This concise guideline follows an extensive and systematic review of the evidence of certain common work activities (heavy physical effort and lifting, prolonged standing, working long hours and shift working) to see whether these might adversely affect pregnancy outcomes (eg miscarriage, pre-term delivery, delivering a small-for-dates baby).
- Pregnant women can be reassured that current evidence offers no justification for imposing mandatory restrictions in relation to their working hours, shift working, lifting, standing and physical workload at work.
- Pregnant women can be informed that it is uncertain whether long working hours, shift work, prolonged standing, lifting and heavy physical work increase risks for preterm delivery, SGA, miscarriage and pre-eclampsia and/or gestational hypertension to a small degree. Best estimates generally suggest small increases in risk, but typically the data are also compatible with no effect (or even a small benefit) from work. There might also be disadvantages in refraining from work, which need to be considered. Thus, advice on work avoidance should be tailored to each patient’s tolerance of uncertainty at apparently low levels of risk, and the anxiety or otherwise that this engenders.
- In communicating risk information to pregnant women, a structured approach is recommended, covering the background level of risk in unexposed women, best estimates of any excess risk with uncertainties (both in the estimate of risk and in the quality of evidence), and any follow-on advice.
- Women with an adverse obstetric history or with obstetric risk factors and/or pregnancy complications need to receive individualised advice from their obstetrician or midwife.
- Regardless of any potential risks to the fetus, the physiological demands of late pregnancy (after 28 weeks’ gestation) are such that women might struggle to cope with excessive work demands, such as: long working hours (eg >40 h/wk); shift work; prolonged standing (eg >4 h/d); heavy physical work and heavy lifting. A good case exists for limiting them, and employers should have regard to making reasonable adjustments to the worker’s job profile.
The guideline is accompanied by summary leaflets on heavy lifting, shiftwork, heavy physical work, standing and long working hours.
- Faculty of Occupational Medicine