{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T03:08:40Z","timestamp":1785035320932,"version":"3.55.0"},"reference-count":76,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling &gt; 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle\u2013Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.<\/jats:p>","DOI":"10.3390\/ijerph18168277","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T21:45:06Z","timestamp":1628113506000},"page":"8277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Occupational Risk Factors and Hypertensive Disorders in Pregnancy: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Emanuela","family":"Spadarella","sequence":"first","affiliation":[{"name":"Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3039-2856","authenticated-orcid":false,"given":"Veruscka","family":"Leso","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4621-7374","authenticated-orcid":false,"given":"Luca","family":"Fontana","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0444-3792","authenticated-orcid":false,"given":"Ivo","family":"Iavicoli","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"l2381","DOI":"10.1136\/bmj.l2381","article-title":"Pre-eclampsia: Pathophysiology and clinical implications","volume":"366","author":"Burton","year":"2019","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol., 135, e237\u2013e260.","DOI":"10.1097\/AOG.0000000000003891"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0140-6736(20)32335-7","article-title":"Pre-eclampsia","volume":"398","author":"Chappell","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","article-title":"Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice","volume":"72","author":"Brown","year":"2018","journal-title":"Hypertension"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1161\/CIRCRESAHA.118.313276","article-title":"Preeclampsia: Pathophysiology, Challenges, and Perspectives","volume":"124","author":"Rana","year":"2019","journal-title":"Circ. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"211","DOI":"10.14310\/horm.2002.1582","article-title":"Pregnancy-Induced hypertension","volume":"14","author":"Kintiraki","year":"2015","journal-title":"Hormones"},{"key":"ref_7","unstructured":"WHO World Health Organization (2011). WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia, WHO."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S0140-6736(05)17987-2","article-title":"Pre-eclampsia","volume":"365","author":"Sibai","year":"2005","journal-title":"Lancet"},{"key":"ref_9","unstructured":"Roberts, J. (2003). Preeclampsia: A Two Stage Disorder, RCOG Press."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.ajog.2005.10.813","article-title":"Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?","volume":"194","author":"Villar","year":"2006","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1161\/HYPERTENSIONAHA.110.150078","article-title":"Preeclampsia and cardiovascular disease death: Prospective evidence from the child health and development studies cohort","volume":"56","author":"Cirillo","year":"2010","journal-title":"Hypertension"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/hr.2016.126","article-title":"Epidemiology of hypertensive disorders in pregnancy: Prevalence, risk factors, predictors and prognosis","volume":"40","author":"Umesawa","year":"2017","journal-title":"Hypertens. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e009382","DOI":"10.1161\/JAHA.118.009382","article-title":"Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk","volume":"7","author":"Ying","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2925","DOI":"10.1038\/s41467-020-16775-8","article-title":"Association between ambient temperature and hypertensive disorders in pregnancy in China","volume":"11","author":"Xiong","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1161\/HYPERTENSIONAHA.119.13139","article-title":"Wintertime Wood Smoke, Traffic Particle Pollution, and Preeclampsia","volume":"75","author":"Glantz","year":"2020","journal-title":"Hypertension"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s12940-020-00655-1","article-title":"Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China","volume":"19","author":"Su","year":"2020","journal-title":"Environ. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"43667","DOI":"10.18632\/oncotarget.6190","article-title":"Cigarette smoking during pregnancy and preeclampsia risk: A systematic review and meta-analysis of prospective studies","volume":"6","author":"Wei","year":"2015","journal-title":"Oncotarget"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kawashima, A., Koide, K., Hasegawa, J., Arakaki, T., Takenaka, S., Maruyama, D., Matsuoka, R., and Sekizawa, A. (2015). Maternal Smoking History Enhances the Expression of Placental Growth Factor in Invasive Trophoblasts at Early Gestation Despite Cessation of Smoking. