Abstract
Objective:
In view of the hazards of occupational noise exposure, this study investigated the relationship between occupational noise exposure and gestational hypertension in Taizhou City, Zhejiang Province, China to provide inspiration and reference for reducing the occurrence of gestational hypertension.
Methods:
This cross-sectional study analyzed the clinical data of 316 pregnant women in Taizhou City admitted to Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University from May 2020 to May 2023. In accordance with Acoustic Environment Quality Standards (GB3096-2008), 60 dB was used as the cut-off point. These pregnant women were divided into the low noise group (LNG, n = 161) and high noise group (HNG, n = 155) according to the noise exposure level in the working environment. This also study compared the noise exposure, blood pressure (BP), fasting blood glucose (FBG), blood lipid (BL), fetal size, and heart rate (HR), and analyzed the relationship of noise exposure with BP, FBG, BL, fetal size, HR, and occurrence of gestational hypertension.
Results:
The HNG had higher noise exposure level (P < 0.001), BP, FBG, BL and HR (P < 0.001), larger fetal size (P < 0.001) and higher occurrence of gestational hypertension (P < 0.05) compared with the LNG. Correlation analysis showed that noise exposure level was positively correlated with BP, FBG, BL, HR, and fetal size (P < 0.001) and had the strongest association with gestational hypertension.
Conclusion:
Occupational noise exposure has adverse effects on pregnant women and fetuses. Pregnant women should pay attention to their exposure to occupational noise to prevent gestational hypertension. The results of this study must be further verified and generalized.
Keywords: Noise, Occupational, Gestational hypertension, Cross-sectional study
KEY MESSAGES:
-
(1)
The blood pressure, fasting blood glucose, blood lipid, and heart rate of pregnant women with high noise exposure were higher than those of pregnant women with low noise exposure
-
(2)
The fetal size in high noise group is larger than that in low noise group
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(3)
Noise exposure level is positively correlated with gestational hypertension in pregnant women.
INTRODUCTION
With the continuous intensification of industrialization, noise exposure is evolving into a major occupational hazard and environmental pollutant. Noise is an unwanted and unpleasant sound that damages hearing and a pervasive workplace hazard that varies spatially and temporally.[1] Regarded as the fourth environmental pollutant, noise continues to take alarming dimensions, becoming a real threat especially in professional environments. In practice, approximately 250.85 million workers around the world are exposed to noise.[2] In particular, mechanical workers engaged in high-speed cutting technology are exposed to prolonged noise. During machining, the bearings, gears, and motors are the common sources of noise from machine tools.[3] Maritime workers are usually exposed to hazardous noise levels. Fish harvesters reported avoiding using hearing protection onboard due to navigation safety concerns.[4] Firefighters are no exception: devices or instruments such as alarms, pumps, saws, engines, and radios in the firefighting system increase the risk of noise-induced changes in the inner ear.[5] The issue of occupational noise exposure is universal.
According to the noise response model proposed by Babisch,[6] noise may damage the function of multiple organs, and systems can damage through direct pathways (for instance, by causing hearing loss and tinnitus, which result from exposure to high levels of noise) and indirect pathways (such as reflecting cognitive and emotional stress responses, activation of the autonomic nervous system and endocrine system, and chronic stress state). Chronic stress is a well-known risk factor for the development of hypertension.[7] Gestational hypertension generally occurs after 20 weeks of pregnancy, increasing the risk of caesarean section, placental abruption, renal insufficiency, and secondary cardiovascular disease in pregnant women and making the fetus prone to growth restriction, premature delivery, and low birth weight.[8] Cavallari et al.[9] found that occupational noise exposure influences hypertension and increased cholesterol levels. However, research on the correlation between occupational noise exposure and gestational hypertension is still insufficient. Therefore, the present study aimed to explore their correlation, improve the lifestyle of pregnant women, and reduce the incidence of gestational hypertension.
RESEARCH SUBJECTS AND METHODS
Research Subjects
This cross-sectional study analyzed the clinical data of 325 pregnant women in Taizhou City admitted to Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University from May 2020 to May 2023, excluding nine pregnant women who did not meet the inclusion criteria. Finally, 316 pregnant women were included. According to the noise exposure level in the working environment, these women were divided into the low noise group (LNG, n = 161) and high noise group (HNG, n = 155). In accordance with the Acoustic Environment Quality Standards (GB3096-2008),[10] 60 dB was used as the cut-off point.
