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Learn more: PMC Disclaimer | PMC Copyright Notice J Anesth Analg Crit Care . 2026 Mar 3;6:59. doi: 10.1186/s44158-026-00366-y Search in PMC Search in PubMed View in NLM Catalog Add to search Pregnancy and parenthood among Italian residents in anesthesia and intensive care — a national survey Annalisa Boscolo Annalisa Boscolo 1 Section of Anaesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padova, Padova, Italy 2 Institute of Anaesthesia and Intensive Care, Padova University Hospital, Padova, Italy Find articles by Annalisa Boscolo 1, 2, ✉ , Denise Battaglini Denise Battaglini 3 Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy 4 Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy Find articles by Denise Battaglini 3, 4 , Tiziana Bove Tiziana Bove 5 Department of Basic Biotechnological Sciences, Intensive Care and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, Rome, 00168 Italy 6 Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy Find articles by Tiziana Bove 5, 6 , Gilda Cinella Gilda Cinella 7 Department of Anesthesia, Intensive Care and Palliative Care, Policlinico Riuniti Hospital, University of Foggia, Foggia, Italy Find articles by Gilda Cinella 7 , Antonello Discenza Antonello Discenza 7 Department of Anesthesia, Intensive Care and Palliative Care, Policlinico Riuniti Hospital, University of Foggia, Foggia, Italy Find articles by Antonello Discenza 7 , Ornella Piazza Ornella Piazza 8 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy Find articles by Ornella Piazza 8 , Monica Rocco Monica Rocco 9 Anesthesia, Intensive Care, and Pain Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy Find articles by Monica Rocco 9 , Giuliana Scarpati Giuliana Scarpati 10 San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy Find articles by Giuliana Scarpati 10 , Rosanna Vaschetto Rosanna Vaschetto 11 Anesthesia and Critical Care, University of Eastern Piedmont, Novara, Italy Find articles by Rosanna Vaschetto 11 , Francesca Rubulotta Francesca Rubulotta 12 Department of Anesthesia and Intensive Care, CHIRMED, University Hospital Policlinico “G. Rodolico–San Marco”, Catania, 95123 Italy 13 Chair of the International Women in Intensive and Critical Care Medicine Network (iWIN), Catania, Italy Find articles by Francesca Rubulotta 12, 13 , Nicolò Sella Nicolò Sella 1 Section of Anaesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padova, Padova, Italy 2 Institute of Anaesthesia and Intensive Care, Padova University Hospital, Padova, Italy Find articles by Nicolò Sella 1, 2 , Paolo Navalesi Paolo Navalesi 1 Section of Anaesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padova, Padova, Italy 2 Institute of Anaesthesia and Intensive Care, Padova University Hospital, Padova, Italy Find articles by Paolo Navalesi 1, 2 ; the INSPIRE (Italian National Survey On Parenthood During Intensive Care REsidency) group Author information Article notes Copyright and License information 1 Section of Anaesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padova, Padova, Italy 2 Institute of Anaesthesia and Intensive Care, Padova University Hospital, Padova, Italy 3 Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy 4 Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy 5 Department of Basic Biotechnological Sciences, Intensive Care and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, Rome, 00168 Italy 6 Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy 7 Department of Anesthesia, Intensive Care and Palliative Care, Policlinico Riuniti Hospital, University of Foggia, Foggia, Italy 8 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy 9 Anesthesia, Intensive Care, and Pain Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy 10 San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy 11 Anesthesia and Critical Care, University of Eastern Piedmont, Novara, Italy 12 Department of Anesthesia and Intensive Care, CHIRMED, University Hospital Policlinico “G. Rodolico–San Marco”, Catania, 95123 Italy 13 Chair of the International Women in Intensive and Critical Care Medicine Network (iWIN), Catania, Italy ✉ Corresponding author. Received 2025 Oct 8; Accepted 2026 Feb 18; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067416 PMID: 41772650 Abstract Background Parenthood during medical residency is challenging, especially in Anesthesia and Intensive Care Medicine, given the irregular schedules, long working hours, and high levels of stress. Prior studies among surgeons and intensivists reported increased miscarriage and pregnancy complications, while cultural stigma and limited support further increase difficulties. This national survey among Italian Anesthesia and Intensive Care Medicine residents aimed to elucidate the experience of (i) parenthood and pregnancy outcomes, (ii) maternity leave and work arrangements, (iii) breastfeeding