Hospital managers' perspectives on pregnancy policy and work adjustments: A cross-sectional study.

BACKGROUND: Risk assessment and work adjustment according to EU legislation may safeguard pregnant employees and their offspring. Knowledge on management perspectives in relation to implementation of protective measures is limited. OBJECTIVES: The primary aim was to describe Danish hospital managers' engagement in pregnancy policy and work adjustment for pregnant employees. The secondary aim was to investigate how managers' characteristics and the setting affect engagement and behaviour. METHODS: This was a cross-sectional study of survey data from 212 managers. Outcomes were within dimensions of health promotion, pregnancy policy, work adjustment, collaboration, manager support, and sick leave. Logistic and ordinal logistic regression models were applied to identify associations between background information and outcomes. RESULTS: Of the managers included, 84% arranged meetings and 76% conducted occupational risk assessment. Most managers (96%) engaged in dialogue with the employees before sick leave. Most managers felt competent in providing guidance for pregnant employees and 99% considered work adjustment important, mainly to safeguard mothers and children. The self-reported data showed positive associations between female managers and feeling competent to guide the employee. Further, management training was associated with meetings with pregnant employees. Seniority was associated with feeling competent to guide and dialogue. Midwifery support was associated with competence in guiding employees about risk factors. CONCLUSION: Work adjustment and risk assessment for pregnant employees are considered a priority by Danish hospital managers. Overall, managers feel competent guiding pregnant employees. However, managers experience midwifery support beneficial for the guidance of pregnant employees.

Healthcare workers' SARS-CoV-2 infection rates during the second wave of the pandemic: follow-up study.

OBJECTIVES: This study aimed to assess if, during the second wave of the COVID-19 pandemic, healthcare workers had increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates, following close contact with patients, co-workers and persons outside work with COVID-19. METHODS: A follow-up study of 5985 healthcare workers from Denmark was conducted between November 2020 and April 2021 and provided day-to-day information on COVID-19 contacts. SARS-CoV-2 infection was defined by the first positive polymerase chain reaction (PCR) test ever. Data was analyzed in multivariable Poisson regression models. RESULTS: The SARS-CoV-2 infection rates following close contact 3-7 days earlier with patients, co-workers and persons outside work with COVID-19 were 153.7, 240.8, and 728.1 per 100 000 person-days, respectively. This corresponded with age, sex, month, number of PCR tests and mutually adjusted incidence rate ratios of 3.17 [40 cases, 95% confidence interval (CI) 2.15-4.66], 2.54 (10 cases, 95% CI 1.30-4.96) and 17.79 (35 cases, 95% CI 12.05-26.28). The risk of SARS-CoV-2 infection was thus lower, but the absolute numbers affected was higher following COVID-19 contact at work than COVID-19 contact off work. CONCLUSIONS: Despite strong focus on preventive measures during the second wave of the pandemic, healthcare workers were still at increased risk of SARS-CoV-2 infection when in close contact with patients or co-workers with COVID-19. There is a need for increased focus on infection control measures in order to secure healthcare workers' health and reduce transmission into the community during ongoing and future waves of SARS-CoV-2 and other infections.

Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes.

INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (< 37 weeks), low birth weight (LBW) (< 2,500 g) and small for gestational age (SGA). METHODS: In a cohort study, 1,202 deliveries among pregnant women referred to two Danish clinics of occupational medicine (Copenhagen and Aarhus) from 1984 to 2010 were compared with the referred women's 1,077 non-referred pregnancy outcomes and with the pregnancy outcomes of 345,467 gainfully employed women from the same geographical areas and time period. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Calculations were adjusted for the mother's age at delivery, parity, ethnicity, socioeconomic status, smoking, and in supplementary analyses for year of birth. RESULTS: Referred women gave birth to children with a higher birth weight than the average employee (difference 47.8 g; 95% CI: 19.9-75.6), but the outcomes did not differ with respect to gestational age (difference 0.05 weeks; 95% CI: -0.06-0.17), preterm delivery (OR: 0.8; 95% CI: 0.62-1.04), LBW (OR: 0.81; 95% CI: 0.52-1.26) or SGA (OR: 0.92; 95% CI: 0.72-1.17). CONCLUSION: The women who are referred for occupational risk assessment at two large occupational university departments are not at an increased risk of preterm birth or of delivering low birth weight children. This may reflect that reproductive hazards in Danish workplaces are limited and/or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study was conducted using systematically collected data including the refereed women's occupational exposure codes, which were anonymised and linked to national registries at Statistic Denmark. The Danish Data Protection Agency approved the study (R. no. 2012-41-1267).

