Advertisement

Reevaluating the Relationship Between Prenatal Employment and Birth Outcomes: A Policy-Relevant Application of Propensity Score Matching

Published:December 20, 2012DOI:https://doi.org/10.1016/j.whi.2012.11.004

      Abstract

      Background

      Prior research shows an association between prenatal employment characteristics and adverse birth outcomes, but suffers methodological challenges in disentangling women's employment choices from birth outcomes, and little U.S.-based prior research compares outcomes for employed women with those not employed. This study assessed the effect of prenatal employment status on birth outcomes.

      Methods

      With data from the Listening to Mothers II survey, conducted among a nationally representative sample of women who delivered a singleton baby in a U.S. hospital in 2005 (n = 1,573), we used propensity score matching to reduce potential selection bias. Primary outcomes were low birth weight (<2,500 g) and preterm birth (gestational age <37 weeks). Exposure was prenatal employment status (full time, part time, not employed). We conducted separate outcomes analyses for each matched cohort using multivariable regression models.

      Findings

      Comparing full-time employees with women who were not employed, full-time employment was not causally associated with preterm birth (adjusted odds ratio [AOR], 1.37; p = .47) or low birth weight (AOR, 0.73; p = .41). Results were similar comparing full- and part-time workers. Consistent with prior research, Black women, regardless of employment status, had increased odds of low birth weight compared with White women (AOR, 5.07; p = .002).

      Conclusions

      Prenatal employment does not independently contribute to preterm births or low birth weight after accounting for characteristics of women with different employment statuses. Efforts to improve birth outcomes should focus on the characteristics of pregnant women (employed or not) that render them vulnerable.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andridge R.R.
        • Little R.J.A.
        A review of hot deck imputation for survey non-response.
        International Statistical Review. 2010; 78: 40-64
        • Angood P.
        • Armstrong E.
        • Ashton D.
        • Burstin H.
        • Corry M.
        • Delbanco S.
        • et al.
        Blueprint for action: Steps toward a high-quality, high-value maternity care system.
        Women’s Health Issues. 2010; 20: S18-S49
        • Ashton D.
        Elective delivery at less than 39 weeks.
        Current Opinion in Obstetrics and Gynecology. 2010; 22: 506-510
        • Austin P.C.
        A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003.
        Statistics in Medicine. 2008; 27: 2037-2049
        • Baker M.
        • Milligan K.
        Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates.
        Journal of Health Economics. 2008; 27: 871-887
        • Becker G.
        Theory of the allocation of time.
        The Economic Journal. 1965; 75: 493-517
        • Behrman R.E.
        • Butler A.S.
        Preterm birth: Causes, consequences, and prevention.
        National Academy Press, Institute of Medicine, Washington, DC2007
        • Bell J.F.
        • Zimmerman F.J.
        • Diehr P.K.
        Maternal work and birth outcome disparities.
        Maternal and Child Health Journal. 2008; 12: 415-426
      1. Bock, R., & Miller, M. (2012). Federal report shows drop in infant mortality, preterm birth. Retrieved September 16, 2012, from http://www.nichd.nih.gov/news/releases/071312-annual-federal-statistics.cfm