Inclusion criteria were as follows: (1) pregnant women with fixed workplace, (2) pregnant women with complete clinical data, (3) gestational weeks < 28 weeks, and (4) 8 hours ≤ daily working hours < 10 hours or weekly working hours > 40 hours.
Exclusion criteria were as follows: (1) pregnant women with hypertension before pregnancy and (2) pregnant women with hearing dysfunction. The flow chart is presented in Figure 1.
Figure 1.
Flowchart of study population inclusion.
Research Contents and Methods
General information
A questionnaire survey was used to collect relevant clinical information of the subjects, including age, gestational weeks, working time, parity, smoking and drinking history (smoking history: smoke at least one cigarette a day for more than 6 months or previously meet smoking standards and quit smoking for <6 months; drinking history: drink at least once a week for more than 6 months or previously meet drinking standards and quit drinking for <6 months) and enterprise scale (large enterprises: sale volume ≥ 300 million yuan, total assets ≥ 400 million yuan, and employees ≥ 2000; medium enterprise: employees < 2000, or sale volume < 300 million yuan, or total assets < 400 million yuan; small enterprise: employees ≤ 500, sale volume ≤ 200 million yuan, and total assets ≤ 200 million yuan; micro-enterprise: annual taxable income ≤ 300,000 yuan, employees ≤ 100, and total assets ≤ 30 million yuan; other enterprises: annual taxable income ≤ 300,000 yuan, employees ≤ 80, and total assets ≤ 10 million yuan).
Observation indicators
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(1)
Noise exposure level. This study used the sound level meter (YSD130, Hangzhou Aihua Instruments Co., Ltd., Hangzhou, Zhejiang, China) and the personal noise dosimeter (ASV5911, Hangzhou Aihua Instruments Co., Ltd., Hangzhou, Zhejiang, China) to measure the noise exposure level in fixed workplaces and mobile workplaces, respectively. The microphone was placed at the height of the pregnant women’s ear while working, with a standing position of 1.5 m and a sitting position of 1.10 m (GB/T 21230 specifies a standing position of 1.55 ± 0.075 m and a sitting position of 0.80 ± 0.05 m). The microphone was preferably placed on the exposed person as far as possible from the entrance of the external auditory canal (approximately 0.1 m). When remarkable difference in noise intensity existed between the two ears, the microphone was placed on the side with higher noise level. The measurement was carried out during the working hours in the working day. When the wind speed in the workplace exceeded 3 m/seconds, a wind shield was placed on the microphone. In the terms of impulse noise, the peak value of impulse noise and the number of pulses in the working day were measured. Acoustic calibration was performed on the instruments before and after each measurement, and sound level calibrators with level 1 or 2 technical indicators were selected for sound calibration. The noise exposure level was monitored after 2 hours of work for pregnant women with an interval of 5 seconds.
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(2)
Blood pressure (BP). Systolic blood pressure (SBP, normal level: 90–140 mmHg) and diastolic blood pressure (DBP, normal level: 60–90 mmHg) were measured. The subjects should empty their bladder before examination and refrain from smoking, drinking or coffee drinking within 30 minutes. An automatic electronic sphygmomanometer (Omron HBP-9030, Shanghai Mingyuan Industrial Co., Ltd., Shanghai, China) was used to measure BP. The pregnant women sat on chairs and kept relaxed, with their feet naturally flat and the upper arms on the table. The cuff was tied and placed at the same height as the heart. The BP of pregnant women (fasting state) was measured at 8:00 with an interval of 2 min for three times, and the average was recorded. Gestational hypertension was diagnosed when SBP was ≥140 mmHg or DBP was ≥90 mmHg.
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(3)
Fasting blood glucose (FBG) and blood lipid (BL). The levels of FBG (normal value: 4.4–6.1 mmol/L), total cholesterol (TC, normal value: <5.18 mmol/L) and triglyceride (TG, normal value: <1.70 mmol/L) were measured. Pregnant women ought to avoid strenuous exercise and overeating on the day before examination. Briefly, 3 mL of fasting blood was taken at 8:00 the next day. After separating the serum, FBG and BL were detected using an automatic biochemical analyzer (DXC800, Beckman Company, Brea, CA, USA).