Occupational exposures and sick leave during pregnancy: results from a Danish cohort study.

OBJECTIVE: This study aimed to investigate associations between work postures, lifting at work, shift work, work hours, and job strain and the risk of sick leave during pregnancy from 10-29 completed pregnancy weeks in a large cohort of Danish pregnant women. METHODS: Data from 51 874 pregnancies in the Danish National Birth Cohort collected between 1996-2002 were linked to the Danish Register for Evaluation of Marginalization. Exposure information was based on telephone interviews. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by Cox regression analysis, using time of first episode of sick leave as the primary outcome. RESULTS: We found statistically significant associations between all the predictors and risk of sick leave; for non-sitting work postures (HRrange 1.55-2.79), cumulative lifting HRtrend 1.29, 95% CI 1.26-1.31, shift work (HRevening 1.90, 95% CI 1.73-2.09, HRnight 1.52, 95% CI 1.15-2.01), monthly night shifts HRtrend 1.12, 95% CI 1.11-1.14, increasing weekly work hours HRtrend 0.93, 95% CI 0.91-0.95 and high job strain HR 1.52, 95% CI 1.42-1.63. Some exposures influenced HR in either a positive or negative time-dependent way. CONCLUSION: Our results support previous findings and suggest that initiatives to prevent sick leave during pregnancy could be based on work conditions. Preventive measures may have important implications for pregnant women and workplaces.

Predictors of sickness absence in pregnancy: a Danish cohort study.

OBJECTIVE: The aim of this cohort study was to investigate associations between parity, pre-pregnancy body mass index (BMI), assisted reproductive therapy (ART), time to pregnancy (TTP), and engagement in physical exercise and the risk of sickness absence in pregnancy from 10-29 completed pregnancy weeks. METHODS: Data from 51 874 pregnancies in the Danish National Birth Cohort collected from 1996 until 2002 were linked to the Danish Register for Evaluation of Marginalization. Exposure information was based on questionnaires. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by Cox regression, using time of first episode of sickness absence as the primary outcome. RESULTS: Multiparity 1.26 (95% CI 1.10-1.45), overweight 1.13 (95% CI 1.08-1.18), obesity 1.23 (95% CI 1.15-1.31), ART 1.10 (95% CI 1.01-1.20), and TTP >12 months 1.06 (95% CI 0.99-1.13) were associated with higher HR of sickness absence. Physical exercise of >120 minutes per week was associated with lower HR 0.84 (95% CI 0.75-0.95). CONCLUSION: Risk for sickness absence was higher among women who were multiparous, overweight, obese, received ART, and had prolonged TTP, and lower among women engaged in leisure-time physical exercise. Few studies have investigated these associations, and the results should be confirmed in other studies of pregnant women.

Rehabilitation of individuals on long-term sick leave due to sustained stress-related symptoms: a comparative follow-up study.

