Research Article: Night work during pregnancy and preterm birth—A large register-based cohort study

Date Published: April 18, 2019

Publisher: Public Library of Science

Author(s): Ina Olmer Specht, Paula E. C. Hammer, Esben M. Flachs, Luise M. Begtrup, Ann D. Larsen, Karin S. Hougaard, Johnni Hansen, Åse M. Hansen, Henrik A. Kolstad, Reiner Rugulies, Anne Helene Garde, Jens Peter Bonde, Pal Bela Szecsi.


Melatonin stimulates the production of progesterone, which is essential for the maintenance of pregnancy. Since melatonin in blood is reduced due to work under illuminated conditions during night work, it has been hypothesized that night work may increase the risk of preterm birth. Previous meta-analyses have not revealed increased risk of preterm birth in women working night shifts during pregnancy. Still, these studies might have been limited by inaccurate self-reports of timing, intensity and duration of night work most likely causing bias towards the null. The aim of this is study was to investigate if the frequency and duration of night work during the first (week 1–12) and second (week 13–22) trimester of pregnancy were associated with risk of preterm birth when objective and prospective data on night work are used.

In a register-based prospective cohort study, we obtained individual day-to-day information on working hours from The Danish Working Hour Database (DWHD, a payroll database including all public service employees in administrative Danish Regions from 2007–2013) and information on preterm birth from the Danish Medical Birth Registry. Night-shift was defined as at least three working hours between 23:00 and 06:00. Preterm birth was defined as giving birth during gestational weeks 23–37. Odds of preterm birth according to working night shifts were analysed by logistic regression.

We identified 16,501 pregnant women eligible for the study, of which 10,202 women (61.8%) had at least one night-shift during the first 22 gestational weeks. The risk of preterm birth was not elevated among women working night shifts compared to women working only day shifts during either the first or second trimester. Within night-shift workers, the risk was not related to the number of night shifts, the duration of night shifts, consecutive night shifts or quick returns defined as short intervals between shifts. Odds of preterm birth was not related to change of working schedule from the first to second trimester, although women changing from night shifts in the first trimester to day work only in the second trimester displayed a weak increased odds of preterm birth (OR 1.21, 95%CI 0.98–1.49) compared to women working night shifts in both trimesters.

Our results, which are without bias from self-report of either exposure or outcome, are in line with the results of previous meta-analyses. Due to the detailed information on hours worked during pregnancy, we were able to investigate several dimensions of night work not previously investigated, of which none were associated with elevated risk of preterm birth.

Partial Text

Working hours outside what is regarded as regular working hours, including night work, are highly prevalent in both industrialized and post-industrialized societies [1], particularly among health care professionals. As most employees in health care are women [2], many within their reproductive age, there is a concern about possible hazardous effects of night work on the course of pregnancy and fetal development.

The study population consisted of 16,501 pregnant women, of which 10,202 women (61.8%) worked at least one night shift during the first 22 gestational weeks (Table 1). Compared to day workers, night workers more often were first time pregnant (54.7% vs. 45.0%, respectively), more often had a medium SES (70.3% vs. 53.9%, respectively) and less often a low SES (7.2% vs. 21.3%, respectively), and were less often current smokers (2.6% vs. 3.6%, respectively). The prevalence of preterm birth was 5.2% among night workers and 5.1% among day workers.

In this study, the potential association of night work with risk of preterm birth was investigated with the use of objective and precise daily exposure information on working time. Based on these data we were also able to investigate selection in and out of night work during pregnancy. We found no associations of the number of night shifts, consecutive night shifts or quick returns with preterm birth, after adjustment for covariates. However, women working at least one night shift lasting >8 hours during the second trimester had lower odds of preterm birth compared to day workers.