Working conditions in low risk nulliparous women in The Netherlands: are legislation and guidelines a guarantee for a healthy working environment? A cohort study.

OBJECTIVE: Hazardous working conditions increase the risk of adverse pregnancy outcomes. In this study, we examine adherence to legislation and guidelines aimed at improving working conditions in pregnancy. METHODS: Between 2014 and 2016, we recruited a prospective cohort of low-risk nulliparous pregnant women in paid employment or self-employed in 16 community midwifery practices in The Netherlands. Participants completed two questionnaires concerning demographics, education, general health and working conditions between 10-16 and 20-24 weeks of pregnancy. We calculated the proportion of participants with work-related risk factors not in accordance with legislation and/or guidelines. RESULTS: Of 269 participants included, 214 (80%) completed both questionnaires. At 10-16 weeks 110 (41%) participants and at 20-24 weeks 129 (63%) participants continued to work under circumstances that did not meet recommendations. Employers provided mandated information on work adjustment to 37 (15%) participants and 96 (38%) participants received no information about the potential hazards while working with biological and chemical hazards. Participants with lower educational attainment (aOR 2.2 95%CI 1.3-3.9), or employment in healthcare (aOR 4.5, 95%CI 2.2-9.0), education/childcare and social service (aOR 2.6, 95%CI 1.1-6.0 2),, catering (aOR 3.6, 95%CI 1.1-12) and industry, construction and cleaning (aOR 3.3, 95%CI 1.1-10.3) more often continued work which did not meet recommendations. CONCLUSION: There is poor adherence to national legislation and guidelines for safe working in pregnancy in The Netherlands: 50% of the pregnant women worked under hazardous conditions. Given the impact on adverse pregnancy outcomes as well as on the public purse, action to improve compliance must be taken by all stakeholders.

Evaluation of a blended care programme for caregivers and working pregnant women to prevent adverse pregnancy outcomes: an intervention study.

OBJECTIVE: Work-related activities can be a risk factor for pregnancy complications such as preterm birth. This study evaluates the effectiveness of a blended care programme, Pregnancy and Work, that provides pregnant workers and their obstetrical caregivers with advice on work adjustment. METHODS: Women less than 20 weeks of gestation, in paid employment or self-employed, in the care of four participating hospitals and their referring midwifery practices in the Netherlands received either the blended care programme (n=119), consisting of a training for professionals and a mobile health application, or care as usual (n=122) in a controlled intervention study with a follow-up in intervention and control populations. All participants completed three questionnaires concerning health and working conditions at 16, 24 and 32 weeks of pregnancy. Primary outcome was the percentage of women who received advice from their obstetrical caregiver about work adjustment. Secondary outcomes were work status, realised work adjustment and working conditions. Groups were compared using univariate and multivariate regression analyses. RESULTS: A total of 188 (78%) completed all three questionnaires. In the blended care group, women received more advice from obstetrical caregivers to adjust their work than in the control group, 41 (39%) vs 21 (18%) (adjusted relative risk (aRR) 2.2, 95% CI 1.4 to 3.4), but less from their employer 8 (8%) vs 31 (28%) (aRR 0.29, 95% CI 0.14 to 0.61). There were no significant differences in realised work adjustments. At 24 weeks, 30% of the pregnant women in both groups continued to work in hazardous workplaces. CONCLUSION: Among working pregnant women, the blended care intervention increases advice on work adjustment given by midwives and obstetricians, but does not lead to more work adjustments.

First trimester employment, working conditions and preterm birth: a prospective population-based cohort study.

OBJECTIVES: To explore the association between working conditions during first trimester and total preterm birth (PTB), and subtypes: spontaneous PTB and iatrogenic PTB, additionally to explore the role of hypertension. METHODS: Pregnant women from the Amsterdam Born Children and their Development study, filled out a questionnaire between January 2003 and March 2004, two weeks after first prenatal screening (singleton liveborn, n=7561). Working conditions were working hours/week, standing/walking hours/week, physical work load and job strain. RESULTS: Prolonged standing/walking during first trimester was associated with an increased risk for total PTB (OR=1.5; 95% CI 1.0-2.3, after adjustments). Other working conditions were not related to total PTB. The separation into spontaneous and iatrogenic PTB revealed that standing/walking was associated with iatrogenic PTB only (OR=2.09; 95% CI 1.00-4.97). The highest risk was found for the combination of a long workweek with high physical work load (OR=3.42; 95% CI 1.04-8.21). Hypertension did not mediate these associations; however, stratified analysis revealed that high physical work load was only related to iatrogenic PTB when pregnancy-induced hypertension was present (OR=6.44; 95% CI 1.21-29.76). CONCLUSION: This study provides evidence that high physically demanding work is associated with an increased risk for iatrogenic PTB and not with spontaneous PTB. Pregnancy-induced hypertension may play a role: when present, high physical work load leads to a more severe outcome.

