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Evaluation of adverse pregnancy outcomes in physicians compared with nonphysicians

Cusimano MC, Baxter NN, Sutradhar R, McArthur E, Ray JG, Garg AX, Vigod S, Simpson AN. JAMA Netw Open. 2022; 5(5):e2213521. Epub 2022 May 23. DOI:

Importance — Physicians may be at risk of pregnancy complications due to prolonged work hours, overnight shifts, occupational hazards, and older maternal age at first birth compared with nonphysicians. Observational studies of physicians, including comparisons across physician specialties, are needed.

Objective — To compare adverse maternal and perinatal outcomes between pregnant physicians and nonphysicians and between physicians of different specialties.

Design, Setting, and Participants — A population-based retrospective cohort study was conducted in Ontario, Canada. Participants included physicians and nonphysician comparators residing in high-income areas who experienced a birth at 20 or more weeks’ gestation from April 1, 2002, to November 26, 2018. Data analysis was performed from December 2020 to March 2022.

Exposures — Physician occupation and physician specialty.

Main Outcomes and Measures — Severe maternal morbidity (in pregnancy and up to 42 days’ post partum) and severe neonatal morbidity (up to hospital discharge among live-born infants) were the primary outcomes. Logistic regression under a generalized estimating equations approach was used to compare outcomes between physicians and nonphysicians, accounting for potentially more than 1 pregnancy per woman. Odds ratios were adjusted (aOR) for maternal age, parity, previous preterm birth, calendar year, immigration status, comorbidities, multiple gestation, and mode of delivery.

Results — A total of 10 489 births occurred among 6161 licensed physicians, and 298 683 births occurred among 211 191 nonphysician counterparts. Physicians were older (median [IQR] age, 34 [31-36] vs 32 [29-35] years) and more likely to be nulliparous (5049 [48.1%] vs 128 961 [43.2%]) compared with nonphysicians. Severe maternal morbidity was more likely to occur among physicians than nonphysicians (unadjusted OR, 1.21; 95% CI, 1.04-1.41) but not after adjusting for study covariates (aOR, 1.13; 95% CI, 0.97-1.32). Severe neonatal morbidity was less likely to occur among infants of physicians than infants of nonphysicians (aOR, 0.79; 95% CI, 0.72-0.87). Compared with family physicians, neither nonsurgical specialists (aOR, 1.12; 95% CI, 0.82-1.53) nor surgical specialists (aOR, 1.43; 95% CI, 0.74-2.76) were at increased risk of severe maternal morbidity. Similar findings were observed for severe neonatal morbidity (nonsurgical specialists: aOR, 0.98; 95% CI, 0.80-1.19; surgical specialists: aOR, 1.08; 95% CI, 0.68-1.71).

Conclusions and Relevance — The findings of this study suggest that female physicians may be at slightly higher risk of severe maternal morbidity. This association appeared to be mediated by their tendency to delay childbearing compared with nonphysicians. Newborns of physicians appear to experience less morbidity. Such differences were not observed between physician specialty groups.

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