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0134181"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0146-0005(00)80052-X","article-title":"Calcium, nitric oxide, and preeclampsia","volume":"24","year":"2000","journal-title":"Semin. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0301-2115(02)00111-2","article-title":"Pregnant women with a low milk intake have an increased risk of developing preeclampsia","volume":"105","author":"Duvekot","year":"2002","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rolfo, A., Nuzzo, A., De Amicis, R., Moretti, L., Bertoli, S., and Leone, A. (2020). Fetal\u2013Maternal Exposure to Endocrine Disruptors: Correlation with Diet Intake and Pregnancy Outcomes. Nutrients, 12.","DOI":"10.3390\/nu12061744"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2732","DOI":"10.1096\/fj.201800934RRR","article-title":"Bisphenol A exposure alters placentation and causes preeclampsia-like features in pregnant mice involved in reprogramming of DNA methylation ofWNT2","volume":"33","author":"Ye","year":"2019","journal-title":"FASEB J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.ajog.2019.06.051","article-title":"The impact of occupational shift work and working hours during pregnancy on health outcomes: A systematic review and meta-analysis","volume":"221","author":"Cai","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s11906-020-01070-0","article-title":"Hypertension during Pregnancy","volume":"22","author":"Agrawal","year":"2020","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_25","unstructured":"Johnson, T. (2007). Maternity Leave and Employment Patterns: 2001\u20132003, Current Population Report."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/S0002-9378(97)70607-0","article-title":"Reproductive hazards of the American lifestyle: Work during pregnancy","volume":"176","author":"Gabbe","year":"1997","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00001648-199607000-00002","article-title":"Psychosocial work stress and pregnancy-induced hypertension","volume":"7","author":"Landsbergis","year":"1996","journal-title":"Epidemiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/00001648-199605000-00005","article-title":"Job stress and preeclampsia","volume":"7","author":"Cross","year":"1996","journal-title":"Epidemiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1136\/jech.56.5.389","article-title":"The relation between maternal work, ambulatory blood pressure, and pregnancy hypertension","volume":"56","author":"Higgins","year":"2002","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nugteren, J.J., Snijder, C.A., Hofman, A., Jaddoe, V.W., Steegers, E.A., and Burdorf, A. (2012). Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039263"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s10995-016-1919-y","article-title":"Physical Activity During Pregnancy and Subsequent Risk of Preeclampsia and Gestational Hypertension: A Case Control Study","volume":"20","author":"Spracklen","year":"2016","journal-title":"Matern. Child Health J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Eir\u00edksd\u00f3ttir, V.H., Valdimarsd\u00f3ttir, U.A., \u00c1sgeirsd\u00f3ttir, T.L., Hauksd\u00f3ttir, A., Lund, S.H., Bjarnad\u00f3ttir, R.I., Cnattingius, S., and Zo\u00ebga, H. (2015). Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138534"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"304","DOI":"10.5271\/sjweh.1147","article-title":"Population-based study on occupational risk factors for preeclampsia and gestational hypertension","volume":"33","author":"Haelterman","year":"2007","journal-title":"Scand. J. Work. Environ. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/aje\/kwh277","article-title":"Work, Leisure-Time Physical Activity, and Risk of Preeclampsia and Gestational Hypertension","volume":"160","author":"Saftlas","year":"2004","journal-title":"Am. J. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1093\/occmed\/kqp119","article-title":"Working hours and risk of gestational hypertension and pre-eclampsia","volume":"60","author":"Chang","year":"2009","journal-title":"Occup. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"188a","DOI":"10.1089\/jwh.2012.3975","article-title":"Occupation as a Risk Factor for Hypertensive Disorders of Pregnancy","volume":"22","author":"Bilhartz","year":"2013","journal-title":"J. Women Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/j.1479-828X.1995.tb02146.x","article-title":"The Effect of Work Activity in Pregnancy on the Risk of Severe Preeclampsia","volume":"35","author":"Spinillo","year":"1995","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_40","first-page":"40","article-title":"Risk factors for pre-eclampsia\/eclampsia among working women in Mexico City","volume":"15","author":"Harlow","year":"2001","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s10995-007-0224-1","article-title":"Association Between Maternal Infections and Preeclampsia: A Systematic Review of Epidemiologic Studies","volume":"12","author":"Rustveld","year":"2007","journal-title":"Matern. Child Health J."