support, and (iv) workplace well-being. Methods A national anonymous online survey (ethical approval no. 0017063), endorsed by the National Board of Anesthesia and Intensive Care Professors (Collegio dei Professori di Anestesia e Rianimazione—CPAR), was systematically distributed via institutional emails to members of the Italian Society of Anaesthesia, Analgesia and Intensive Care Medicine (SAARTI). The questionnaire, designed with the BRUSO model and pretested, targeted Italian residents in Anesthesia and Intensive Care Medicine. Results A total of 1387 residents completed the survey (national response rate: 33%, 62% female). Most responses (61%, 748/1387) and pregnancies (52%, 151/289) were from Northern Italy. Parenthood was reported by 24% (208/862) female residents and 18% (92/525) males ( p = 0.004). Complications during full-term pregnancies were more frequent among female residents than among partners of male colleagues (47% vs 22%, p < 0.001). When healthy residents were pregnant, 34% were reassigned to alternative tasks, 11% lost their tasks with no new assignments, and 44% were declared at high risk regardless of being healthy and remained at home. Breastfeeding was reported in 61% (144/235), and only 33% (48/144) requested leave. Workplace support was inadequate, particularly during work arrangements, breastfeeding, and fertility attempts. Finally, residents from Northern Italy declared to work more than 38 h/week ( p < 0.001). Pregnancy-related complications were similar between regions. Conclusions This first Italian national survey, among anesthesia residents, highlights organizational and cultural barriers to parenthood, as well as significant regional disparities, stressing the need for institutional strategies ensuring equity, safety, and workplace well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-026-00366-y. Keywords: Pregnancy, Parenthood, Female physicians, Working conditions Introduction Parenthood during medical residency presents a significant yet often underestimated challenge, particularly in demanding specialties such as Anesthesiology and Intensive Care Medicine (ICM). These fields are characterized by unpredictable schedules, extended working hours, and frequent night shifts [ 1 ], all of which may interfere with family planning and the maintenance of a healthy pregnancy [ 2 , 3 ]. While in recent years an increasing number of female residents has been reported worldwide, the balance between training and parenthood remains fraught with obstacles, raising both medical and cultural concerns [ 4 , 5 ]. International literature consistently demonstrates that female physicians—particularly surgeons and anesthesiologists—experience higher rates of infertility, pregnancy loss, and pregnancy-related complications compared to the general population [ 6 , 7 ]. For instance, up to 42% of female surgeons report experiencing a miscarriage, more than double the rate observed in the general population [ 6 ]. Actually, occupational exposures such as prolonged standing, repetitive lifting, and high job strain significantly increase the likelihood of sick leave and adverse pregnancy outcomes [ 2 , 3 ]. Indeed, residents working more than 12 h per week in the operating room during pregnancy have been shown to be at higher risk of major complications [ 6 , 7 ]. Beyond the medical risks, the cultural climate within training programs can profoundly influence residents’ decisions regarding parenthood. Several surveys of surgical residents in the USA revealed that many trainees faced stigma, unmodified work schedules during pregnancy, and inadequate maternity leave [ 6 , 8 ]. Negative attitudes from peers and supervisors were frequently reported, with some residents even reconsidering their specialty choice due to these pressures [ 9 , 10 ]. A French qualitative study further emphasized that becoming a parent during residency requires not only individual adaptation but also flexibility and support from the training team to mitigate the risk of burnout and preserve both professional and personal well-being [ 6 ]. Moreover, a recent comparative survey demonstrated that anesthesiologists and obstetrician-gynecologists experience similarly high rates of pregnancy complications and losses, with more than half of respondents reporting at least one adverse event [ 7 ]. In Italy, there is currently a lack of national data regarding parenthood during residency in Anesthesiology and Intensive Care, despite the relevance of this topic. To address this gap, we conducted a national survey entitled “Pregnancy and Parenthood among Italian Anesthesia Residents” aiming to elucidate the experience of the following: Parenthood and pregnancy outcomes Maternity leave and work arrangements Breastfeeding and lactation support Feelings related to parenthood and workplace well-being. By mapping these dimensions for the first time