Workplace Stress And Pregnancy Complications: A Cross-Sectional Study Among Working Pregnant Women

Abstract

Background: Workplace stress during pregnancy contributes to adverse maternal-fetal
outcomes, including preterm birth, low birth weight, and pregnancy-induced hypertension. Limited
research has examined this relationship in the Indonesian population. Objective: This study
examined associations between workplace stress levels and pregnancy complications among
working pregnant women. Methods: Cross-sectional study involving 160 pregnant women in urban
Indonesia using the Work Stress Assessment Scale (WSAS), Pregnancy Experience Scale (PES),
and comprehensive demographic questionnaires. Multivariable logistic regression analyzed
relationships between workplace stress and pregnancy complications, adjusting for demographic
and environmental factors. Results: Participants had an average work stress score of 79.52±11.87,
pregnancy experience score of 81.88±11.84, and lifestyle and work environment factors of
80.04±11.60. There was a strong positive correlation between all work stress variables (r=0.818
0.961, p<0.001). Work stress was significantly associated with pregnancy complications in the
initial model (OR=0.077; 95% CI: 0.031-0.190; p<0.001); however, the OR below 1.0 likely
reflects healthy worker survivor bias rather than a true protective effect. Work stress lost statistical
significance in the final model (OR=0.500; p=0.325) after inclusion of lifestyle and work
environment factors, which emerged as the sole independent predictor (OR=0.080; 95% CI: 0.018
0.349; p=0.001). Conclusions: While initial models showed significant associations between work
stress and pregnancy complications, the final model indicated that concrete work environment
factors—such as working hours, rest periods, and physical hazards—were the dominant predictors,
mediating the perceived stress-complication relationship. The counterintuitive OR direction and the
loss of significance for work stress in the fully adjusted model highlight important methodological
limitations of the cross-sectional design. Healthcare providers should incorporate occupational
exposure assessment into routine antenatal care, with emphasis on modifiable working conditions.