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Working during pregnancy

Josephine R Fowler, MD, MSc
Larry Culpepper, MD, MPH
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


Data from the Organisation for Economic Co-operation and Development (OECD) indicate that the employment rate among women age 15 to 64 years is 63 percent worldwide [1]. In the United States, the US Bureau of Labor Statistics reported that 58.1 percent of women age ≥16 years were in the labor force in 2011 [2]. Thus, issues about working during pregnancy often arise. This topic will address several common concerns of women who want to work or have to work during pregnancy.


Pregnancy is associated with a wide variety of physical, functional, and even emotional changes. (See "Clinical manifestations and diagnosis of early pregnancy".)

Two common discomforts of early pregnancy that could affect a woman’s ability to perform her job include nausea and vomiting and fatigue. In particular, nausea and/or vomiting can be provoked by workplace odors or restrictions around eating [3]. These problems can usually be managed by medication, taking a brief break, snacking, as needed, and scheduling the most demanding work for times when the woman tends to feel less nauseous, if possible. However, sometimes a short-term absence from work is required.

Nausea and vomiting and fatigue generally improve during the second trimester. However, by the end of the second trimester and continuing through term, physical and physiologic changes may bring on additional discomforts such as heartburn, back pain, varicose veins, hemorrhoids, and physical discomfort from the enlarging uterus. Because of the normal physiological demands of the third trimester, women may have difficulty coping with excessive work demands, such as long working hours (eg, >40 hours/week), shift work, prolonged standing (eg, >4 hours/day), heavy physical work, and heavy lifting [4].

Ideally, the woman and her employer will be able to make reasonable adjustments to deal with these discomforts in the workplace. Simple precautions that can help reduce excessive fatigue and potentially reduce the risk of pregnancy complications include modifying shift times and tasks; minimizing lifting, bending, and prolonged standing; using proper lifting techniques; taking regular breaks every few hours and a longer break after five hours; and drinking plenty of fluids [5-11]. However, lost work time and interruptions in workflow may be necessary.