in Italy, we aimed to contribute to a better understanding of the challenges faced by Italian anesthesia residents and to lay the groundwork for institutional strategies and policies that promote equity, safety, and well-being for trainees who choose to pursue parenthood during residency training. Methods he study population comprised all Italian residents in Anesthesiology and Intensive Care Medicine. A comprehensive list of Italian Anesthesiology and Intensive Care schools was provided by the Ministry of Education (Supplementary Material 1). An extensive literature review failed to identify existing validated surveys for this specific population. Consequently, a novel survey tool was developed, with each item designed according to Peterson’s BRUSO model (brief, relevant, unambiguous, specific, and objective) [ 11 , 12 ]. The tool underwent a two-phase pretesting process for content refinement. In the first phase, a subset of the survey team meticulously reviewed the items, focusing on overall survey flow, typographical errors, and potential skip logic issues (e.g., respondents may inadvertently bypass sections of the survey based on their previous answers, leading to incomplete data collection). The second phase involved a review by a small group of residents, who provided feedback on the survey’s appropriateness, completeness, and estimated completion time (determined to be between 6 and 12 min). The final questionnaire consisted of 15 (up to 20 questions), presented on two pages in a consistent order for all respondents with a similar familial and/or relational status. The complete survey is available in Supplementary Material 2. No incentives were offered at any stage to the study population. The questionnaire and dissemination plan were reviewed and approved by the Institutional Review Board of the University Hospital of Padua, Italy (protocol reference: 0017063, 7th March 2025). The survey The questionnaire and dissemination plan were reviewed and approved by the Institutional Review Board of the University Hospital of Padua, Italy (protocol reference: 0017063, 7th March 2025). The survey received endorsement from the National Board of Anesthesia and Intensive Care Professors (Collegio dei Professori di Anestesia e Rianimazione—CPAR). The Internet-based survey was conducted using LimeSurvey and disseminated through departmental offices using academic emails, with four weekly reminders subsequently issued. Although anonymous, LimeSurvey collected respondents’ IP addresses to prevent multiple responses from the same device. Questionnaires were excluded from analysis if they lacked age or gender information, were incomplete for more than 40% of questions, came from schools with missing data on total resident numbers or with a global response rate below 5%, or when coming from males with pregnant partners attending OR, ICU, or similar (Supplementary Material 1). The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was employed to enhance the accuracy and transparency of the study’s reporting [ 13 ]. Data protection The questionnaire was entirely anonymous. During data collection, access to the database was restricted to one author (A. B. B.) using institutional credentials. To ensure data security, the online database was deleted upon survey completion. A single copy of the data was then saved locally in an Excel file (Microsoft Corporation, USA) on the personal computer of the survey’s principal investigator (A. B. B.), with password protection known only to her, for result analysis. De-identified survey data generated and analyzed in this study is available upon reasonable request. Statistical analysis For sample size calculation, we estimated a population of 3204 Italian residents (1804 (56%) females and 1400 (44%) males) informed about the survey by their directors. To achieve a representative sample with 99% confidence and a 5% margin of error, we estimated a minimum requirement of 487 females and 452 males to complete the survey. Descriptive statistics were used to summarize the survey data. Categorical variables were presented as counts (n) and proportions (%), while continuous variables were expressed as mean and standard deviation (SD) or median and interquartile range (IQR), as appropriate. Categorical variables were compared between groups using the chi-square test or Fisher’s exact test, where appropriate. The normality of individual survey items was assessed using the Shapiro–Wilk test. Parametric data were analyzed using Student’s t -test, while the Mann–Whitney U -test or Kruskal–Wallis test was used to compare non-normally distributed variables. p -values less than 0.05 were considered statistically significant. All statistical analyses were performed using R version 4.4.1. Results General characteristics A total of 1387 Italian residents responded to the survey, representing 43% of all potential