Importance While surgeons often delay pregnancy and childbearing because of training and establishing early careers, little is known about risks of infertility and pregnancy complications among female surgeons.

Objective To describe the incidence of infertility and pregnancy complications among female surgeons in the US and to identify workplace factors associated with increased risk compared with a sociodemographically similar nonsurgeon population.

Design, Setting, and Participants This self-administered survey questionnaire was electronically distributed and collected from November 2020 to January 2021 through multiple surgical societies in the US and social media among male and female attending and resident surgeons with children. Nonchildbearing surgeons were asked to answer questions regarding the pregnancies of their nonsurgeon partners as applicable.

Exposures Surgical profession; work, operative, and overnight call schedules.

Main Outcomes and Measures Descriptive data on pregnancy loss were collected for female surgeons. Use of assisted reproductive technology was compared between male and female surgeons. Pregnancy and neonatal complications were compared between female surgeons and female nonsurgeon partners of surgeons.

Results A total of 850 surgeons (692 women and 158 men) were included in this survey study. Female surgeons with female partners were excluded because of lack of clarity about who carried the pregnancy. Because the included nonchildbearing population was therefore made up of male individuals with female partners, this group is referred to throughout the study as male surgeons. The median (IQR) age was 40 (36-45) years. Of 692 female surgeons surveyed, 290 (42.0%) had a pregnancy loss, more than twice the rate of the general population. Compared with male surgeons, female surgeons had fewer children (mean [SD], 1.8 [0.8] vs 2.3 [1.1]; P < .001), were more likely to delay having children because of surgical training (450 of 692 [65.0%] vs 69 of 158 [43.7%]; P < .001), and were more likely to use assisted reproductive technology (172 of 692 [24.9%] vs 27 of 158 [17.1%]; P = .04). Compared with female nonsurgeon partners, female surgeons were more likely to have major pregnancy complications (311 of 692 [48.3%] vs 43 of 158 [27.2%]; P < .001), which was significant after controlling for age, work hours, in vitro fertilization use, and multiple gestation (odds ratio [OR], 1.72; 95% CI, 1.11-2.66). Female surgeons operating 12 or more hours per week during the last trimester of pregnancy were at higher risk of major pregnancy complications compared with those operating less than 12 hours per week (OR, 1.57; 95% CI, 1.08-2.26). Compared with female nonsurgeon partners, female surgeons were more likely to have musculoskeletal disorders (255 of 692 [36.9%] vs 29 of 158 [18.4%]; P < .001), nonelective cesarean delivery (170 of 692 [25.5%] vs 24 of 158 [15.3%]; P = .01), and postpartum depression (77 of 692 [11.1%] vs 9 of 158 [5.7%]; P = .04).

Conclusions and Relevance This national survey study highlighted increased medical risks of infertility and pregnancy complications among female surgeons. With an increasing percentage of women representing the surgical workforce, changing surgical culture to support pregnancy is paramount to reducing the risk of major pregnancy complications, use of fertility interventions, or involuntary childlessness because of delayed attempts at childbearing.

重要性 虽然外科医生经常因为培训和建立早期职业而推迟怀孕和生育，但对女性外科医生的不孕症和妊娠并发症的风险知之甚少。

目的 描述美国女性外科医生的不孕症和妊娠并发症的发生率，并确定与社会人口学相似的非外科医生人群相比，与风险增加相关的工作场所因素。

设计、设置和参与者 这份自我管理的调查问卷于 2020 年 11 月至 2021 年 1 月通过美国多个外科协会和社交媒体在男性和女性主治医生和有孩子的住院外科医生中以电子方式分发和收集。非生育外科医生被要求回答有关其非外科医生伴侣怀孕的问题。

暴露 外科专业；工作、操作和通宵通话时间表。

主要结果和措施 为女性外科医生收集了关于流产的描述性数据。比较了男性和女性外科医生对辅助生殖技术的使用情况。比较女性外科医生和外科医生的女性非外科医生伴侣之间的妊娠和新生儿并发症。

结果 共有 850 名外科医生（692 名女性和 158 名男性）参与了这项调查研究。有女性伴侣的女性外科医生被排除在外，因为不清楚谁怀孕了。由于纳入的非生育人群因此由男性个体和女性伴侣组成，因此该群体在整个研究中被称为男性外科医生。中位 (IQR) 年龄为 40 (36-45) 岁。在接受调查的 692 名女性外科医生中，有 290 名（42.0%）流产，是普​​通人群的两倍多。与男性外科医生相比，女性外科医生的孩子更少（平均 [SD]，1.8 [0.8] vs 2.3 [1.1]；P  < .001），更有可能因为手术培训而推迟生育（692 人中有 450 人 [65.0% ] 对比 158 人中的 69 人 [43.7%]；P < .001)，并且更有可能使用辅助生殖技术（692 人中有 172 人 [24.9%] vs 158 人中有 27 人 [17.1%]；P  = .04）。与女性非外科医生伴侣相比，女性外科医生更容易出现严重的妊娠并发症（692 名中的 311 名 [48.3%] vs 158 名中的 43 名 [27.2%]；P < .001），在控制年龄、工作时间、体外受精使用和多胎妊娠后显着（优势比 [OR]，1.72；95% CI，1.11-2.66）。与每周手术时间少于 12 小时的女性相比，在妊娠最后三个月每周手术时间超过 12 小时的女性外科医生发生严重妊娠并发症的风险更高（OR，1.57；95% CI，1.08-2.26）。与女性非外科医生伴侣相比，女性外科医生更容易出现肌肉骨骼疾病（692 名中的 255 名 [36.9%] vs 158 名中的 29 名 [18.4%]；P  < .001），非择期剖宫产（692 名中的 170 名 [25.5%] vs 158 人中有 24 人 [15.3%]；P  = .01）和产后抑郁症（692 人中有 77 人 [11.1%] vs 158 人中有 9 人 [5.7%]；P  = .04）。

结论和相关性 这项全国性调查研究强调了女性外科医生不孕和妊娠并发症的医疗风险增加。随着代表外科劳动力的女性比例越来越高，改变外科文化以支持怀孕对于降低重大妊娠并发症、生育干预的使用或因延迟生育而导致的非自愿无子女的风险至关重要。