Job loss and fetal growth restriction: identification of critical trimesters of exposure

Abstract

Purpose: Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight.

Methods: We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester.

Results: Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference.

Conclusions: Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.

Keywords: Birth outcomes; Fetal growth; Job loss; Sibling comparison designs; Unemployment.

Fig. 1.

(A and B) Unadjusted prevalence (%) of (A) low birthweight and (B) small-for-gestational age¹ by sibling order and trimester of exposure to father’s unexpected job loss, Denmark, 1980–2017. ¹SGA restricted to infants born between 1997 and 2017, the time period in which sex information on the live birth is fully available (n = 362,089).