national respondents informed about the survey by their respective directors. The sample comprised 862 (62%) female and 525 (38%) male participants (Fig. 1 A, B). Fig. 1. Open in a new tab A Survey flowchart and national response rate. B Percent of responders among females and males over time. Abbreviations: F, female; M, male; n, number; ICU, intensive care unit; OR, operative room Response timing analysis revealed a significant gender difference in survey completion rates. Among female respondents, 69% completed the survey within the first week of distribution. In contrast, only 39% of male residents responded within the same timeframe ( p = 0.053). The demographic characteristics of the respondents are presented in Table 1 . The majority of participants ( n = 848, 61%) were from Northern Italy since schools in the North are generally more numerous. The most represented universities were the University of Padua, University of Genoa, University of Eastern Piedmont “Amedeo Avogadro”, and University of Milan (see Supplementary Material 1 for detailed distribution). Table 1. General characteristics Overall* Females Males p Responders , n 1387 862 (62%) 525 (38%) < 0.001 Age , years 31 (29–34) 31 (29–34) 31 (29–34) 0.999 Year of residency I–II 375/1247 (30%) 233/803 (29%) 141/438 (32%) 0.041 III–IV 576/1247 (46%) 390/803 (49%) 183/438 (42%) 0.041 V 296/1247 (24%) 180/803 (22%) 114/438 (26%) 0.041 Employment contract Residents: 993/1217 (82%) Residents: 648/785 (83%) Residents: 343/430 (80%) 0.232 DC: 217/1217 (18%) DC: 131/785 (17%) DC: 86/430 (20%) 0.232 DS: 7/1217 (< 1%) DS: 6/785 (< 1%) DS: 1/430 (< 1%) 0.232 Relationship status Married/live-in partner, n 760/1307 (58%) 512/839 (61%) 244/462 (53%) 0.025 Living w/o the partner, n 296/1307 (23%) 187/839 (22%) 109/462 (24%) 0.025 Single, n 251/1307 (19%) 140/839 (17%) 109/462 (24%) 0.025 Partner age, years 32 (30–36) 33 (30–37) 31 (28–33) 0.045 Healthcare partner, n 510/1056 (48%) 285/699 (41%) 224/353° (63%) < 0.001 Open in a new tab Data are expressed as number and (percentage) or median and [interquartile range] All bold values are significant Abbreviations: DC Decreto Calabria, DS Decreto Schillaci, h hours, w/o without, Y yes, N no *To note, 9% of female and 10% of male residents do not want children Parenthood and pregnancy outcomes As shown in Table 2 , 208 female respondents (24% of the total female sample, 208/862) reported either being currently pregnant (3%, 29/862) or having experienced pregnancy during residency (21%, 179/862). In contrast, only 92 male respondents (18%) reported experiencing fatherhood during residency ( p = 0.004). Table 2. Parenthood and pregnancy outcomes Female residents experiencing pregnancy Male residents experiencing pregnancy a p Experiencing at least one pregnancy during residency , n 208 92 0.004 Overall pregnancies during residency , n (including miscarriages and cases of VTOP) 289 c 128 d Full-term pregnancies , n (gestational age > 37 weeks) 217 c (217/289, 75%) 96 d (96/128, 75%) 0.899 i. i. without complications , n 116 (116/289, 40%) (116/217, 53%) 75 (75/128, 59%) (75/96, 78%) < 0.001 ii. ii. with complications , n 101 (101/289, 35%) (101/217, 47%) 21 (21/128, 16%) (21/96, 22%) < 0.001 Causes • Placental dysfunction/IUGR: 34% • Hypertension/preeclampsia:• 28% • Others or not declared:• 38% Causes • Placental dysfunction/IUGR: 19% • Hypertension/preeclampsia: 39% • Others or not declared:• 42% Preterm pregnancies , n (gestational age ≤ 37 weeks) 72 (72/289, 25%) 32 (32/128, 25%) 0.999 early pre-term (gestational age ≤ 14 weeks of gestation (i.e., miscarriages and cases of VTOP)), n 54 b (54/289, 19%) (54/72, 75%) Causes • Fetal death or malformations: 53% • Other reasons: 47% 24 (24/128, 25%) (24/32, 75%) Causes • Fetal death or malformations: 54% • Other reasons or not declared: 46% 0.867 Late pre-term (14 weeks < gestational age < 37 weeks), n 18 e (18/289, 6%) (18/72, 25%) Causes • Preterm labor/PROM: 41% • Hypertension/preeclampsia: 29% • Placental dysfunction/IUGR: 29% 8 (8/128, 6%) (8/32, 25%) Causes • Not declared 0.867 Pregnancies after MAP , n 14/289 (5%) f 1/92 (1%) 0.893 (3 residents: 1–3 days off, 5 residents > 8 days) (1 resident: < 8 days) Previous pregnancies , n 76 (76/862, 9%) 54 (54/525, 10%) 0.765 Total no. of children 1 (1–3) 1 (1–2) 0.321 Newborns requiring intensive cares , n 20 (20/289, 7%) Pre-term: 10 (10/20, 50%) Mid- and long-term complications: 50% (mostly respiratory complications (83%)) 12 (12/128, 9%) Pre-term: 1 (1/12, 8%) Mid- and long-term complications: 83% (respiratory complications 50%; sepsis and necrotizing enterocolitis 50%) 0.430 Open in a new tab All bold values are significant Abbreviations: VTOP voluntary termination of pregnancy, n number, PROM premature rupture of membranes, IUGR intrauterine growth restriction, C-section cesarean section, MAP medically assisted procreation a