AIMS: Nature-assisted therapy for mental health problems receives increased attention. However, quantitative evaluations are rare. This study evaluates the effects of an all-outdoors vocational rehabilitation program for individuals on long-term sick leave due to sustained stress-related symptoms. METHODS: In a comparative pre-post intervention design the intervention group contained 48 participants from Mariendal Gardens (MG), while 45 participants at Stress- & Jobmanagement (SJ) formed the comparison group. At MG all activities took place outdoors, while activities at SJ were mainly indoors. Questionnaires were completed at baseline, 3- and 6-month follow-up. Outcomes included Perceived Stress Scale (PSS-10) and measures of sleep, mindfulness, self-efficacy, daily functioning, and work ability. Data were analyzed using mixed model repeated measures analysis of variance. RESULTS: At baseline the MG-group PSS-10 mean score was 25.15 points (SD=7.20), while the SJ-group mean score was 23.91 (SD=7.48). At 3-months the MG within-group score dropped 4.61 [2.71; 6.52] points (p<0.01), corresponding to at standardized mean difference (Cohen's d) of d=0.64 [0.38; 0.91], while the SJ within-group score dropped 4.16 [1.73; 6.59] points (p<0.01), corresponding to d=0.56 [0.23; 0.88]. The between-group mean difference was not significant (p=0.77). Similarly, results for sleep, mindfulness, self-efficacy, daily functioning, and work ability demonstrated significant within-group effects and minimal between-group differences. CONCLUSIONS: Both interventions demonstrated small to large pre-post effect sizes. Negligible differences were observed between the effects of the two interventions, indicating no added effect of the all-outdoors setting. Results should be interpreted with caution as unequal lost to follow-up rates threatens the comparability of changes in the two groups.

Exposure to psychosocial job strain during pregnancy and odds of asthma and atopic dermatitis among 7-year old children - a prospective cohort study.

OBJECTIVES: Few epidemiological studies have studied maternal stress exposure during pregnancy and odds of asthma and atopic dermatitis (AD) among offspring, and none have extended the focus to psychosocial job strain. The aim of this study was to assess the association between maternal job strain during pregnancy and asthma as well as AD among 7-year-old children. METHODS: The study is based on the Danish National Birth Cohort and includes prospective data from 32 104 pregnancies. Job strain was assessed early in pregnancy by use of two questions on demands and control. We categorized participants into four job strain categories: low strain (low demands, high control), active (high demands, high control), passive (low demands, low control), and high strain (high demands, low control). Information on asthma and AD until age seven was collected using maternal self-report. Multinomial logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (95% CI) adjusted for several covariates. RESULTS: Maternal exposure to self-reported high strain during pregnancy was associated with 15% higher odds of atopic dermatitis among 7-year-old children (OR adj1.15, 95% CI 1.02-1.31). Furthermore, an association between the active jobs and asthma among 7-year-old children was found (OR adj1.13, 95% CI 1.03-1.24). CONCLUSION: Maternal exposure to high strain and active jobs during pregnancy was associated with asthma and atopic dermatitis among 7-year-old children.

In utero exposure to alcohol and puberty in boys: a pregnancy cohort study.

OBJECTIVES: Epidemiological studies have raised concerns about the reproductive consequences of in utero exposure to alcohol. Maternal lifestyle factors have been associated with altered pubertal development, but the impact of prenatal alcohol exposure on male puberty is unknown. Thus, the objective was to explore whether prenatal alcohol exposure alters pubertal development in boys. SETTING: Follow-up of a Danish pregnancy cohort. PARTICIPANTS: Sons (N=2522) of women who were enrolled in a Danish pregnancy cohort between 1984 and 1987. PRIMARY AND SECONDARY OUTCOME MEASURES: Indicators of pubertal development, assessed by age at first nocturnal emission, voice break, acne and regular shaving. RESULTS: We found a tendency towards a later age at first nocturnal emission and voice break following in utero exposure to binge drinking. Boys exposed to ≥5 binge drinking episodes during pregnancy experienced their first nocturnal emission 7.3 months (95% CI -2.8 to 17.4) later and voice break 4.9 months (95% CI -0.6 to 10.4) later than the unexposed boys. Results for average weekly alcohol consumption were in the same direction, but differences were smaller and not statistically significant. CONCLUSIONS: We found no strong support for the hypothesis that in utero exposure to weekly alcohol consumption is a risk factor for altered pubertal development, but a tendency towards delayed pubertal development among boys exposed to binge drinking during fetal life was observed. Longitudinal studies, with data collected as children go through puberty, are needed to explore this further.

Psychosocial job strain and risk of adverse birth outcomes: a study within the Danish national birth cohort.

