STUDENTJAMA. Residency training and pregnancy.

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OFTEN OCCURRING DURING A WOMAN’S PRIME REPRODUCtive years, the demands of residency can collide with the challenges of planning for and undergoing pregnancy. Pregnancy presents special challenges for medical residents, including the potential maternal-fetal health risks of undergoing a pregnancy simultaneous to rigorous medical training and the associated stressors of starting a family and a career simultaneously. Other concerns include maternity leave and its impact on fellow residents and the fulfillment of specialty board certification requirements. Each specialty board has requirements regarding the length of leave from a residency program and eligibility to sit for that specialty’s board examination. Extended pregnancy-related leaves may delay residents’ graduation up to a year. In 2002-2003, the average age of the graduating medical student was 28 years and 44.5% were women, a percentage that has been increasing in recent years. While resident programs in any specialty can be affected by a pregnant trainee, obstetrics and gynecology programs—74% of whose residents are female—may be disproportionately affected. Sixty-seven percent of pediatrics residents are women, whereas surgery and radiation oncology have the lowest percentages of women residents at 25% and 26%, respectively. Although not every specialty tracks the percentage of its residents who are or become pregnant during residency, a recent cross-sectional study with a 95.5% response rate found that 14% of female obstetrics and gynecology residents reported a pregnancy at some time during residency. A smaller cross-sectional study of female pediatricians found that 38% were pregnant during residency. Although the number of residency programs with maternity leave policies has increased, unanswered questions remain regarding the safety and advisability of pregnancy during residency. A recent review noted that between 1984 and 2001, 9 studies of varying validity and power examined pregnancy outcomes of resident physicians in all specialties. The studies were retrospective surveys or chart reviews of recent graduates across a variety of specialties and were limited at times by low response rates, small sample sizes, selection bias, and absent or inadequate control groups. In aggregate, however, these data suggested an increased risk of preterm labor, premature delivery, preeclampsia, stillbirth, low birth weight, and placental abruption among pregnant residents. A recent survey comparing female obstetrics and gynecology residents with their male counterparts’ spouse or partner found that female residents had generally good pregnancy outcomes but were significantly more likely to report premature labor, preeclampsia, and fetal growth restriction. Pregnancy during residency may also have psychosocial effects on a resident’s quality of life. A study comparing the pregnancies of female residents vs those of the spouses of male residents found that twice the number of female residents rated their pregnancy very or extremely stressful. However, the control group did not account for potentially significant baseline variables such as educational background and career aspirations. A survey of plastic surgery residents found that 36% of program directors actively discouraged pregnancy during training because of the perceived negative effects on the pregnant resident, her colleagues, and the department. In terms of specific stressors, a 1985 retrospective survey (n=1197) found that fatigue, frequency of call, emotional strain, physical activity, long hours, scant time with partner, depression, and inadequate maternity leave were all associated with pregnancy. A perceived lack of support from peers and faculty appears to be a major stressor among pregnant residents. Reported concerns included unstated expectations that absent residents’ workloads will be shouldered by other residents and the perception that their peers found pregnancy disruptive to the functioning of the department. Although 76% of female obstetrics and gynecology residents in a recent survey reported taking no days off prior to delivery, nearly 95% of respondents in the same survey reported that they assumed work responsibilities at least once for colleagues on maternity or paternity leave. Additional data are needed to assess resident pregnancy and maternal-fetal outcomes and the impact of pregnancy on residency programs and fulfilling educational requirements.