The responses to the questions regarding pregnancy refer to the experience of female partners of male residents. Obviously, responses from female partners attending anesthesia residency [ 9 ], or surgical residency [ 7 ], were excluded from this analysis b Thirty-five out of 54 (65%) early pre-term pregnancies occurred during the residency program (gestation age of interruption: 8 (IQR 7–11) weeks) c C-sections required in 38 out of 289 (13%) overall pregnancies and, in particular, in 38 out of 101 (38%) full-term pregnancies with complications (38%) d C-sections required in 12 out of 128 (9%) overall pregnancies and, in particular, in 12 out of 21 (57%) full-term pregnancies with complications (38%) e Mean gestational age of interruption: 36 (IQR 35–36) weeks) f Eight out of 14 MAPs were performed during the residency program No significant gender differences were observed regarding the median age at the first childbirth (32 years (IQR 29–34) for mothers versus 33 years (IQR 31–36) for fathers, p = 0.456) or the year, mostly the fourth, of residency during the first pregnancy ( p = 0.621). Overall, pregnancy outcomes among female residents and partners of male residents were comparable in terms of gestational age at delivery. Full-term pregnancies were reported in 75% of cases for both groups (217/289 for residents and 96/128 for partners), while preterm deliveries accounted for 25% (72/289) for residents and (32/128) for partners ( p = 0.867). From a descriptive point of view, complications during full-term pregnancies were significantly more frequent among residents compared to partners (47% (101/217) versus 22% (21/96), respectively; p < 0.001). Maternity leave and work arrangements Overall, 36% (76/208) of pregnant residents continued working through alternative tasks, namely preoperative evaluations (15%, 32/208), pain medicine (10%, 20/208), and research, thesis work, paperwork, or other duties (16%, 24/208). These residents were granted a lighter workload compared to their preconception period, with 83% working less than 38 h per week. A total of 11% (22/208) of pregnant residents received no alternative tasks to accomplish. In fact, of those residents, 27% (6/22) requested “early” maternity leave, while 73% (16/22) continued their regular duties with reduced weekly hours. Finally, 44% (91/208) of females commenced early maternity leave due to high-risk pregnancies, and 9% (19/208) did not provide a response. Regardless of maternity arrangements, 61% (130/208) of expectant mothers avoided high-risk environments (e.g., operating rooms, emergency departments) from the first trimester, 24% (49/208) from the second trimester, and 15% (29/208) from the third trimester ( p < 0.001). Comparing maternity leave patterns, female residents typically began leave 1 month before birth (IQR 1–2), while female partners of male residents started a median of 3 months prior to delivery (IQR 1–5) ( p = 0.041). The timing of return to work was similar between groups: 6 months (IQR 5–8) for residents versus 8 months (IQR 5–10) for partners ( p = 0.056). Requests for extended maternity leave, particularly for taking care of neonates requiring intensive care, were infrequent in both groups: 20% (4/20) among female residents and 33% (4/12) among male residents ( p = 0.651). The primary reasons for not extending leave included reluctance to prolong residency (32%), perceived lack of necessity (26%), concern about burdening colleagues (21%), opposition from tutors/supervisors (11%), and financial constraints (10%). Breastfeeding and lactation support Of the 235 live births (excluding miscarriages and voluntary terminations of pregnancy), 61% (144/235) of neonates were breastfed, with 71% (102/144) of these cases extending beyond 6 months. Despite this high rate of breastfeeding, only 33% (48/144) of mothers took breastfeeding leave. The majority (65%) deemed it unnecessary, while 35% were discouraged from requesting it. Only 21% (30/144) of breastfeeding mothers reported insufficient breastfeeding, primarily due to maternal factors (63%) rather than work-related issues (37%). The main reasons for cessation of breastfeeding were insufficient milk supply (44%), maternal mental health concerns or personal choice (44%), and lack of lactation facilities (12%). It should be noted that data from partners of male residents were insufficient for analysis. Postpartum depression was reported by 16% (37/235) of female residents. Feelings related to parenthood and workplace well-being As illustrated in Fig. 2 , the perception of negative stigma associated with pregnancy was not significantly different between female residents and partners (45% vs. 33%, p = 0.063). However, a higher proportion of resident respondents (51%) perceived a lack of support regarding lighter work schedules during pregnancy compared to female partners (37%) ( p = 0.048). Additionally, only 