OBJECTIVE: A number of studies examined the effects of prenatal stress on birth outcomes with diverging and inconclusive results. We aimed to examine if working with high job strain during pregnancy measured in week 16 was associated with risk of giving birth to a child born preterm or small/large for gestational age (SGA/LGA), and second, if social support affected any associations. DESIGN: Study population was 48 890 pregnancies from the Danish National Birth Cohort. Multinomial logistic regression estimated ORs. Covariates included: maternal age, BMI, parity, exercise, smoking, alcohol and coffee consumption, manual work, serious maternal disease, parental height and gestational age at interview. In accordance with Good Epidemiological Practice, a protocol outlined the study design before analyses were initiated. RESULTS: High job strain was associated with significantly lower odds of being born LGA (OR=0.81, CI 0.70 to 0.92) when compared to low-strain jobs, but no associations between high strain and preterm birth or SGA were found. Stratification by social support showed a non-statistically significant tendency of higher odds of preterm birth when exposed to high strain and low social support. CONCLUSIONS: In spite of the high statistical precision, we did not find any clear association between job strain and preterm birth nor between job strain and SGA.

Maternal occupational exposure to asthmogens during pregnancy and risk of asthma in 7-year-old children: a cohort study.

OBJECTIVES: The objective of this study was to examine whether maternal exposure to asthmogens during pregnancy is associated with the development of asthma in 7-year-old Danish children, taking atopic status and sex into consideration. DESIGN: The study is a prospective follow-up of a birth cohort. SETTING AND PARTICIPANTS: A total of 41 724 women and their children from The Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy and 18 months after pregnancy with a commonly used asthma Job Exposure Matrix. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was parent-reported asthma among their 7-year-old children in an internet-based questionnaire. Secondary outcome was asthma among the same children with or without atopic dermatitis and among boys and girls, respectively. RESULTS: Prenatal exposure to low molecular weight (LMW) agents was borderline associated with asthma in children with OR 1.17 (0.95 to 1.44) for children with atopic dermatitis and 1.10 (0.98 to 1.22) for children without. Maternal postnatal exposure was associated with asthma (OR 1.15 (1.04 to 1.28). After mutual adjustment,postnatal exposure (OR 1.13 (0.99 to 1.29) and the combined effects of prenatal and postnatal exposure (OR 1.34 (1.19 to 1.51)) seem to increase the risk of asthma in children. No significant associations were observed for other prenatal or postnatal exposures. The gender of the child did not modify the aforementioned associations. CONCLUSIONS: Maternal occupational exposures during pregnancy do not seem to be a substantial risk factor for the development of asthma in 7-year-old children. Maternal prenatal and postnatal exposures to LMW agents may predispose the propensity of the children to develop asthma. Future studies should prioritise the characterisation of the timing of exposure in relation to the birth.

Occupational exposure during pregnancy and the risk of hay fever in 7-year-old children.

OBJECTIVES: The prevalence of allergic diseases including hay fever has increased in the last decades, especially in Westernised countries. The aim of this study was to analyse whether occupational exposure during pregnancy is associated with development of hay fever in 7-year-old Danish children. METHODS: A total of 42,696 women and their children from the Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy with a commonly used asthma Job Exposure Matrix. Information on hay fever in the child was obtained by an internet questionnaire at follow-up at 7 years of age. RESULTS: Adjusted logistic regression analyses showed no significant association between maternal occupational exposure during pregnancy and hay fever among the 7-year-old children. Stratifying for atopic status in the children did not change the results. The prevalence of hay fever was 10.0% in the atopic children compared with 3.6% in the non-atopic children. Maternal atopic disposition increased the risk of hay fever in the offspring, odds ratio (OR) 2.49 [95% confidence interval (CI) 2.26; 2.74]. Rural residence during pregnancy decreased the risk for hay fever [OR 0.74 (95% CI 0.59; 0.92)] as did parity, OR 0.72 (95% CI 0.66; 0.80) and 0.70 (95% CI 0.48; 1.00) for 2nd and 3rd child, respectively, compared with the firstborn child. CONCLUSION: The results suggest that occupational exposure among pregnant women in Denmark is not a risk factor for hay fever among young children.

Notification of occupational disease and the risk of work disability: a two-year follow-up study.