        • Bonzini M.
        • Coggon D.
        • Palmer K.T.
        Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: A systematic review.
        Occupational and Environmental Medicine. 2007; 64: 228-243
        • Braitman L.
        • Rosenbaum P.
        Rare outcomes, common treatments: Analytic strategies using propensity scores.
        Annals of Internal Medicine. 2002; 137: 693-695
        • U.S. Census Bureau, Fertility and Family Statistics Branch
        Women 15 to 44 years old who had a child in the last year and their percentage in the labor force: selected years, 1976 to 2010.
        Author, Washington, DC2010
        • Chollet D.J.
        • Newman Jr., J.F.
        • Sumner A.T.
        The cost of poor birth outcomes in employer-sponsored health plans.
        Medical Care. 1996; : 1219-1234
        • D'Agostino R.B.
        Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.
        Statistics in Medicine. 1998; 2281: 2265-2281
        • Declercq E.
        • Cunningham D.K.
        • Johnson C.
        • Sakala C.
        Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey.
        Birth. 2008; 35: 16-24
        • Declercq E.
        • Labbok M.H.
        • Sakala C.
        • O'Hara M.A.
        Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed.
        American Journal of Public Health. 2009; 99: 929
        • Declercq E.R.
        • Sakala C.
        • Corry M.P.
        • Applebaum S.
        Listening to Mothers II: Report of the Second National Survey of Women's Childbearing Experiences.
        Childbirth Connection, New York2006
        • Declercq E.R.
        • Sakala C.
        • Corry M.P.
        • Applebaum S.
        • Risher P.
        Listening to Mothers: Report of the first national U.S. survey of women's childbearing experiences.
        Maternity Center Association, New York2002
        • Goldenberg R.L.
        • Culhane J.F.
        • Iams J.D.
        • Romero R.
        Epidemiology and causes of preterm birth.
        Lancet. 2008; 371: 75-84
        • Grossman M.
        The demand for health: A theoretical and empirical investigation (vol. occasional paper 119, National Bureau of Economic Research).
        Columbia University Press, New York1972
        • Hirano K.
        • Imbens G.W.
        Estimation of causal effects using propensity score weighting: An application to data on right heart catheterization.
        Health Services and Outcomes Research Methodology. 2001; 2: 259-278
        • Jansen P.W.
        • Tiemeier H.
        • Verhulst F.C.
        • Burdord A.
        • Jaddoe V.W.V.
        • Hofman A.
        • et al.
        Employment status and the risk of pregnancy complications: The Generation R Study.
        Occupational and Environmental Medicine. 2012; 67: 387-394
        • Johnson P.J.
        • Oakes J.M.
        • Anderton D.L.
        Neighborhood poverty and American Indian infant death: Are the effects identifiable?.
        Annals of Epidemiology. 2008; 18: 552-559
        • Johnson, T.D.
        Maternity leave and employment patterns of first-time mothers: 1961-2003.
        U.S. Census Bureau, Washington, D.C.2008
        • Lawson C.C.
        • Whelan E.A.
        • Hibert E.N.
        • Grajewski B.
        • Spiegelman D.
        • Rich-Edwards J.W.
        Occupational factors and risk of preterm birth in nurses.
        American Journal of Obstetrics and Gynecology. 2009; 200: 51e51-51e58
        • Maldonado G.
        • Greenland S.
        Estimating causal effects.
        International Journal of Epidemiology. 2002; 31: 422-429
        • Mander A.
        • Clayton D.
        Hotdeck imputation.
        Stata Technical Bulletin. 1999; 51: 32-34
        • Martin J.A.
        • Hamilton B.E.
        • Sutton P.D.
        • Ventura S.J.
        • Mathews T.
        • Osterman M.J.
        Births: Final data for 2008.
        National Vital Statistics Reports. 2010; 59: 1-72
        • Martin J.A.
        • Hamilton B.E.
        • Sutton P.D.
        • Ventura S.J.
        • Menacker F.
        • Kirmeyer S.
        • et al.
        Births: final data for 2005.
        National Vital Statistics Reports. 2007; 56: 1-103
        • McGovern P.
        • Dowd B.
        • Gjerdingen D.
        • Gross C.R.
        • Kenney S.
        • Ukestad L.K.
        • et al.
        Postpartum health of employed mothers 5 weeks after childbirth.
        Annals of Family Medicine. 2006; 4: 159-167
        • Mercer B.
        • Goldenberg R.L.
        • Moawad A.H.
        • Iams J.D.
        • Meis P.J.
        • Copper R.L.
        • et al.
        The preterm prediction study: A clinical risk assessment system.
        American Journal of Obstetrics and Gynecology. 1996; 174: 1885-1893
        • Naeye R.L.
        • Peters E.C.
        Working during pregnancy: Effects on the fetus.
        Pediatrics. 1982; 69: 724-727
        • Oakes J.M.
        • Johnson P.J.
        Propensity score matching for social epidemiology.
        in: Oakes J.M. Kaufman J.S. Methods in social epidemiology. Jossey-Bass, San Francisco2006: 370-392
        • Peoples-Sheps M.D.
        • Siegel E.
        • Suchindran C.M.
        • Origasa H.
        • Ware A.
        • Barakat A.
        Characteristics of maternal employment during pregnancy: Effects on low birthweight.
        American Journal of Public Health. 1991; 81: 1007
      2. Preterm Birth Projects. (2012, May 30). Retrieved September 16, 2012, from http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirthProjects.htm

