence of other adverse maternal outcomes, such as fetal growth restriction, pre-eclampsia without severe features, and postpartum hemorrhage, according to Collins-Smith’s poster presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

Collins-Smith concluded that “it may be important for providers to screen healthcare workers more frequently for these adverse outcomes.” Healthcare workers in the study included physicians, residents, physician assistants, nurses, nursing assistants, and midwives.

“I wasn’t exactly surprised by the incidence of hypertension, but I was surprised by the incidence of diabetes,” Collins-Smith told MedPage Today, noting that doctors’ demanding schedule can make it difficult to make time to eat.

She also noted that adverse maternal outcomes in pregnancy are on the rise in general. There is likely an assumption that healthcare workers are healthier than the general population — even during pregnancy — so this group is often excluded from research.

David Stamilio, MD, of Wake Forest University School of Medicine in Winston Salem, North Carolina, told MedPage Today that the increased relative risk of developing GDM among healthcare workers wasn’t shocking, but said he was curious about the population differences between the comparison groups.

“It makes me wonder if it’s not the healthcare worker but the cofactors that go along with it,” said Stamilio, who was not involved in the research. For instance, age, since healthcare workers often delay family building because of their demanding jobs and thus have kids later, on average.

Collins-Smith said she didn’t stratify for age, though that would be interesting in the future. She did stratify for race, which can be a cofactor for diabetes, fetal growth restriction, and hypertensive disorders, and still found increased risk for GDM, pre-eclampsia, and gestational hypertension.

For this retrospective cohort study, Collins-Smith looked at data of people, ages 18-50, from 2008 to 2023 from TriNetX Research platform, which has deidentified patient data from a network of more than 80 healthcare organizations. Pregnant healthcare workers were identified and ICD, CPT, and LOINC codes were used to diagnose the presence or absence of fetal growth restriction, GDM, chronic hypertension, gestational hypertension, pre-eclampsia (both with and without severe features), and postpartum depression.

Collins-Smith said she is currently working on a similar study using identified data.

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