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(4)
Fetal size. Fetal size was measured using GE color Doppler ultrasound diagnostic instrument (VOLUSON E8, Nanjing Vedeng Medical Co., Ltd., Nanjing, Jiangsu, China) through the abdomen. The ultrasound method accurately estimated the fetal size from the various growth diameters of the fetus, including biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC). To exclude the influence of different gestational weeks on fetal size, this study measured the fetal size at the 32nd week of pregnancy.
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(5)
Heart rate (HR). The HR (normal value: 60–100 beats/minute) of pregnant women (fasting state) was measured using a Littmann stethoscope (Classic III, Minnesota Mining and Manufacturing, St. Paul, MN, USA) at 8:00.
Statistical Analysis
SPSS software (version 26.0, International Business Machines Corporation, Armonk, NY, USA) was utilized for data analysis and processing. The categorical variables were represented by (n (%)) and tested by χ2 test. The Kolmogorov–Smirnov method was employed to assess whether the continuous variables are normally distributed. Normally distributed continuous variables were expressed as (mean ± standard deviation) and subjected to t test, and non-normally distributed continuous variables were expressed as M (P25, P75) and analyzed using non-parametric tests. Additionally, correlation analysis was performed. Pearson product-moment correlation was used when two columns of variables were normally distributed, and Spearman’s rank correlation was utilized when the two columns of variables did not satisfy normal distribution. Statistical significance was set at P < 0.05.
RESULTS
Comparison of General Information in Both Groups
To reduce the error caused by individual differences between groups, this study compared general information in the LNG and HNG, such as age, gestational weeks and working time. No significant difference was found (P > 0.05). After the differences in general data were excluded, the results showed that the noise exposure in the HNG was significantly higher than that in the LNG (P < 0.001) [Table 1].
Table 1.
Comparison of General Information in Both Groups (M (P25, P75), n (%))
| Indicators | LNG (n = 161) | HNG (n = 155) | χ2/z | P |
|---|---|---|---|---|
| Age (years) | 31. (26.00, 35.00) | 31.00 (26.00, 35.00) | −0.196 | 0.844 |
| Gestational weeks (weeks) | 16.00 (10.00, 20.00) | 15.00 (10.00, 20.00) | −0.065 | 0.948 |
| Working time | 0.738 | 0.691 | ||
| Day shift (9:00–17:00) | 99 (61.49) | 90 (58.06) | ||
| Night shift (22:00–6:00) | 29 (18.01) | 27 (17.42) | ||
| In shifts | 33 (20.50) | 38 (24.52) | ||
| Parity (times) | 1.00 (1.00, 2.00) | 1.00 (1.00, 2.00) | −0.720 | 0.472 |
| Smoking and drinking history | 0.441 | 0.507 | ||
| Yes | 48 (29.81) | 41 (26.45) | ||
| No | 113 (70.19) | 114 (73.55) | ||
| Enterprise scale | 0.161 | 0.997 | ||
| Large enterprise | 21 (13.04) | 22 (14.19) | ||
| Medium enterprise | 33 (20.50) | 30 (19.35) | ||
| Small enterprise | 81 (50.31) | 78 (50.33) | ||
| Micro-enterprise | 10 (6.21) | 9 (5.81) | ||
| Others | 16 (9.94) | 16 (10.32) | ||
| Noise exposure level (dB (A)) | 42.00 (33.00, 53.00) | 79.00 (70.00, 90.00) | −15.370 | <0.001 |
| Total duration of noise exposure (years) | 3.00 (2.00, 4.00) | 2.00 (1.00, 4.00) | −0.598 | 0.550 |
Note: A stands for weighted sound, dB (A) can accurately reflect the response of the human ears to frequency.
Comparison of Observation Indicators in Both Groups
The HNG had higher levels of BP (SBP and DBP), FBG, BL (TC and TG) and HR (P < 0.001), higher fetal growth and development indicators (BPD, FL and AC) (P < 0.001) and higher occurrence of gestational hypertension (P < 0.05) compared with the LNG [Table 2].