Health risk assessment of exposure to TriCresyl Phosphates (TCPs) in aircraft: a commentary.

Possible exposure to TriCresyl Phosphates (TCPs) has led to concerns among airline crew members. One isomer, Tri-ortho-Cresyl Phosphate (ToCP) is known to be neurotoxic and exposure to ToCP via contaminated cabin air has been suggested to be associated with the alleged Aerotoxic syndrome. The symptoms associated with Aerotoxic syndrome are diverse, including headaches, loss of balance, numbness and neurobehavioral abnormalities such as emotional instability, depression and cognitive dysfunction. Other ortho-isomers are toxic as well, but the non-ortho isomers are regarded as less toxic. In a collaborative effort to increase insight into the possible association between exposure to TCPs via contaminated cabin air and Aerotoxic syndrome, we performed an exposure- and toxicological risk assessment. Measurements in KLM 737 aircraft have demonstrated the presence of non-ortho isomers in low concentrations, though ToCP and other ortho-isomers could not be detected. Based on this exposure assessment, we established a toxicological risk model that also takes into account human differences in bioactivation and detoxification to derive a hazard quotient. From this model it appears unlikely that the health effects and alleged Aerotoxic syndrome are due to exposure to ToCP. Alternative explanations for the reported symptoms are discussed, but evaluation of the current findings in light of the criteria for occupational disease leads to the conclusion that the Aerotoxic Syndrome cannot be regarded as such. Additional research is thus required to unravel the underlying causes for the reported health complaints.

[Every physician should know how to take an occupational history: the importance of teaching occupational medicine in medical school]. / Iedere arts moet arbeidsanamnese uitvragen: belang van 'arbeid en gezondheid' in de medische opleiding.

Working and participating in society are important for one's health and wellbeing. This also works the other way around: in order to work or participate, one has to be healthy. Every doctor should learn about this reciprocal relationship during their medical training. In a survey undertaken by the Netherlands Society of Occupational Medicine, the amount of time spent on occupational medicine in the curriculum of eight Dutch medical faculties was examined. The study showed vast differences between faculties in the amount of time spent on occupational medicine, in the learning methods employed and also in the number of students who participate in internships. The situation in the Netherlands compares favourably with that in other European countries. Sufficient specific attention to subjects related to health and work during undergraduate education is important for all doctors and a prerequisite to increase the number of medical students who subsequently choose a career in occupational health medicine.

Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study.

OBJECTIVES: Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different trimesters during pregnancy and the risks of adverse birth outcomes. METHODS: Associations between physically demanding work and fetal growth were studied in 4680 pregnant women participating in a population-based prospective cohort study from early pregnancy onwards in The Netherlands (2002-2006). Mothers who filled out a questionnaire during mid-pregnancy (response 77% of enrolment) were included if they conducted paid employment and had a spontaneously conceived singleton live born pregnancy. Questions on physical workload were obtained from the Dutch Musculoskeletal Questionnaire and concerned questions on lifting, long periods of standing or walking, night shifts and working hours. Fetal growth characteristics were repeatedly measured by ultrasound and were used in combination with measurements at birth. RESULTS: There were no consistent significant associations between physically demanding work nor working hours in relation to small for gestational age, low birth weight or preterm delivery. Women exposed to long periods of standing had lower growth rates for fetal head circumference (HC), resulting in a reduction of approximately 1 cm (3%) of the average HC at birth. Compared with women working <25 h/week, women working 25-39 h/week and >40 h/week had lower growth rates for both fetal weight and HC, resulting in a difference of approximately 1 cm in HC at birth and a difference of 148-198 g in birth weight. CONCLUSION: Long periods of standing and long working hours per week during pregnancy seem to negatively influence intrauterine growth.

[Preconceptual care should include looking at the effect of working conditions on pregnancy]. / Effecten van arbeidsomstandigheden op de zwangerschap verdienen aandacht binnen de preconceptiezorg.

Working conditions are amongst the exogenous factors that can lead to pregnancy complications. Attention within preconceptual care to the working conditions experienced by women who plan to become pregnant can change this, by influencing exposure to harmful working conditions. Until now, relatively little attention has been given to working conditions within preconceptual care, and the subject is often not discussed in daily midwifery practice. The most relevant literature on this topic is summarized in this article. Occupational exposure to certain chemicals, stressful work and nightshifts during early pregnancy increase the risk of spontaneous abortion. There is also an increased risk of congenital malformations if the mother has been exposed to solvents or pesticides during early pregnancy, or the father has been exposed to these substances before or shortly after conception. We conclude that the occupational physician should be involved in the preconceptual consultation in order to contribute to the prevention of pregnancy complications.