Objective Psychosocial work stress is a predictor of adverse pregnancy outcomes. However, there is limited comprehensive and conclusive evidence available on the associations between psychosocial work stress and adverse pregnancy outcomes. This systematic review and meta-analysis paper addressed this gap by synthesizing the available evidence.

Methods Studies were retrieved from six electronic databases that include pregnant mothers as study population, psychosocial work stress as variable exposure, and adverse pregnancy outcomes – including pregnancy loss, gestational hypertension and diabetes mellitus, preterm birth, low birth weight, and low fetal growth – as the outcomes of interest. The quality and certainty of evidence were assessed. Depending on the study characteristics, either a fixed or random effect model was employed. Heterogeneity was assessed using I² statistics, and further subgroup and sensitivity analysis was employed as appropriate.

Results A total of 26 studies (N=1 346 686) were included. Psychosocial work stress decreased birth weight by 77.09 grams, increased the occurrence of preeclampsia by 50%, and preterm birth by 18% with moderate certainty of evidence, and increased the chance of pregnancy loss by 20% with low certainty of evidence. With a low grading scale, low birth weight and small-for-gestational-age had no significant association with psychosocial work stress.

Conclusions Psychosocial work-stress increased the risks of pre-eclampsia, preterm birth, and pregnancy loss, and decreased fetus weight. Therefore, occupational therapists, employers, policy makers, and relevant stakeholders should work together to minimize the impact of psychosocial work-stress on the mother and baby.

Key terms adverse pregnancy outcome; birth weight; fetal growth; gestational hypertension; meta-analysis; occupational hazard; pre-eclampsia; pregnancy; pregnancy loss; prenatal; preterm; psychosocial; stress; systematic review

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