42% of residents reported adequate support from colleagues during breastfeeding. Support from supervisors during fertility attempts was generally moderate across groups (43% for mothers, 40% for fathers, 45% for male residents without children, while female residents without children reported significantly lower support (8%, p = 0.042)). Fig. 2. Open in a new tab Workplace well-being in relation to parenthood and work motivation. To note, women and males without children were 569 and 388, respectively. For “feelings related to parenthood during residency,” the total number of females (208) and males (92) experiencing at least one pregnancy during residency was considered as “references”; otherwise, the references were the total number of females (645) and males (146) with children, not necessarily conceived during residency, respectively The perception of delaying parenthood to complete training was most pronounced among females without children (54%), followed by mothers (34%). This perception was less prevalent among male residents with children (24%) than among those without (38%) ( p = 0.013). A majority of residents would favor part-time employment to support family life (95% mothers, 79% fathers, 79% female, and 74% male residents without children, p = 0.650). Finally, few residents would recommend a career in anesthesiology to their children (35% mothers, 41% fathers, 42% female, and 49% male residents without children, p = 0.541), despite a work motivation relatively high across all groups ( p = 0.645). National differences Overall, the majority of residents reported working more than 38 h per week, with significant regional variations: 70% (502/748) in the Northern (of these, approximately 60% worked between 38 and 60 h), 65% (116/207) in the Centre (of these, 54% worked between 38 and 60 h), and 60% (130/266) in the South and Islands (of these, 47% worked between 38 and 60 h) ( p < 0.001). No gender-related differences were observed in these work patterns (Fig. 3 , red boxes). Fig. 3. Open in a new tab Workplace well-being in relation to parenthood and work motivation. Overall, no differences were found between females (≤ 38 h/week: 42% (285/682); > 38 h/week: 58% (397/682)) and males (≤ 38 h/week: 168/451 (37%); > 38 h/week: 283/451 (63%)) ( p = 0.111; overall population: ≤ 38 h/week: 487/1281 (38%); > 38 h/week: 794/1281 (62%)). Abbreviations: n, number; w/o, without; h, hours From a descriptive point of view, full-term pregnancies without complications (Fig. 3 , yellow boxes) were prevalent in the Northern (44%, 66/151) and Centre (46%, 25/56) compared to the Southern (29%, 24/82). The Southern showed a high percentage of late preterm pregnancies (12%, 10/82) compared to the Northern (4%, 6/151) and Centre (4%, 2/56) (Fig. 3 , light blue boxes). Finally, the trend of full-term pregnancies with complications (Fig. 3 , violet boxes) showed an unfavorable trend in the Southern (39% (32/82) versus 36% (20/56) in the Centre and 32% (49/151) in the Northern) (overall p = 0.098). Discussion This nationwide survey provides, for the first time, an in-depth overview of pregnancy and parenthood among Italian residents in Anesthesiology and Intensive Care. Several key findings emerged: a substantial proportion of residents, predominantly females, experienced pregnancy during training. Female residents had a higher rate of complications compared with partners of male residents, maternity leave and work arrangements were inconsistent and often inadequate, breastfeeding support was only partially available, and negative feelings such as a lack of support regarding lighter work schedules during pregnancy, breastfeeding, and fertility attempts were frequently reported. With regard to regional disparities, from a descriptive point of view, residents in Northern Italy usually work more than 38 h/week, while no regional differences were identified on pregnancy outcomes. Parenthood and pregnancy outcomes Our results confirm that pregnancy during residency is not uncommon, but it carries a considerable burden of difficulties, also in light of the increasing average age of mothers during pregnancy, often related to the need to complete medical specialization in order to secure a stable job and a satisfactory income. In fact, nearly one in two female residents who carried a pregnancy to term experienced complications such as placental dysfunction, preeclampsia, or intrauterine growth restriction, as previously reported particularly among anesthesiologists and surgeons [ 6 , 8 , 10 , 14 , 15 ]. Additionally, occupational factors such as prolonged standing, repetitive lifting, and high job strain increase the risk of sick leave and adverse outcomes during pregnancy [ 2 ]. Similarly, a Spanish cohort highlighted that absences due to pregnancy-related occupational risk were consistently associated with physical and