Table 2.
Comparison of Observation Indicators in Both Groups (M (P25, P75))
| Indicators | LNG (n = 161) | HNG (n = 155) | χ2/z | P |
|---|---|---|---|---|
| BP | ||||
| SBP (mmHg) | 110.00 (99.00, 125.00) | 126.00 (112.00, 137.00) | −6.567 | <0.001 |
| DBP (mmHg) | 71.00 (66.00, 76.00) | 83.00 (76.00, 89.00) | −10.470 | <0.001 |
| FBG (mmol/L) | 5.30 (4.95, 5.90) | 6.70 (6.40, 7.20) | −10.789 | <0.001 |
| BL | ||||
| TC (mmol/L) | 4.25 (3.54, 4.94) | 5.57 (5.31, 5.87) | −10.538 | <0.001 |
| TG (mmol/L) | 1.25 (0.90, 1.60) | 1.88 (1.67, 2.06) | −10.573 | <0.001 |
| Fetal size | ||||
| BPD (cm) | 7.20 (7.00, 7.40) | 7.80 (7.50, 8.10) | −13.553 | <0.001 |
| FL (cm) | 5.90 (5.60, 6.20) | 6.30 (6.00, 6.60) | −9.813 | <0.001 |
| AC (cm) | 23.00 (22.00, 25.00) | 25.00 (24.00, 27.00) | −8.594 | <0.001 |
| HR (beats/min) | 75.00 (67.00, 83.00) | 104.00 (96.00, 114.00) | −14.831 | <0.001 |
| Occurrence of gestational hypertension | 15 (9.32) | 32 (20.65) | 8.004 | 0.005 |
AC = abdominal circumference, BP = blood pressure, BL = blood lipid, BPD = biparietal diameter, DBP = diastolic blood pressure, FBG = fasting blood glucose, FL = femur length, HR = heart rate, SBP = systolic blood pressure, TC = total cholesterol, TG = triglyceride.
Correlation Analysis
Correlation analysis showed that noise exposure was positively correlated with BP, FBG, BL, fetal size, HR, and occurrence of gestational hypertension (P < 0.001). Among them, the correlation of noise exposure was the strongest with gestational hypertension and the weakest with fetal size [Table 3].
Table 3.
Correlation Analysis.
| Indicators | Noise Exposure Level | |
|---|---|---|
|
|
|
|
| r | P | |
| BP | ||
| SBP | 0.614 | <0.001 |
| DBP | 0.732 | <0.001 |
| FBG | 0.557 | <0.001 |
| BL | ||
| TC | 0.560 | <0.001 |
| TG | 0.562 | <0.001 |
| HR | 0.493 | <0.001 |
| Fetal size | ||
| BPD | 0.342 | <0.001 |
| FL | 0.303 | <0.001 |
| AC | 0.379 | <0.001 |
| HR | 0.493 | <0.001 |
| Gestational hypertension | 0.732 | <0.001 |
AC = abdominal circumference, BP = blood pressure, BL = blood lipid, BPD = biparietal diameter, DBP = diastolic blood pressure, FBG = fasting blood glucose, FL = femur length, HR = heart rate, SBP = systolic blood pressure, TC = total cholesterol, TG = triglyceride.
Statistical analysis showed that the two columns of variables did not meet the normal distribution, so Spearman rank correlation was used for the statistical processing of the above data. The criteria for the correlation strength were as follows: r = 1: perfect positive correlation; 0.8 ≤ r < 1: very strong positive correlation; 0.6 ≤ r < 0.8: strong positive correlation; 0.4 ≤ r < 0.6: moderate positive correlation; 0.2 ≤ r < 0.4: weak positive correlation; r = 0: no correlation.
DISCUSSION
Occupational noise exposure has become one of the risk factors for occupational workers, attracting the attention from researchers in occupational disease. China is the largest industrial country worldwide, comprising a vast number of industries and labor. Noise, a common physical and harmful factor in industrial processes, can be found in different workplaces and may directly cause hearing loss, cardiovascular damage, and even death in severe cases.[11] Gestational hypertension is a leading cause of maternal and infant mortality, and its prevalence is increasing annually.[12] Although many studies have been conducted on the relationship between occupational noise exposure and various diseases, most of their subjects are non-pregnant population. Hence, they cannot provide data support for pregnant women. Therefore, the present work explored the relationship between occupational noise exposure and gestational hypertension to improve noise prevention awareness among pregnant women.
