title: Spontaneous miscarriages and infant deaths among female farmers in rural South Africa.
abstract: OBJECTIVE
  This study examined associations of demographics and occupational factors with spontaneous miscarriages and infant deaths among women working in agriculture in KwaZulu-Natal, South Africa.
  
  
  METHODS
  This cross-sectional study in 2006 described and compared reproductive outcomes among 911 women working in agriculture in two distinct areas (ie, the irrigation scheme and drylands) of the Makhatini Flats, KwaZulu-Natal, South Africa. Associations between demographics, agricultural activities, physical load, pesticide spraying and self-reported "spontaneous miscarriage" and "infant death" (death in the first year) were explored using univariate and multivariate analyses. Results Women (N=887) reported 4796 pregnancies, 322 spontaneous miscarriages, 137 infant deaths. Adjusting for age, education, and length of recall of pregnancy, spraying pesticides during the first three months of a pregnancy was associated with spontaneous miscarriage [irrigation scheme odds ratio (OR) 2.8, (95% CI) 1.1-7.2; drylands OR 2.5, 95% CI 1.2-5.6]. Irrigation scheme women aged ≥ 40 years were more likely to report spontaneous miscarriage (OR 3.1, 95% CI 1.2-8.2). Owning one's farm or working a family farm among irrigation scheme women (OR: 2.3; 95 % CI 1.2-4.4) and working for ≥ 10 years among drylands women (OR 2.1, 95 % CI 1.1-4.3) were associated with infant death. Weeding was inversely associated with infant death among irrigation scheme women (OR 0.4, 95 % CI 0.2-0.7).
  
  
  CONCLUSIONS
  This study found that women reporting spontaneous miscarriage were more likely to have sprayed pesticides during pregnancy, and those reporting infant death were more likely to have owned their farms and worked longer in agriculture.
authors.affiliation: Department of Occupational and Environmental Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa. naidoos71@ukzn.ac.za
authors.forename: Saloshni
authors.initials: S
authors.lastname: Naidoo
authors.forename: Leslie
authors.initials: L
authors.lastname: London
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
authors.forename: Rajen
authors.initials: R
authors.lastname: Naidoo
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016014:Linear Models; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010575:Pesticides / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016526:Workload; D055815:Young Adult
chemical_list: D010575:Pesticides