psychosocial exposures [ 8 ]. These findings reinforce the notion that work environment and job structure are key determinants of pregnancy safety during residency. Maternity leave and work arrangements Our survey highlights wide variability in maternity leave patterns among Italian residents. Over one-third of pregnant residents continued working through alternative assignments, while almost half required early leave due to high-risk pregnancies. Yet, the decision to extend maternity leave was often hindered by cultural and professional barriers—fear of prolonging residency, reluctance to burden colleagues, or even opposition from supervisors. These barriers echo prior studies among surgical trainees in the USA, where many residents reported working until late in pregnancy with no schedule modifications and where maternity leave was consistently perceived as insufficient [ 8 , 16 ]. Qualitative data from French medical residents also emphasized that becoming a parent during training requires not only individual adaptation but also flexibility and support from the training team to mitigate burnout and preserve well-being [ 2 ]. The parallels between these contexts suggest that inadequate support for parenthood during residency is a widespread phenomenon, transcending national borders and healthcare systems. Breastfeeding and lactation support While breastfeeding rates among Italian anesthesia residents were relatively high, formal institutional support was scarce. Only one in three mothers accessed breastfeeding leave, and many reported being discouraged from requesting it. These experiences mirror those reported in US surveys of surgical residents, where access to lactation facilities and protected time for breastfeeding was often lacking [ 9 , 14 ]. Beyond individual inconvenience, the absence of structured lactation support may contribute to early weaning, maternal stress, and reduced overall job satisfaction. Our data also revealed that postpartum depression was reported by 16% of respondents, further underscoring the importance of creating supportive environments for new mothers in residency programs. Feelings and workplace well-being The cultural climate within training programs appears to play a pivotal role in shaping reproductive decisions and well-being. More than half of our female respondents perceived an inadequate support in adjusting their workload before birth and upon returning from maternity leave. These findings are consistent with surveys of surgical residents in the USA, where negative attitudes from peers and supervisors were commonly reported and, in some cases, influenced trainees to reconsider their career paths [ 6 , 8 , 16 ]. Moreover, a French qualitative study further emphasized that becoming a parent during residency requires not only individual adaptation but also flexibility and support from the training team to mitigate the risk of burnout and preserve both professional and personal well-being, and, according to our data, this kind of support is still possible [ 6 ]. Keeping in line, the British Medical Association, one of the most important international models on parenting policies, encourages the development of supportive return-to-work plans for new mothers, helping them regain a healthy and sustainable work routine. Moreover, the perception of needing to postpone parenthood until after residency was widespread among our respondents, particularly among women without children, confirming that cultural and institutional pressures, rather than personal choice, often dictate the timing of family planning. Regional differences A novel aspect of our study is the identification of regional disparities. To note, residents in Northern Italy reported a similar rate of late preterm deliveries and pregnancy complications compared with those in the Center and Southern. These findings highlight the importance for national-level harmonization of policies to ensure equitable protection for all residents, regardless of training location. International literature demonstrates that occupational exposures and long working hours are modifiable risk factors for adverse pregnancy outcomes [ 6 , 8 ]. In addition, recent surveys highlight the widespread problem of fatigue among European anesthesiologists, calling for structured fatigue risk management systems in line with the European Working Time Directive [ 7 ]. However, given the considerably lower number of responses from the South, we cannot exclude the possibility that the findings on regional differences could be influenced by response bias, reflecting a higher participation of female residents who experienced more complications and were directly affected by the issue. Limitations This study has several limitations that should be acknowledged. First, although the survey reached the majority of Italian Anesthesiology and Intensive Care residency programs, the