        • Reilly M.
        Data analysis using hot deck multiple imputation.
        The Statistician. 1993; : 307-313
        • Rubin D.B.
        Estimating causal effects from large data sets using propensity scores.
        Annals of Internal Medicine. 1997; 127: 757-763
        • Russell R.B.
        • Green N.S.
        • Steiner C.A.
        • Meikle S.
        • Howse J.L.
        • Poschman K.
        • et al.
        Cost of hospitalization for preterm and low birth weight infants in the United States.
        Pediatrics. 2007; 120: e1-e9
        • Saurel-Cubizolles M.J.
        • Zeitlin J.
        • Lelong N.
        • Papiernik E.
        • Di Renzo G.C.
        • Bréart G.
        Employment, working conditions, and preterm birth: Results from the Europop case-control survey.
        Journal of Epidemiology and Community Health. 2004; 58: 395-401
        • Stuart E.
        • Rubin D.B.
        Best practices in quasi-experimental designs: Matching methods for causal inference.
        in: Osborne J.W. Best practices in quantitative methods. Sage, Thousand Oaks, CA2008: 155-176
        • Tatano Beck C.
        • Gable R.K.
        • Sakala C.
        • Declercq E.R.
        Postpartum depressive symptomatology: Results from a two-stage US national survey.
        The Journal of Midwifery & Women’s Health. 2011; 56: 427-435
        • Taylor H.
        • Brenner J.
        • Overmeyer G.
        • Siegel J.W.
        • Terhanian G.
        Touchdown! Online polling scores big in November 2000.
        Public Perspective. 2001; 12: 38-39
        • Teitelman A.M.
        • Welch L.S.
        • Hellenbrand K.G.
        • Bracken M.B.
        Effect of maternal work activity on preterm birth and low birth weight.
        American Journal of Epidemiology. 1990; 131: 104
        • Terhanian G.
        • Bremer J.
        • Smith R.
        • Thomas R.
        Correcting data from online surveys for the effects of nonrandom selection and nonrandom assignment.
        Harris Interactive White Paper. 2000; : 1-13
        • Tita A.T.N.
        • Landon M.B.
        • Spong C.Y.
        • Lai Y.
        • Leveno K.J.
        • Varner M.W.
        • et al.
        Timing of elective repeat cesarean delivery at term and neonatal outcomes.
        New England Journal of Medicine. 2009; 360: 111-120
        • U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion
        Healthy people 2020 topics and objectives: Maternal, infant and child health.
        Author, Washington, DC2010
        • Young R.L.
        • Declercq E.
        Implications of subdividing marital status: Are unmarried mothers with partners different from unmarried mothers without partners? An exploratory analysis.
        Maternal and Child Health Journal. 2010; 14: 209-214

      Biography

      Katy B. Kozhimannil, PhD, MPA, is Assistant Professor in the Division of Health Policy and Management at the University of Minnesota. She is a health policy analyst who studies institutional and government policies affecting health care delivery, quality, and outcomes for women and families.

      Biography

      Laura B. Attanasio, BA, is a doctoral student in the Division of Health Policy and Management, University of Minnesota. She applies sociological and health services research methods to questions of equity in maternal and reproductive health care.

      Biography

      Patricia M. McGovern, PhD, MPH, is Professor in the Division of Environmental Health Sciences at the University of Minnesota. Her research applies the tools of health services research and policy to occupational and environmental health issues, in particular, issues of women's and children's health.

      Biography

      Dwenda K. Gjerdingen, MD, MS, is a family physician and Professor at the University of Minnesota Medical School. She maintains an active clinical practice while also conducting research on women's mental and physical health, with a focus on pregnancy and the postpartum period.

      Biography

      Pamela Jo Johnson, PhD, MPH, is a Research Investigator at Medica Research Institute and adjunct Assistant Professor in the Division of Epidemiology & Community Health at the University of Minnesota. She is a health services epidemiologist with broad interests in population health focusing on social disparities in health and healthcare.