},{"key":"ref_42","first-page":"311","article-title":"Association of Helicobacter pylori infection with systemic inflammation in preeclampsia","volume":"23","author":"Ozkaplan","year":"2009","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1111\/j.1471-0528.2012.03420.x","article-title":"Cytomegalovirus antibody status at 17\u201318 weeks of gestation and pre-eclampsia: A case-control study of pregnant women in Norway","volume":"119","author":"Strand","year":"2012","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/AOG.0000000000001424","article-title":"Risk of Preeclampsia in Human Immunodeficiency Virus\u2013Infected Pregnant Women","volume":"127","author":"Sansone","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/ajim.4700140208","article-title":"Exposure to Organic Solvents and Hypertensive Disorders of Pregnancy","volume":"14","author":"Eskenazi","year":"1988","journal-title":"Am. J. Ind. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"280891","DOI":"10.1155\/2015\/280891","article-title":"Gestational Hypertension and Organophosphorus Pesticide Exposure: A Cross-Sectional Study","volume":"2015","author":"Ledda","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/ajim.4700250305","article-title":"Study of occupational risk factors for pregnancy-induced hypertension among active duty enlisted navy personnel","volume":"25","author":"Irwin","year":"1994","journal-title":"Am. J. Ind. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.envint.2018.09.049","article-title":"The association of traffic-related air and noise pollution with maternal blood pressure and hypertensive disorders of pregnancy in the HOME study cohort","volume":"121","author":"Sears","year":"2018","journal-title":"Environ. Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4103\/1463-1741.90288","article-title":"Risk of hypertension related to road traffic noise among reproductive-age women","volume":"13","author":"Bendokiene","year":"2011","journal-title":"Noise Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5271\/sjweh.3913","article-title":"Occupational exposure to noise in relation to pregnancy-related hypertensive disorders and diabetes","volume":"47","author":"Gustavsson","year":"2021","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0020-7292(97)00083-0","article-title":"Working conditions and prevalence of pre-eclampsia, Norway 1989","volume":"58","author":"Wergeland","year":"1997","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"117","DOI":"10.5271\/sjweh.1873","article-title":"Occupational noise exposure and course of pregnancy","volume":"15","author":"Nurminen","year":"1989","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/oemed-2020-106519","article-title":"Occupational exposure to whole-body vibrations and pregnancy complications: A nationwide cohort study in Sweden","volume":"77","author":"Pettersson","year":"2020","journal-title":"Occup. Environ. Med."},{"key":"ref_54","unstructured":"European Agency for Safety Health and Work (2021, May 21). Worplace Exposure to Vibration in Europe: An Expert Review, Available online: https:\/\/osha.europa.eu\/en\/publications\/report-workplace-exposure-vibration-europe-expert-review."},{"key":"ref_55","unstructured":"International Labour Office (ILO) Shift Work (2021, May 14). Conditions of Work and Employment Programme. Information Sheet No. WT-8 2004., Available online: https:\/\/www.ilo.org\/wcmsp5\/groups\/public\/---ed_protect\/---protrav\/---travail\/documents\/publication\/wcms_170713.pdf."},{"key":"ref_56","unstructured":"(2021, May 14). Your Europe\u2013European Union Working Hours. Available online: https:\/\/europa.eu\/youreurope\/business\/human-resources\/working-hours-holiday-leave\/working-hours\/index_en.htm#shortcut-5."