It’s Complicated: Impact of Work-Related Stressors on Pregnancy Outcomes of Cardiologists and Cardiovascular Team Members
Key result
Inflexible work schedules and extra pregnancy duties linked to ~50% higher maternal and fetal complications.
- Adjusted OR 1.495
- 95% CI 1.084-2.062
- P=0.014
- n=484
Figures
Why the study?
Pregnancy concerns and work-life balance difficulties may deter women from cardiology careers, and occupational factors contributing to pregnancy complications in cardiologists and cardiovascular team members are not well described.
Does exposure to work-related stressors increase the risk of pregnancy and fetal complications in pregnant cardiologists and cardiovascular team members?
Study Design
Type
Cross-Sectional (n=484)
Multicenter
Yes
Structured PICO
Does exposure to work-related stressors increase the risk of pregnancy and fetal complications in pregnant cardiologists and cardiovascular team members?
P
Population
484 female physicians and cardiovascular team members with 921 pregnancies surveyed about the association between occupational stressors and maternal/fetal complications.
E
Exposure
Exposure to work-related stressors during pregnancy (e.g., additional duties/call, inflexible work schedules) and sociomedical factors (unpartnered status, use of fertility treatments).
C
Comparator
Absence of these work-related and sociomedical stressors.
O
Outcome
Composite of any maternal or fetal complication (hyperemesis gravidarum, preterm labor, bleeding/hemorrhage, placenta abruption/infarction, placenta previa, pulmonary embolism, cholestasis of pregnancy, HELLP syndrome, pre-eclampsia, gestational hypertension, premature rupture of membranes, gestational diabetes, fetal growth restrictions, stroke, peripartum cardiomyopathy, miscarriage, stillbirth, preterm birth, low birth weight, small for gestational age, or birth defects).composite
Main Result
Odds Ratio: 1.495 (95% CI 1.084–2.062)
Absolute Event Rate: 47.1% vs 36.4%
p-value: p=0.014
Demanding work conditions, specifically inflexible schedules and additional workload, are significantly associated with a higher likelihood of maternal and fetal complications in cardiovascular professionals.
Limitations
- Low survey response rate (9%)
- Outcomes were self-reported, leading to inherent recall bias
- Selection bias as those with complications or parenting bias may have been more likely to respond
- Small sample size underpowered to detect associations with medical comorbidities
- Low response rate of 9% (though self-exclusion of those without pregnancy may lower it)
- Self-reported outcomes susceptible to recall bias
- Selection bias as individuals with strong feelings or past complications might be more likely to respond
- Not adequately powered to assess correlations between medical comorbidities and pregnancy complications
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Solutions for improving work conditions for the pregnant cardiologist and [cardiovascular team] member could include adjusted call responsibilities, schedule flexibility, providing appropriate coverage during and after pregnancy, and having institutional policies that discuss mechanisms to accommodate work duties during pregnancy and the postpartum period as well as support breast feeding.”
MGMartha GulatiCardiologist, University of Arizona, Phoenix
“As a former chief of cardiology, I can say that it is very hard to hire women. Sometimes, the biggest reasons were related to these issues around pregnancy and maternity leave. I wanted to know more about why it is hard to hire and retain women cardiologists and if this is why our numbers are not growing in cardiology.”
LHLeila HaghighatCardiologist, University of California, San Francisco
“Especially as more and more women are going into cardiology, I think we're realizing it's a bigger issue.”
Implication
Supports flexible scheduling for pregnant cardiovascular professionals; cross-sectional data leave causality and practice change open.
Abstract
BACKGROUND: Pregnancy concerns and difficulties in work-life balance may deter women from careers in cardiology; a gender-balanced workforce is needed to improve patient experience and outcomes. OBJECTIVES: The purpose of this study is to describe occupational, medical, and lifestyle factors that may contribute to pregnancy complications in physicians and cardiovascular team (CVT) members. METHODS: A survey was emailed to 6,786 randomly selected women of the American College of Cardiology inquiring about prepregnancy medical conditions and lifestyle, age and work environment during pregnancy, and pregnancy complications and outcomes. Multiple logistic regressions were conducted to examine associations between pregnancy/fetal complications (composite any maternal or fetal) and potential risk factors. RESULTS: The study included 921 pregnancies in 273 physicians and 211 CVT members, with 39% of respondents (n = 188) reporting at least one pregnancy or fetal complication. Complications (n = 401) were associated with being unpartnered during pregnancy (adjusted OR 3.439; 95% CI: 1.048-11.283), fertility treatments (1.552; 95% CI: 1.037-2.323), as well as stressful work conditions including additional duties during pregnancy (1.402; 95% CI: 1.015-1.936), and inflexible work schedules (1.495; 95% CI: 1.084-2.062). Bed rest, fetal complications, and less breast feeding were more likely to occur in complicated pregnancies. Fetal complications occurred in close to 40% of complicated pregnancies, most commonly preterm birth, low birth weight, and small-for-gestational-age. CONCLUSIONS: This study found associations between self-reported work-related stressors and pregnancy complications in physicians and CVT members. Hospitals are encouraged to improve work conditions for pregnant physicians and CVT members with the goal of improving provider, employee, and fetal outcomes.
Discussion
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Cite This Study
Oliveros et al. (2026) conducted a cross-sectional in Pregnancy in women cardiologists and cardiovascular team members (n=484). Inflexible work schedules vs. Flexible work schedules was evaluated on Composite any maternal or fetal complication (Adjusted OR 1.495, 95% CI 1.084-2.062, p=0.014). Inflexible work schedules and additional duties during pregnancy significantly increased the risk of maternal and fetal complications among women in the cardiovascular workforce.