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A screening questionnaire for occupational and hobby exposures during pregnancy.

ABSTRACT: BACKGROUND:Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care. AIMS:To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics. METHODS:A cross-sectional survey assessed prenatal clinic patients at a public hospital who were currently employed and <20 weeks gestation. Questionnaires evaluated job characteristics, workplace and hobby exposures, protective equipment use and symptoms during pregnancy. RESULTS:Of 69 participants (96% response rate), 46% were predominantly Spanish-speaking. Primary occupations were caregiver (16%), cleaner (14%) and administrative assistant (14%). Overall, 93% were exposed to a workplace hazard, with most participants reporting physical stressors (82%) or organic solvent exposure (78%). Most women (74%) used some personal protective equipment. Nearly half (54%) reported at least one non-pregnancy symptom, and 52% were referred for follow-up with an occupational medicine practitioner. Household and hobby-related chemical exposures were common in our sample (91%). We observed moderate consistency between job task and chemical use responses: 67-99% of intentionally redundant questions were fully or partially matched. Closed- compared to open-ended activity questions identified a higher proportion of physical stressors (82% versus 12%) and cleaning product (76% versus 30%) exposures. CONCLUSIONS:A self-administered questionnaire is an effective screening tool for identifying women with occupational and hobby-related exposures during pregnancy. Consistent incorporation of exposure assessment into prenatal care can improve clinical communications and early interventions for at-risk pregnant women.

SUBMITTER: Zachek CM

PROVIDER: S-EPMC6939873 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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A screening questionnaire for occupational and hobby exposures during pregnancy.

Zachek C M CM Schwartz J M JM Glasser M M DeMicco E E Woodruff T J TJ

Occupational medicine (Oxford, England) 20191001 6

<h4>Background</h4>Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care.<h4>Aims</h4>To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics.<h4>Methods</h4>A cross-sectional survey assessed prenatal clinic patients at a pu ...[more]

PMID: 31247109

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Project description:Silicone wristbands can assess multipollutant exposures in a non-invasive and minimally burdensome manner, which may be suitable for use among pregnant women. We investigated silicone wristbands as passive environmental samplers in the New Hampshire Birth Cohort Study, a prospective pregnancy cohort. We used wristbands to assess exposure to a broad range of organic chemicals, identified multipollutant exposure profiles using self-organizing maps (SOMs), and assessed temporal consistency and determinants of exposures during pregnancy. Participants (n = 255) wore wristbands for 1 week at 12 gestational weeks. Of 1,530 chemicals assayed, 199 were detected in at least one wristband and 16 were detected in >60% of wristbands. A median of 23 (range: 12,37) chemicals were detected in each wristband, and chemicals in commerce and personal care products were most frequently detected. A subset of participants (n=20) wore a second wristband at 24 gestational weeks, and concentrations of frequently detected chemicals were moderately correlated between time points (median intraclass correlation: 0.22; range: 0.00,0.69). Women with higher educational attainment had fewer chemicals detected in their wristbands and the total number of chemicals detected varied seasonally. Triphenyl phosphate concentrations were positively associated with nail polish use, and benzophenone concentrations were highest in summer. No clear associations were observed with other a priori relations, including certain behaviors, season, and socioeconomic factors. SOM analyses revealed 12 profiles, ranging from 2 to 149 participants, captured multipollutant exposure profiles observed in this cohort. The most common profile (n = 149) indicated that 58% of participants experienced relatively low exposures to frequently detected chemicals. Less common (n ≥ 10) and rare (n < 10) profiles were characterized by low to moderate exposures to most chemicals and very high and/or very low exposure to a subset of chemicals. Certain covariates varied across SOM profile membership; for example, relative to women in the most common profile who had low exposures to most chemicals, women in the profile with elevated exposure to galaxolide and benzyl benzoate were younger, more likely to be single, and more likely to report nail polish use. Our study illustrates the utility of silicone wristbands for measurement of multipollutant exposures in sensitive populations, including pregnant women.

Project description:BackgroundVariation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum.MethodsA prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (??13) and postpartum (??10) and for 'probable major depression' during pregnancy (??15) and postpartum (??13). PHQ-2 was analysed using two methods: [1] scored (cut-points ? 2 and ? 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy.ResultsProbable major depression: Over four timepoints PHQ-2 ? 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ? 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%).ConclusionsRecommended method of case-identification (PHQ-2 ? 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

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A screening questionnaire for occupational and hobby exposures during pregnancy.

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A screening questionnaire for occupational and hobby exposures during pregnancy.

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