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1111\/j.1471-0528.2011.03066.x","article-title":"Shift work and pregnancy outcomes: A systematic review with meta-analysis of currently available epidemiological studies","volume":"118","author":"Bonzini","year":"2011","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"403","DOI":"10.5271\/sjweh.3728","article-title":"Night work and hypertensive disorders of pregnancy: A national register-based cohort study","volume":"44","author":"Hammer","year":"2018","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/birt.12463","article-title":"The Japan Environment & Children\u2019s Study Group Effects of long working hours and shift work during pregnancy on obstetric and perinatal outcomes: A large prospective cohort study\u2014Japan Environment and Children\u2019s Study","volume":"47","author":"Suzumori","year":"2019","journal-title":"Birth"},{"key":"ref_60","first-page":"84","article-title":"Shift Work Effects and Pregnancy Outcome: A Historical Cohort Study","volume":"12","author":"Davari","year":"2018","journal-title":"J. Fam. Reprod. Health"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"395","DOI":"10.5271\/sjweh.1833","article-title":"Shift work, fetal development and course of pregnancy","volume":"15","author":"Nurminen","year":"1989","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"285","DOI":"10.2307\/2392498","article-title":"Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign","volume":"24","author":"Karasek","year":"1979","journal-title":"Adm. Sci. Q."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/00001648-199907000-00007","article-title":"Job Strain and Pregnancy-Induced Hypertension","volume":"10","author":"Marcoux","year":"1999","journal-title":"Epidemiology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1479-828X.2005.00411.x","article-title":"Risk factors for pre-eclampsia in Lagos, Nigeria","volume":"45","author":"Anorlu","year":"2005","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/j.1471-0528.2008.01665.x","article-title":"Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension?","volume":"115","author":"Vollebregt","year":"2008","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/10641950701274870","article-title":"Emotional stress and the risk to develop hypertensive diseases in pregnancy","volume":"26","author":"Leeners","year":"2007","journal-title":"Hypertens. Pregnancy"},{"key":"ref_67","unstructured":"Eurostat (2021, May 25). Employment and Activity by Sex and Age\u2014Annual Data. Available online: http:\/\/ec.europa.eu\/eurostat\/web\/products-datasets\/-\/lfsi_emp_a)."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/1471-0528.15661","article-title":"Impact of maternal body mass index and gestational weight gain on pregnancy complications: An individual participant data meta-analysis of European, North American and Australian cohorts","volume":"126","author":"Santos","year":"2019","journal-title":"BJOG"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1093\/ije\/dyy079","article-title":"Is shift work associated with a higher risk of overweight or obesity? A systematic review of observational studies with meta-analysis","volume":"47","author":"Liu","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"371","DOI":"10.2147\/IJWH.S168569","article-title":"Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome","volume":"10","author":"Kongwattanakul","year":"2018","journal-title":"Int. J. Womens Health"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"129","DOI":"10.5271\/sjweh.770","article-title":"Urinary catecholamines and salivary cortisol on workdays and days off in relation to job strain among female health care providers","volume":"30","author":"Fujiwara","year":"2004","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_72","first-page":"338","article-title":"Catecholamine levels in pregnant physicians and nurses: A pilot study of stress and pregnancy","volume":"77","author":"Katz","year":"1991","journal-title":"Obstet. Gynecol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1136\/oem.52.7.464","article-title":"Lorry drivers\u2019 work stress evaluated by catecholamines excreted in urine","volume":"52","author":"Meijman","year":"1995","journal-title":"Occup. Environ. Med."},{"key":"ref_74","unstructured":"Young, W.F., and Landsberg, L. (1998). Catecholemines and the adrenal medulla. Williams Textbook of Endocrinology, Saunders."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0301-2115(97)00112-7","article-title":"Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia","volume":"74","author":"Khatun","year":"1997","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/BF00599687","article-title":"Uterine circulatory dysfunction induced by whole-body vibration and its endocrine pathogenesis in the pregnant rat","volume":"72","author":"Nakamura","year":"1996","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8277\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:40:37Z","timestamp":1760164837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,4]]},"references-count":76,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["ijerph18168277"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18168277","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,4]]}}}