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Literature review current through: Sep 2016. | This topic last updated: Sep 15, 2014.
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  1. http://stats.oecd.org (Accessed on February 19, 2014).
  2. http://www.oecd-ilibrary.org/employment/employment-rate-of-women_20752342-table5 (Accessed on December 10, 2013).
  3. Wood H, McKellar LV, Lightbody M. Nausea and vomiting in pregnancy: blooming or bloomin' awful? A review of the literature. Women Birth 2013; 26:100.
  4. Palmer KT, Bonzini M, Bonde JP, et al. Pregnancy: occupational aspects of management: concise guidance. Clin Med (Lond) 2013; 13:75.
  5. Mozurkewich EL, Luke B, Avni M, Wolf FM. Working conditions and adverse pregnancy outcome: a meta-analysis. Obstet Gynecol 2000; 95:623.
  6. Saurel-Cubizolles MJ, Zeitlin J, Lelong N, et al. Employment, working conditions, and preterm birth: results from the Europop case-control survey. J Epidemiol Community Health 2004; 58:395.
  7. Katz VL. Work and work-related stress in pregnancy. Clin Obstet Gynecol 2012; 55:765.
  8. MacDonald LA, Waters TR, Napolitano PG, et al. Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations. Am J Obstet Gynecol 2013; 209:80.
  9. Bonde JP, Jørgensen KT, Bonzini M, Palmer KT. Miscarriage and occupational activity: a systematic review and meta-analysis regarding shift work, working hours, lifting, standing, and physical workload. Scand J Work Environ Health 2013; 39:325.
  10. Palmer KT, Bonzini M, Harris EC, et al. Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis. Occup Environ Med 2013; 70:213.
  11. Juhl M, Strandberg-Larsen K, Larsen PS, et al. Occupational lifting during pregnancy and risk of fetal death in a large national cohort study. Scand J Work Environ Health 2013; 39:335.
  12. Salihu HM, Myers J, August EM. Pregnancy in the workplace. Occup Med (Lond) 2012; 62:88.
  13. Pelé F, Muckle G, Costet N, et al. Occupational solvent exposure during pregnancy and child behaviour at age 2. Occup Environ Med 2013; 70:114.
  14. Brooks-Gunn J, Han WJ, Waldfogel J. Maternal employment and child cognitive outcomes in the first three years of life: the NICHD Study of Early Child Care. National Institute of Child Health and Human Development. Child Dev 2002; 73:1052.
  15. Hill JL, Waldfogel J, Brooks-Gunn J, Han WJ. Maternal employment and child development: a fresh look using newer methods. Dev Psychol 2005; 41:833.
  16. Zoritch B, Roberts I, Oakley A. Day care for pre-school children. Cochrane Database Syst Rev 2000; :CD000564.
  17. Lin YC, Chen MH, Hsieh CJ, Chen PC. Effect of rotating shift work on childbearing and birth weight: a study of women working in a semiconductor manufacturing factory. World J Pediatr 2011; 7:129.
  18. Bilhartz TD, Bilhartz P. Occupation as a risk factor for hypertensive disorders of pregnancy. J Womens Health (Larchmt) 2013; 22:188a.
  19. Nugteren JJ, Snijder CA, Hofman A, et al. Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study. PLoS One 2012; 7:e39263.
  20. Chang PJ, Chu LC, Hsieh WS, et al. Working hours and risk of gestational hypertension and pre-eclampsia. Occup Med (Lond) 2010; 60:66.
  21. Cardwell MS. Stress: pregnancy considerations. Obstet Gynecol Surv 2013; 68:119.
  22. Larsen AD, Hannerz H, Thulstrup AM, et al. Psychosocial job strain and risk of congenital malformations in offspring--a Danish National cohort study. BJOG 2014; 121:830.
  23. Thompson GN, Robertson EF, Fitzgerald S. Lead mobilization during pregnancy. Med J Aust 1985; 143:131.
  24. Gomaa A, Hu H, Bellinger D, et al. Maternal bone lead as an independent risk factor for fetal neurotoxicity: a prospective study. Pediatrics 2002; 110:110.
  25. United States Department of Labor Occupational Safety and Health Administration. Substance data sheet for occupational exposure to lead. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10031 (Accessed on October 12, 2016).
  26. United States Department of Labor Occupational Safety and Health Administration. Toxic and hazardous substances, hazard communication. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10099&p_table=STANDARDS (Accessed on October 12, 2016).
  27. http://www.epa.gov/hg/effects.htm (Accessed on May 12, 2014).
  28. http://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=115&tid=24 (Accessed on May 12, 2014).
  29. Laslo-Baker D, Barrera M, Knittel-Keren D, et al. Child neurodevelopmental outcome and maternal occupational exposure to solvents. Arch Pediatr Adolesc Med 2004; 158:956.
  30. Rouvet JF, Westall C, Koren G, Till C. Maternal occupational exposure to organic solvents during pregnancy and infant visual processing. University of Toronto, Workplace Safety and Insurance Board of Ontario, 2006.
  31. Taskinen H, Kyyrönen P, Hemminki K, et al. Laboratory work and pregnancy outcome. J Occup Med 1994; 36:311.
  32. Cordier S, Garlantézec R, Labat L, et al. Exposure during pregnancy to glycol ethers and chlorinated solvents and the risk of congenital malformations. Epidemiology 2012; 23:806.
  33. Mercury OSHA standards. US Department of Labor, Occupational Safety and Health Administration. Toxic and Hazardous Substances. Employee standard Summary 1910.
  34. National Institute for Occupational Safety and Health (NIOSH). Preventing occupational exposure to antineoplastic and other hazardous drugs in healthcare settings, 2004. https://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf (Accessed on October 12, 2016).