The study subjects were divided into the LNG and HNG according to their noise exposure levels. Comparison of SBP, DBP, FBG, TC, TG, BPD, FL, AC, and HR between the two groups showed that the above indexes were higher in the HNG than in the LNG (P < 0.001). This finding indicated that an increase in noise exposure can lead to an increase in maternal BP, FBG, BL, and HR, as well as the incidence of fetal macrosomia. On the basis of the above results, the relationship between these clinical indicators and occupational noise exposure was analyzed. The results revealed that noise exposure had the strongest correlation with gestational hypertension (r = 0.732, P < 0.001) and the weakest correlation with fetal size (BPD, FL and AC) (r = 0.342, 0.303, 0.379, P < 0.001), indicating that occupational noise exposure could threaten the life and health of mothers and infants.
In view of the strong correlation between noise exposure and gestational hypertension, the possible influence mechanism was analyzed. Noise pollution may increase the risk of cardiovascular disease, especially in vulnerable populations such as pregnant women.[13] Pregnancy represents a particular and vulnerable life period. Extensive physiological and metabolic changes and alterations in cardiovascular and respiratory systems during pregnancy can cause increased sensitivity to damage by environmental factors. Exposure to noise environment is associated with placental dysfunction and damage, which in turn may lead to maternal complications such as gestational hypertension.[14] Sivakumaran et al.[15] found that exposure to noise can increase biological stress reactions and the risk of stress-related prenatal effects. From the perspective of biological mechanisms, BP is regulated by a variety of mechanisms, involving multiple biological systems such as renal, cardiovascular, and endocrine systems as potential targets.[16] Noise can activate the sympathetic adrenal gland and cause endothelial dysfunction through indirect pathways, leading to disorders in the cardiovascular and endocrine systems and thereby inducing gestational hypertension.[17] Additionally, noise exposure can alter the function of multiple organs and systems and potentially lead to increased BP, HR and cardiac output by activating the autonomic nervous system.[18,19] A national cohort study by Lissåker et al.[20] revealed that noise exposure in the workplace is associated with an increased risk of gestational hypertension, especially in first-time mothers who work full-time. This finding is consistent with the results of the present study.
However, this study has some shortcomings. (1) Subject to time, manpower, and financial resources, this study selected a relatively small number of subjects in the same hospital. Future research should expand the sample size and conduct multicenter studies. (2) This study selected the samples in the same time period, so the differences of observation indicators caused by variables such as air pollution and life pressure in different times cannot be ruled out. The confusion of social factors may also affect the results. (3) This study was carried out for a short time without long-term follow-up. Future study should investigate the harm of occupational noise exposure to the human body for a long time. (4) The subjects were pregnant women. The effect of noise on the incidence of hypertension in non-pregnant women requires further research for confirmation.
CONCLUSION
Pregnant women are sensitive to occupational noise exposure on the account of physiological and psychological differences. This study seems to demonstrate the correlation between noise and the occurrence of gestational hypertension in pregnant women, providing a reference for reducing occupational noise exposure and carrying out noise prevention. However, the results of this study still need to be verified by more scholars’ research for further promotion.
Financial support and sponsorship
This research was funded by Taizhou Science and Technology Bureau Subject, NO. 21ywb01.
Conflicts of interest
The authors have no conflicts of interest to declare.
Author contributions
LYY and HCY designed the study; all authors conducted the study; HHJ and QFG collected and analyzed the data. All authors participated in drafting the manuscript, and all authors contributed to critical revision of the manuscript for important intellectual content. All authors gave final approval of the version to be published. All authors participated fully in the work, take public responsibility for appropriate portions of the content, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or completeness of any part of the work are appropriately investigated and resolved.
Ethics approval and consent to participate
This study has been approved by the Medical Ethics Committee of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University (Approval No.: KL20240317). Pregnant women who were aware of the purpose of study signed an informed consent.
Availability of data and materials
The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.
Acknowledgment
Not applicable.
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Associated Data
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Data Availability Statement
The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.