Surgeons Twice as Likely to Miscarry

[The White Coat Investor]

Compared with female nonsurgeon partners, female surgeons were more likely to have major pregnancy complications (311 of 692 [48.3%] vs 43 of 158 [27.2%]; P < .001), which was significant after controlling for age, work hours, in vitro fertilization use, and multiple gestation (odds ratio [OR], 1.72; 95% CI, 1.11-2.66). Female surgeons operating 12 or more hours per week during the last trimester of pregnancy were at higher risk of major pregnancy complications compared with those operating less than 12 hours per week (OR, 1.57; 95% CI, 1.08-2.26). Compared with female nonsurgeon partners, female surgeons were more likely to have musculoskeletal disorders (255 of 692 [36.9%] vs 29 of 158 [18.4%]; P < .001), nonelective cesarean delivery (170 of 692 [25.5%] vs 24 of 158 [15.3%]; P = .01), and postpartum depression (77 of 692 [11.1%] vs 9 of 158 [5.7%]; P = .04).

https://jamanetwork.com/journals/jam...tm_term=072821

Seems like a really important paper, but what's the hypothesis as to WHY? Standing for hours in the OR? Getting crummy sleep? The stress of knowing lives depend on you? What? Because it's not age, work hours, or IVF.

I also wonder what it looks like in other specialties.

[wideopenspaces]

This is so interesting. I had a pt come to me for resources a month or so ago after her second miscarriage. . . And she's a surgeon. I wish I'd known this then. I certainly don't have any answers but I'm guessing it's a combination of things. Would definitely be interesting to compare different specialties.

Thanks for passing this along!

[ObgynMD]

Surgeries start at 730a. Long cases can be hours and surgeons rarely scrub out to do human-things like eat and drink. Lack of sleep, the physical stress, and the physical deprivation could increase complications are my guess. I would be interested to see if there are significant differentiators by field of surgery. I almost fainted during a c-section in the late 3rd trimester and that was only an hour long. I wonder how transplant surgeons fare.

Also makes me wonder what kind of long-term
health consequences surgeons in general carry that non-surgeons might not carry. For example, do male surgeons have higher rates of illness compared to male non-surgeon counterparts. I bet female surgeons aren’t ‘weak’. There probably is something underlying that is just not optimal for humans, male and female alike- something about surgery that is bad for ones health. That awful smelling bovie burn comes to mind.

[Tim]

So much in a medical career is self selective but based upon very incomplete data.

When looking at percentage of women by specialty, I always assumed under representation was due to some sort of bias.

It may sound silly, I believe in “women’s intuition”. Maybe that’s why ortho is at 9%.

Additional data would be helpful. Health impacts on specialty choices would meaningful.

[StateOfMyHead]

If I understand correctly anesthesiologists are also prone to experience several adverse events which has always made me wonder about the implications of exposure to anesthesia.

[Hatton]

Good article. I am not surprised at all. I suspect the increased rate of miscarriage is secondary to the delay of childbearing until over 35.

[Huggy]

Good article. I am not surprised at all. I suspect the increased rate of miscarriage is secondary to the delay of childbearing until over 35.

Good theory, but the data was controlled for age so probably not that either.

[ENT Doc]

I'm sure this wasn't the best study in the world, but of course it's making headlines. I don't doubt that women surgeons delay having kids or have less than their male counterparts. Comparing to the male counterparts is like comparing apples to oranges. You're really comparing the female surgeon to the spouses of the male counterpart, which is bizarre. Anyhow, a good study would look prospectively and control for various factors affecting the ability to get pregnant and pregnancy complications. I'm skeptical as to whether or not that will occur.

[Sigrid]

This is anecdotal, but there isn't a single female emergency doc in my group who has had an uncomplicated pregnancy if she chose to have kids. Most of the complications have been pretty serious (abruption, PPROM, etc.). Lots of miscarriages as well. We've always attributed it to the stress of shift work.

[SpacemanSpiff12]

My wife and I went through IVF for our first. After a successful transfer, we discussed concerns about shift work in the hospital (she’s also in medicine and often takes long calls). It’s been a while, but I remember reading a meta analysis which showed significantly increased risks of miscarriage and preterm labor for women who worked long shifts and/or were on their feet for extended periods of time. I’ll try to find the study.

We were fortunate in that we had the ability to scale back her hours, but that was a scary time for our family. I had sympathized with pregnant colleagues before this, but the experience took it to a new level.

[Tim]

Comparing a female physician to the spouse of male physician seems rather strange. I wonder which age they used? That of the spouse or male physician? Some problems with the population used.

[ObgynMD]

Comparing a female physician to the spouse of male physician seems rather strange. I wonder which age they used? That of the spouse or male physician? Some problems with the population used.

Good point. They didn’t compare to non-surgeon physicians. They compared to partners of male physicians.

[burritos]

Chronic stress. That's why night shifters die earlier too.

[MPMD]

Chronic stress. That's why night shifters die earlier too.

at this point we are all in this game too much to be able to really evaluate it.

that said, i've had more of an admin component to my job lately that is now most of my work.

it has been eye opening, the stress of even high stakes admin just doesn't even compare to a moderately bad shift. to be fair i'm on the educational side so this might be different if you are more focused on ops/money/pt experience etc.

i think we are all so conditioned to the stress of medicine that we can't even see it. if you're a surgeon there's a 99.5% chance you are making high stakes decisions, facing technical challenges etc. you basically start your attending life in a state of chronic sleep deprivation.

i have this ongoing convo w/ several friends and family who are non-medical. i think the non-medical workplace has lots of screwing around baked into the workday. even a family member i talked to lately who is a very highly paid design professional was telling me that he really only works about 3 hours a day. my med school roommate did some entry level software sales gig in our big city and he freely admitted that his day was usually about 2 hours of calls and about 6 hours of "staff meetings" which were mostly planning social events, long lunches, and wandering around the office BS'ing. if he made $1k in sales or whatever his quota was by 11am he was pretty much done for the day and even his boss didn't expect more. he wasn't supposed to leave but he was done.

medicine is hard... save early so you have options.

[Sundance]

Another vote for chronic stress. There’s NOTHING more stressful than the responsibility knowing that the actions of ones hands can hurt or kill another human being.

it’s just a thing that no one can fully grasp.. even doctors who aren’t surgeons

even in the cardiology world where it’s technically the same specialty, I’ve yet to meet a general cardiologist who truly understands what high risk interventions are like to the primary operator.