  35. Dranitsaris G, Johnston M, Poirier S, et al. Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature. J Oncol Pharm Pract 2005; 11:69.
  36. Quansah R, Jaakkola JJ. Occupational exposures and adverse pregnancy outcomes among nurses: a systematic review and meta-analysis. J Womens Health (Larchmt) 2010; 19:1851.
  37. United States Nuclear Regulatory Commission. Regulatory guide 8.13: Instruction concerning prenatal radiation exposure, 1999. http://www.nrc.gov/docs/ML0037/ML003739505.pdf (Accessed on October 12, 2016).
  38. Cawdell-Smith J, Upfold J, Edwards M, Smith M. Neural tube and other developmental anomalies in the guinea pig following maternal hyperthermia during early neural tube development. Teratog Carcinog Mutagen 1992; 12:1.
  39. Graham JM Jr, Edwards MJ, Edwards MJ. Teratogen update: gestational effects of maternal hyperthermia due to febrile illnesses and resultant patterns of defects in humans. Teratology 1998; 58:209.
  40. Graham JM, Edwards MJ, Lipson AH, Webster WS. Gestational hyperthermia as a cause for Moebius syndrome. Teratology 1988; 37:461.
  41. Edwards MJ. Review: Hyperthermia and fever during pregnancy. Birth Defects Res A Clin Mol Teratol 2006; 76:507.
  42. National Institute for Occupational Safety and Health. Criteria for a recommended standard: Occupational exposure to heat and hot environments, 2016. https://www.cdc.gov/niosh/docs/2016-106/pdfs/2016-106.pdf (Accessed on October 04, 2016).
  43. Kurppa K, Rantala K, Nurminen T, et al. Noise exposure during pregnancy and selected structural malformations in infants. Scand J Work Environ Health 1989; 15:111.
  44. Noise: a hazard for the fetus and newborn. American Academy of Pediatrics. Committee on Environmental Health. Pediatrics 1997; 100:724.
  45. www.Reprotox.org (Accessed on September 22, 2009).
  46. Lalande NM, Hétu R, Lambert J. Is occupational noise exposure during pregnancy a risk factor of damage to the auditory system of the fetus? Am J Ind Med 1986; 10:427.
  47. Daniel T, Laciak J. [Clinical observations and experiments concerning the condition of the cochleovestibular apparatus of subjects exposed to noise in fetal life]. Rev Laryngol Otol Rhinol (Bord) 1982; 103:313.
  48. Nurminen T, Kurppa K. Occupational noise exposure and course of pregnancy. Scand J Work Environ Health 1989; 15:117.
  49. Gerhardt KJ, Pierson LL, Huang X, et al. Effects of intense noise exposure on fetal sheep auditory brain stem response and inner ear histology. Ear Hear 1999; 20:21.
  50. Gerhardt KJ, Abrams RM. Fetal exposures to sound and vibroacoustic stimulation. J Perinatol 2000; 20:S21.
  51. ACGIH: 2003 TLVs and BEIs. Publication No. 103.
  52. Navy and Marine Corps Public Health Center Technical Manual NMCPHC-TM-OEM 6260.01C. Reproductive and developmental hazards: A guide for occupational health professionals. http://www.nmcphc.med.navy.mil/downloads/occmed/Repro2010d2.pdf (Accessed on April 12, 2011).
  53. Shaw GM. Adverse human reproductive outcomes and electromagnetic fields: a brief summary of the epidemiologic literature. Bioelectromagnetics 2001; Suppl 5:S5.
  54. Robert E. Intrauterine effects of electromagnetic fields--(low frequency, mid-frequency RF, and microwave): review of epidemiologic studies. Teratology 1999; 59:292.
  55. Blackmore-Prince C, Harlow SD, Gargiullo P, et al. Chemical hair treatments and adverse pregnancy outcome among Black women in central North Carolina. Am J Epidemiol 1999; 149:712.
  56. Burnett C, Goldenthal EI, Harris SB, et al. Teratology and percutaneous toxicity studies on hair dyes. J Toxicol Environ Health 1976; 1:1027.
  57. Holly EA, Bracci PM, Hong MK, et al. West Coast study of childhood brain tumours and maternal use of hair-colouring products. Paediatr Perinat Epidemiol 2002; 16:226.
  58. Gallicchio L, Miller S, Greene T, et al. Cosmetologists and reproductive outcomes. Obstet Gynecol 2009; 113:1018.
  59. Kersemaekers WM, Roeleveld N, Zielhuis GA. Reproductive disorders due to chemical exposure among hairdressers. Scand J Work Environ Health 1995; 21:325.
  60. Efird JT, Holly EA, Cordier S, et al. Beauty product-related exposures and childhood brain tumors in seven countries: results from the SEARCH International Brain Tumor Study. J Neurooncol 2005; 72:133.
  61. McCall EE, Olshan AF, Daniels JL. Maternal hair dye use and risk of neuroblastoma in offspring. Cancer Causes Control 2005; 16:743.
  62. Frazier LM. Reproductive disorders associated with pesticide exposure. J Agromedicine 2007; 12:27.
  63. Wigle DT, Turner MC, Krewski D. A systematic review and meta-analysis of childhood leukemia and parental occupational pesticide exposure. Environ Health Perspect 2009; 117:1505.
  64. https://www.eeoc.gov/eeoc/history/35th/thelaw/pregnancy_discrimination-1978.html (Accessed on October 12, 2016).
  65. The U.S. Equal Employment Opportunity Commission. Pregnancy Discrimination Charges_EEOC & FEPAs Combined: FY 1992 - FY 2005, January 2006.
  66. The United States Equal Employment Opportunity Commission. Pregnancy and discrimination charges. https://www.eeoc.gov/eeoc/statistics/enforcement/pregnancy.cfm (Accessed on October 12, 2016).
  67. https://www.fairwork.gov.au/ (Accessed on October 12, 2016).
  68. www.dol.gov/esa/whd/fmla/ (Accessed on March 22, 2006).
  69. O'Connell M. Maternity leave arrangements: 1961-85. In: Work and family patterns of American women, Government Printing Office, Washington DC 1991.