Sick leave during pregnancy and occupational factors: a systematic review.

BACKGROUND: The reported prevalence of sick leave (SL) during pregnancy is high among European pregnant workers (PW). The causes of SL during pregnancy are complex, and further research is necessary to explain their occurrence. AIMS: Summarize the evidence for an association between occupational risks for pregnancy and SL. METHODS: A systematic review was conducted by two independent reviewers using PRISMA guidelines. Two databases (Pubmed, Embase) were interrogated between January 1990 and November 2021. The search question integrated key terms according to the PICOS acronym (free terms, MeSH, EMTREE). The quality of the selected studies was assessed according to the Methodological Index for Non-randomized Studies score. RESULTS: This review assessed 11 epidemiological studies. Overall, the mean Methodological Index for Non-Randomized Studies score was 11, indicating moderate study quality. The results of the limited number of studies showed limited evidence for associations between psychosocial and physical work-related risk factors and the occurrence of SL among PW. However, this assessment was strengthened by the observation in several studies of a dose-response relationship between the number of occupational risks during pregnancy and SL. CONCLUSIONS: The analysis of this review implicates PW'S exposure to occupational risks in the occurrence of SL. However, the few studies that support this conclusion have provided weak evidence; thus, further research is necessary.

[Occupational risks during pregnancy: Feedback from occupational medical services]. / Exposition aux risques professionnels pendant la grossesse : retour de services médicaux interentreprises.

OBJECTIVES: To describe the follow-up of pregnancies at work and exposures to pregnancy occupational hazards. METHODS: A cross-sectional study was performed between January and December 2014 in occupational health services of Languedoc-Roussillon region. Eligible workers were interviewed by occupational health physicians (OHPs) after delivery and at the time of returning to work (exposure, anticipation, prevention, communication, sick leave). Occupational skill levels were classified according to the French standard classification of occupations (version 2003) from the French National Institute of Statistics. Socioeconomic deprivation was assessed using the Evaluation of Deprivation and Inequalities in Health Examination (EPICES) individual scale. RESULTS: A total of 1347 workers were recruited. The mean age was at 30.7±4.5 years. Among pregnant workers, there were 54.2% of employees, 30.7% of intermediate occupations, 10.4% of managers and, 4.7% of manual workers. Twenty-two percent of workers were classed as deprived. Also, 43.2% of workers were exposed to three or more occupational hazards during pregnancy. Only 17.7% of workers had medical visits with OHP during pregnancy and 14.7% benefited from workstation adjustments. In contrast, the level of sick leaves was high (74.2%). CONCLUSION: Our results argue for the need to follow pregnancies at work. However, the low level of prevention activities and the high level of sick leaves raise the question of the management of pregnant women at work.

Deprivation, occupational hazards and perinatal outcomes in pregnant workers.

BACKGROUND: Recent global economic difficulties have widened social inequalities, but their impact on pregnant workers is not known. AIMS: To investigate the association between deprivation, exposure to occupational hazards and adverse perinatal outcomes in pregnant workers. METHODS: A cross-sectional study performed in 2014 in French occupational health services. Eligible workers were women who had worked during their pregnancy and had a medical visit by occupational health physicians (OHPs) after delivery and at the time of returning to work. Deprivation was measured using the EPICES scale (Evaluation of Precariousness and Inequalities in Health Examination Centres). Information on birth outcomes was self-reported. Occupational risks for pregnancy were assessed by OHPs. Jobs were coded by the occupational health team using standardized French nomenclature. The groups (deprivation/no deprivation) were compared using univariate (chi-squared test) and multivariate Poisson regression analyses. RESULTS: Of 1402 pregnant workers, 293 (21%) were classed as deprived. This group more frequently encountered occupational hazards, particularly for physical exposures (P < 0.001), and had a higher risk of cumulated occupational hazards of three or more for pregnancy [adjusted relative risk (RRa) = 4.2; 95% confidence interval (CI) 2.2-7.9]. Our findings suggest that deprivation and exposure to three or more occupational hazards during pregnancy cumulatively increased the risk of pre-term birth (RRa = 3.9; 95% CI 1.2-12.4). CONCLUSIONS: Our data suggest that deprived pregnant workers are an occupationally vulnerable group.

Short-term effects of ozone air pollution on ischaemic stroke occurrence: a case-crossover analysis from a 10-year population-based study in Dijon, France.

OBJECTIVE: To evaluate the association between air pollutants and the occurrence of acute stroke from 10-year population-based study. METHODS: The daily stroke count was obtained from Dijon Stroke Register between March 1994 and December 2004. The register recorded all first-ever strokes among residents of Dijon (150,000 inhabitants) in France, using standard diagnostic criteria. Pollutant concentrations (SO2, CO, NO2, O3 and PM10) were measured hourly. A bi-directional case-crossover design was used to examine the association between air pollutant and stroke onset. The conditional logistic regression model included the meteorological parameters (temperature, relative humidity), influenza epidemics and holidays. RESULTS: The authors collected 493 large artery infarcts, 397 small artery infarcts, 530 cardio-embolic infarcts, 67 undeterminate infarcts, 371 transient ischaemic attacks and 220 haemorrhagic strokes. For single-pollutant model and for a 10 mg/m(3) increase of O3 exposure, a positive association was observed only in men, over 40 years of age, between ischaemic stroke occurrence and O3 levels with 1-day lag, (OR 1.133, 95% CI 1.052 to 1.220) and 0-day lag (OR 1.058, 95% CI 0.987 to 1.134). No significant associations were found for haemorrhagic stroke. In two-pollutant models, the effects of O3 remained significant after each of the other pollutants were included in the model, in particular with PM10. A significant association was observed for ischaemic strokes of large arteries (p = 0.02) and for transient ischaemic attacks (p = 0.01). Moreover, the authors found an exposure-response relations between O3 exposure and ischaemic stroke (test for trend, p = 0.01). An increase in association in men with several cardiovascular risk factors (smoker, dyslipidemia and hypertension) was also observed. CONCLUSION: These observational data argue for an association between ischaemic stroke occurrence and O3 pollution levels; these results still need to be confirmed by other studies.