total number of responses was 1387, markedly lower than the total number of Italian residents currently enrolled in Anesthesiology and Intensive Care, exceeding 4000. In light of this, a potential selection bias cannot be excluded. Residents with stronger opinions or personal experiences related to pregnancy and parenthood may have been more motivated to participate, potentially overestimating the prevalence of complications and negative experiences. Second, the self-reported nature of the data introduces the possibility of recall bias and subjective interpretation, especially for sensitive outcomes such as pregnancy complications, postpartum depression, or perceptions of stigma. We did not independently verify medical records, and therefore, clinical outcomes should be interpreted with caution. Third, while the questionnaire underwent pretesting for clarity and completeness, no validated instrument was available for this specific population. This limits the comparability of our findings with other international surveys that may have used different tools or definitions. Fourth, the cross-sectional design does not allow us to infer causality between working conditions and adverse outcomes. Finally, although our findings are consistent with international literature, prospective studies would be necessary to confirm these associations. Conclusions In conclusion, our survey demonstrates that pregnancy and parenthood during Anesthesiology and Intensive Care residency in Italy are associated with significant difficulties, inadequate institutional support, and persistent cultural stigma. These results highlight the urgent need for policies that safeguard reproductive health, reduce professional stigma, and promote equity and well-being among residents who choose to become parents during training. Supplementary Information Supplementary Material 1: Survey. (36.5KB, docx) 44158_2026_366_MOESM2_ESM.docx (209.3KB, docx) Supplementary Material 2: Percentages of responders according to universities. Acknowledgements Members of the INSPIRE (Italian National Survey on Parenthood during Intensive care REsidency) group, to be searchable through their individual PubMed records, are listed below: Department of Medicine—DIMED, Section of Anaesthesiology and Intensive Care, University of Padova, Padova, Italy (Carlo Alberto Bertoncello, MD; Mara Bassi, MD; Tommaso Pettenuzzo, MD); Department of Medicine—DIMED, University of Padova, Padova, Italy (Giulia Mormando, MD); and Department of Anesthesia, Intensive Care and Palliative Care, University of Foggia, Policlinico Riuniti Hospital, Foggia, Italy (Antonio Carrideo, MD). Clinical trial number Not applicable. Authors’ contributions ABB, DB, NS, and PN have made substantial contributions to the conception of the work. TB, GC, OP, MR, and RV have made substantial contributions to the conception of the work. AD, GS, and FR have made substantial contributions to the acquisition and analysis of data. ABB, PN, TB, MR, RV, AD, and FR have made substantial contributions to the interpretation of data. DB, NS, GC, OP, and GS have made substantial contributions to the creation of new survey software used in the work. All authors have drafted the work or substantively revised it. All authors have approved the submitted version and have agreed both to be personally accountable for the authors’ own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the authors were not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Funding No funding was received for this study. Data availability De-identified survey data generated and analyzed in this study is available upon reasonable request. Declarations Ethics approval and consent to participate The survey protocol was approved by the Ethical Committee of Padua University Hospital (protocol number 0017063), and the study was conducted in compliance with the Declaration of Helsinki. Participation in the survey was voluntary and completely anonymous; therefore, the collection of written informed consent from each participant was waived. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Contributor Information Annalisa Boscolo, Email: [email protected]. the INSPIRE (Italian National Survey On Parenthood During Intensive Care REsidency) group: Carlo Alberto Bertoncello , Mara Bassi , Tommaso Pettenuzzo , Giulia Mormando , and Antonio Carrideo References 1. 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Gynecol Obstet Fertil Senol 47(12):846–853 [ DOI ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Supplementary Material 1: Survey. (36.5KB, docx) 44158_2026_366_MOESM2_ESM.docx (209.3KB, docx) Supplementary Material 2: Percentages of responders according to universities. Data Availability Statement De-identified survey data generated and analyzed in this study is available upon reasonable request. 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