BACKGROUND AND PURPOSE:

• Cusimano et al. (JAMA Network Open, 2022) examined adverse maternal and perinatal outcomes between pregnant physicians vs nonphysicians

METHODS:

• Population-based retrospective cohort study
  • Data derived from linked databases collected on all residents of Ontario, Canada
• Population
  • All women aged 20 to 50 years 
  • Had a live birth or stillbirth at ≥20 weeks between April 1, 2002, to November 26, 2018
  • Exclusions: Women in in rural areas because neighborhood-level income quintile due to inaccurate data
• Exposures
  • Physician occupation
  • Physician specialty
• Study design
  • To reduce confounding due to socioeconomic status, only nonphysicians living in the highest-income quintile level were included
  • Logistic regression used to compare outcomes between physicians and nonphysicians
  • Odds ratios (ORs) adjusted for
    • Maternal age | Parity | Previous preterm birth | Calendar year | Immigration status | Comorbidities | Multiple gestation | Mode of delivery
• Primary outcomes
  • Severe maternal morbidity (in pregnancy and up to 42 days postpartum)
  • Severe neonatal morbidity (up to hospital discharge among live born infants)

RESULTS:

• Physicians: 6161 (10,489 births) | Nonphysicians: 211,191 (298,683 births)
• Compared to nonphysicians, physicians were
  • Older (median age)
    • Physicians: 34 (IQR, 31 to 36) years
    • Nonphysicians: 31 (IQR, 29 to 35) years
  • More likely to be nulliparous
    • Physicians: 48.1%
    • Nonphysicians: 43.2%

Comparing Physicians to Nonphysicians

• Severe maternal morbidity was more likely to occur among physicians than nonphysicians
  • Unadjusted OR 1.21 (95% CI, 1.04 to 1.41)
• Association did not remain after adjusting for study covariates
  • aOR 1.13 (95% CI, 0.97 to 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 to 0.87)

Comparing Specialties

• Compared with family physicians, there was no increased risk of severe maternal morbidity for
  • Nonsurgical specialists
    • aOR 1.12 (95% CI, 0.82 to 1.53)
  • Surgical specialists
    • aOR 1.43 (95% CI, 0.74 to 2.76)
• Findings were similar for severe neonatal morbidity
  • Nonsurgical specialists
    • aOR 0.98 (95% CI, 0.80 to 1.19)
  • Surgical specialists
    • aOR 1.08 (95% CI, 0.68 to 1.71)

CONCLUSION:

• After controlling for confounders, physicians were not more likely to experience adverse pregnancy outcomes vs nonphysicians
• Infants born to physicians were less likely to experience severe neonatal morbidity
• There was no difference in maternal or neonatal morbidity among physician specialties
• The authors state

Results of this cohort study suggest that physician occupation may be associated with pregnancy complications but that this association is likely mediated by delayed childbearing and advanced maternal age at first birth rather than the nature of the occupation

Learn More – Primary Sources:

Evaluation of Adverse Pregnancy Outcomes in Physicians Compared With Nonphysicians

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