Perceptions of Job Hazards and Requests for Accommodation Among Pregnant Women in a Large Urban Hospital System

Profiles of the maternal occupational exposome during pregnancy and associations with intrauterine growth: Analysis of the French Longitudinal Study of Children - ELFE study

BACKGROUND

Numerous agents in the workplace are suspected of impairing fetal growth. To date, no epidemiological studies have specifically described the occupational exposome during pregnancy.

OBJECTIVE

The objectives were to determine maternal occupational exposome profiles and study their associations with intrauterine growth characteristics measured by small for gestational age (SGA), birthweight (BW), and head circumference (HC).

METHODS

We used data from the French national ELFE cohort. Occupational exposures to 47 agents (chemical, physical, biological, biomechanical, organizational and psychosocial), were identified using job exposure matrices. Mothers were classified as occupationally not exposed, uncertainly exposed, or exposed depending on their probability of exposure. Outcomes of interest were BW, SGA and HC. Maternal profiles of the occupational exposome were determined using hierarchical clustering of principal components. Associations between profiles and intrauterine growth outcomes were studied using linear or logistic regression models adjusted for potential confounders. Analyses were carried out depending on whether mothers stopped working during pregnancy.

RESULTS

The 12,851 included women were exposed to a median of 6 factors. Four occupational exposome profiles were identified, characterized by "low exposure, stress at work"; "strenuous, high organization, low decision"; "postural constraints, psychosocial factors", "postural and strength constraints, chemical and biological factors". In multivariate analyses, and among women who stopped working during the third trimester of pregnancy, analyses found associations between the profile "postural constraints, psychosocial factor" and SGA, and HC. None of the other exposure profiles were statistically significantly associated with foetal growth outcomes.

CONCLUSION

The results show that the specific profile "postural constraints, psychosocial factors" may increase the risk of foetal growth retardation. Although these results need to be replicated, this study provides a first better understanding of the exposome of pregnant women at the workplace which may help to better adapt prevention strategies.

"How Do I Prepare for This?" Patient Perspectives on Providers' Employment-related Support During Pregnancy

BACKGROUND

Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided.

METHODS

We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes.

RESULTS

People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients' individual work-related concerns.

CONCLUSIONS

Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.