Rehabilitation for normal pregnancy can be re-cast in terms of working during pregnancy. Most women can continue to work in jobs to which they are acclimated during most of pregnancy (Gabbe).
While exposure to toxic substances that might harm the fetus should logically be avoided, no one has published a list of occupations or jobs that should be avoided by pregnant women based on known exposures.
Exercise during pregnancy is to some degree analogous to the physical demands of work during pregnancy. Exercise in general in healthy women with normal pregnancies is strongly recommended. Both the American College of Obstetricians and Gynecologists and the Society of Obstetricians and Gynaecologists of Canada have published guidelines that strongly recommend routine exercise during pregnancy ("Guidelines"; Davies).
These guidelines state that exercise has been shown to have beneficial effects on maternal health and pregnancy outcome. Theoretical concerns—about pregnant women being at increased risk of fall due to their altered centers of gravity, and being at increased risk of sprains and strains due to hormonally mediated increased ligamentous laxity—have not been substantiated by data.
Although exercise during pregnancy usually is safe, several things should be avoided. A pregnant woman should avoid holding her breath during exercise (Valsalva maneuver) because this restricts oxygen flow to the placenta. Exercising while lying on the back (supine position) after the first trimester is not recommended because this decreases the cardiac output to the fetus. Activities such as skiing or horseback riding, in which falls could harm the mother or fetus, should be avoided.
In any workout, the woman should pay special attention to strengthening the lower back and pelvic floor muscles (Kegel exercises). In addition to strength training, a cardiovascular workout of walking or riding a bicycle is recommended. If a specific exercise causes pain or discomfort, it should be discontinued and an alternative exercise initiated. According to the American College of Obstetricians and Gynecologists (ACOG), exertion during pregnancy should be governed by the woman’s own good judgment—she can push herself as much or as little as she is comfortable.
Both guidelines contain absolute and relative contraindications to exercise during pregnancy, and logically these conditions would be potential contraindications to moderate, heavy, or very heavy work.
Absolute Contraindications to Exercise During Pregnancy:
• Uncontrolled type 1 diabetes, thyroid disease, or other serious cardiovascular, respiratory, or systemic disorder
• Growth restricted fetus
• Incompetent cervix/cerclage (prior miscarriages)
• Multiple gestation at risk for premature labor
• Persistent second or third trimester bleeding
• Placenta previa after 26 weeks gestation
• Premature labor during the current pregnancy
• Ruptured membranes
• Pregnancy induced hypertension
• Preeclampsia
Relative Contraindications to Exercise During Pregnancy:
• Severe anemia (Hemoglobin < 100 g/L)
• Unevaluated maternal cardiac arrhythmia
• Mild/moderate cardiovascular or respiratory disorder
• Chronic bronchitis
• Poorly controlled type I diabetes
• Extreme morbid obesity
• Extreme underweight (body mass index <12), malnutrition or eating disorder
• History of extremely sedentary lifestyle
• Intrauterine growth restriction in current pregnancy
• Poorly controlled hypertension/preeclampsia
• Orthopaedic limitations
• Poorly controlled seizure disorder
• Poorly controlled thyroid disease
• Heavy smoker
The concerns with work and pregnancy relate to hypertension/preeclampsia, premature delivery, and delivery of small—for gestational age—children (intrauterine growth retardation). In recent years, more women are working during pregnancy, and more women are working to within 1 month of delivery.
In the meta-analysis of 29 published studies (Mozurkewich), statistically significant but very minor risks were found for some work activities and pregnancy outcome. Mozurkewich estimates that one preterm birth might be prevented for each . . .
• 27 to 80 women who discontinue prolonged standing;
• 23 to 171 women who discontinue shift or night work;
• 36 to 65 women who discontinue physically demanding work;
• 12 to 32 women who modify cumulative work fatigue factors.
Thus, based on this meta-analysis, work would be safe for most pregnant women, but work restrictions could be imposed by the woman’s physician if there were any indication of any complications occurring during the monitoring of pregnancy.
A systematic review by Bonzini (2007) found 53 studies on work and/or physical activity on preterm delivery, 34 studies on low birth weight, and 9 on preeclampsia. For pre-term delivery and small for gestational age the larger and more complete studies were less positive and risk was only modest or not present. This review concluded there was not significant evidence to justify mandatory activity or work restrictions.
In summary, work during pregnancy is usually a question of whether a woman can safely continue to work at a job to which she is accustomed. The risk of continuing to work is small, and most of the conditions that might be caused by continuing to work can be monitored by the woman’s physician. If any of the absolute or relative contraindications to exercise during pregnancy are present or develop, the pregnant woman’s physician will logically impose work restrictions.
In the absence of these problems, during an uncomplicated normal pregnancy, the following durations mark the time at which the pregnant woman should stop that type of work activity:
• Sedentary - at onset of labor or 40 weeks gestation
• Light - at 38 weeks gestation
• Moderate - at 32 weeks gestation
• Heavy - at 26 weeks gestation
• Very Heavy - at 20 weeks gestation
If complications occur, transfer to a sedentary job, elimination of strenuous work (especially heavy lifting), elevation of legs during the day, shortened work hours, and extended leave may be required.
Please refer to other MDA monographs for work after spontaneous miscarriage and cases of induced abortion. |
Source: Medical Disability Advisor