OBJECTIVES: The aim of this study was to analyze if notification of an occupational disease increases the risk of work disability. METHODS: We included 2304 patients examined at the Department of Occupational Medicine, Aarhus University Hospital, 1998-2005 and followed them for two years. A total of 564 patients were notified of an occupational disease when they were examined at baseline and 1740 patients were not. We obtained weekly information on sick payment, unemployment payment, disability pension, rehabilitation benefit, and other social benefits during the two years of follow-up from a national register. Using Cox regression models, we analyzed notification and adjusted hazard ratios (HRadj) of work disability (defined as >12 weeks of social benefits during the first or second year of follow-up). RESULTS: Prior to notification, notified patients had higher levels of clinical, occupational, and social characteristics that predict poorer vocational prognosis. Analyses that adjusted for these differences showed an increased risk of work disability following notification for patients who were working when notified at baseline (HRadj 1.46, 95% CI 1.17-1.82). No effect was seen for patients who were not working. CONCLUSIONS: Notification of an occupational disease may, as an unintended side effect, increase the risk of work disability. A cautious interpretation is warranted because data analyses may not fully have accounted for the poorer vocational prognosis already present at baseline.

Phthalates and perfluorooctanesulfonic acid in human amniotic fluid: temporal trends and timing of amniocentesis in pregnancy.

BACKGROUND: Measures of prenatal environmental exposures are important, and amniotic fluid levels may directly reflect fetal exposures during hypothesized windows of vulnerability. OBJECTIVES: We aimed to detect various phthalate metabolites and perfluorooctanesulfonic acid (PFOS) in human amniotic fluid, to study temporal exposure trends, and to estimate potential associations with gestational week of amniocentesis and maternal age and parity at amniocentesis. METHODS: We studied 300 randomly selected second-trimester amniotic fluid samples from a Danish pregnancy-screening biobank covering 1980 through 1996. We used only samples from male offspring pregnancies. We assayed the environmental pollutants by liquid chromatography/triple quadrupole mass spectrometry and analyzed data using generalized linear regression models. RESULTS: We detected the di(2-ethylhexyl) phthalate (DEHP) metabolite mono(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP) at a median concentration of 0.27 ng/mL [interquartile range (IQR): 0.20-0.37 ng/mL], the diisononyl phthalate (DiNP) metabolite mono(4-methyl-7-carboxyheptyl) phthalate (7cx-MMeHP) at 0.07 ng/mL (IQR: 0.05-0.11 ng/mL), and PFOS at 1.1 ng/mL (IQR: 0.66-1.60 ng/mL). An increase of 1 calendar year was associated with 3.5% lower [95% confidence interval (CI): -4.8%, -2.1%] 5cx-MEPP levels and with 7.1% higher (95% CI: 5.3%, 9.0%) 7cx-MMeHP levels. For each later gestational week of amniocentesis, 5cx-MEPP was 9.9% higher (95% CI: 4.8%, 15.2%), 7cx-MMeHP was 8.6% higher (95: CI: 2.7%, 14.9%), and PFOS was 9.4% higher (95: CI: 3.3%, 15.9%). We observed no associations with maternal age or parity. CONCLUSIONS: Measured metabolite levels appeared to parallel decreasing DEHP exposure and increasing DiNP exposure during the study period. The environmental pollutant levels were positively associated with later gestational age at amniocentesis during pregnancy weeks 12-22.

Cryptorchidism and hypospadias in a cohort of 934,538 Danish boys: the role of birth weight, gestational age, body dimensions, and fetal growth.

Early delivery and low birth weight are strong predictors of the urogenital anomalies cryptorchidism (undescended testis) and hypospadias. Understanding these associations may lead to important etiologic clues. Therefore, the authors revisited the prevailing hypotheses regarding fetal growth restriction as a risk factor for urogenital anomalies. They studied a population of 934,538 Danish boys born alive between January 1, 1980, and December 31, 2008. Cryptorchidism and hypospadias were associated with low weight-for-gestational-age, an indicator of fetal growth restriction, and furthermore the authors observed strong interaction with early delivery. Low birth weight in a singleton compared with the mean birth weight of all singleton brothers in the family or in a twin compared with the male co-twin was associated with higher risk of urogenital anomalies, suggesting an effect of relative fetal growth restriction within families. Contrary to previous reports, newborns' body dimensions assessed independently of birth weight were not associated with urogenital anomalies. The hypothesis that shared factors cause both fetal growth restriction and urogenital anomalies was supported by comparison of urogenital anomaly risks in singletons and twins and by patterns of cryptorchidism and hypospadias co-occurrence in individuals. These novel insights might also extend to other male reproductive conditions with prenatal etiology.

The risk of cryptorchidism among sons of women working in horticulture in Denmark: a cohort study.

BACKGROUND: Androgens are crucial for normal testicular descent. Studies show that some pesticides have estrogenic or antiandrogenic effects, and that female workers exposed to pesticides have increased risk of having a boy with cryptorchidism. The main objective of the present study was to investigate whether pregnant women exposed to pesticides due to their work in horticulture experience excess risk of having sons with cryptorchidism. METHODS: We conducted a cohort study of pregnant women working in horticulture using four cohorts including one cohort established with data from the departments of occupational medicine in Jutland and Funen and three existing mother-child cohorts (n=1,468). A reference group was established from the entire Danish population of boys born in the period of 1986-2007 (n=783,817). Nationwide Danish health registers provided information on birth outcome, cryptorchidism diagnosis and orchiopexy. The level of occupational exposure to pesticides was assessed by expert judgment blinded towards outcome status. Risk of cryptorchidism among exposed horticulture workers compared to the background population and to unexposed horticulture workers was assessed by Cox regression models. RESULTS: Pesticide exposed women employed in horticulture had a hazard ratio (HR) of having cryptorchid sons of 1.39 (95% CI 0.84; 2.31) and a HR of orchiopexy of 1.34 (0.72; 2.49) compared to the background population. Analysis divided into separate cohorts revealed a significantly increased risk of cryptorchidism in cohort 2: HR 2.58 (1.07;6.20) and increased risk of orchiopexy in cohort 4: HR 2.76 (1.03;7.35), but no significant associations in the other cohorts. Compared to unexposed women working in horticulture, pesticide exposed women had a risk of having sons with cryptorchidism of 1.34 (0.30; 5.96) and of orchiopexy of 1.93 (0.24;15.4). CONCLUSIONS: The data are compatible with a slightly increased risk of cryptorchidism in sons of women exposed to pesticides by working in horticulture.

Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men.

BACKGROUND: A high body mass index (BMI) has been associated with reduced semen quality and male subfecundity, but no studies following obese men losing weight have yet been published. We examined semen quality and reproductive hormones among morbidly obese men and studied if weight loss improved the reproductive indicators. METHODS: In this pilot cohort study, 43 men with BMI > 33 kg/m² were followed through a 14 week residential weight loss program. The participants provided semen samples and had blood samples drawn, filled in questionnaires, and had clinical examinations before and after the intervention. Conventional semen characteristics as well as sperm DNA integrity, analysed by the sperm chromatin structure assay (SCSA) were obtained. Serum levels of testosterone, estradiol, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH) and inhibin B (Inh-B) were measured. RESULTS: Participants were from 20 to 59 years of age (median = 32) with BMI ranging from 33 to 61 kg/m². At baseline, after adjustment for potential confounders, BMI was inversely associated with sperm concentration (p = 0.02), total sperm count (p = 0.02), sperm morphology (p = 0.04), and motile sperm (p = 0.005) as well as testosterone (p = 0.04) and Inh-B (p = 0.04) and positively associated to estradiol (p < 0.005). The median (range) percentage weight loss after the intervention was 15% (3.5-25.4). Weight loss was associated with an increase in total sperm count (p = 0.02), semen volume (p = 0.04), testosterone (p = 0.02), SHBG (p = 0.03) and AMH (p = 0.02). The group with the largest weight loss had a statistically significant increase in total sperm count [193 millions (95% CI: 45; 341)] and normal sperm morphology [4% (95% CI: 1; 7)]. CONCLUSION: This study found obesity to be associated with poor semen quality and altered reproductive hormonal profile. Weight loss may potentially lead to improvement in semen quality. Whether the improvement is a result of the reduction in body weight per se or improved lifestyles remains unknown.