Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations

Abstract

Empirically based lifting criteria established by the National Institute for Occupational Safety and Health (NIOSH) to reduce the risk of overexertion injuries in the general US working population were evaluated for application to pregnant workers. This report proposes criteria to guide decisions by medical providers about permissible weights for lifting tasks performed at work over the course of an uncomplicated pregnancy. Our evaluation included an extensive review of the literature linking occupational lifting to maternal and fetal health. Although it has been 29 years since the American Medical Association's Council on Scientific Affairs published its report on the Effects of Pregnancy on Work Performance, these guidelines continue to influence clinical decisions and workplace policies. Provisional clinical guidelines derived from the NIOSH lifting criteria that account for recent evidence for maternal and fetal health are presented and aim to improve the standard of care for pregnant workers. Keywordslifting; occupational hazard; pregnancy; recommendations Clinicians play an important role in decisions concerning work activity restrictions during pregnancy. This role is underscored in the United States where federal regulations for occupational lifting are lacking and limited opportunities for paid antenatal leave are available. 1,2 Findings from a recent survey show that recommendations to pregnant workers in physically demanding jobs vary widely, possibly because of limited clinician training in occupational health 3 and the absence of current authoritative guidelines. 4 The views expressed herein are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health or the official policy or position of the Department of the Army, the Department of the Navy, the Department of Defense, or the United States Government.The authors report no conflict of interest.Reprints not available from the authors. HHS Public AccessAuthor manuscript Am J Obstet Gynecol. Author manuscript; available in PMC 2015 August 28. Author Manuscript Author Manuscript Author Manuscript Author ManuscriptTo address the need for updated empirically based recommendations that can be uniformly applied, this paper presents provisional clinical guidelines for occupational lifting in pregnancy based on an extensive review of the literature linking occupational lifting to maternal and fetal health and application of the National Institute for Occupational Safety and Health (NIOSH) lifting equation. Literature review criteriaAn extensive review of the literature linking occupational lifting to maternal and fetal health was conducted to inform the application of the NIOSH lifting equation to pregnant workers. Using the PubMed MESH Thesaurus terms, pregnancy, lifting, occupational diseases, preeclampsia, hypertension, pregnancy complications, pelvis, sacroiliac joint, pubic symphysis, range of motion articular, joint instability, relaxin, estradiol, biomechanics, stress mechanic...

Estudio Piloto: Descripción de la Carga Global de Trabajo, el Factor Físico-Biomecánico y Percepción de Molestias Músculo-Esqueléticas en Trabajadoras Embarazadas

“…Respecto al punto anterior, distintas publicaciones han establecido la necesidad de realizar intervenciones en los puestos de trabajo de embarazadas. [7][8][9][10] Los principales ejes a intervenir son: a) La presencia de factores de riesgo de Trastornos Músculo-Esqueléticos Relacionados con el Trabajo [11][12][13][14][15] ; b) Disminuir los factores de riesgo ergonómicos presentes en puestos de trabajo de embarazadas 16,17 ; c) Disminuir la carga cognitiva de los puestos y jornadas de trabajo [18][19][20][21] ; d) Controlar los factores psicosociales 21 , entre otros. Esto es sustantivo con la existencia de distintos estudios sobre intervenciones que han demostrado tener impacto en la sobrecarga física y mental de la mujer en sus puestos de trabajo.…”

“…Esto es sustantivo con la existencia de distintos estudios sobre intervenciones que han demostrado tener impacto en la sobrecarga física y mental de la mujer en sus puestos de trabajo. [7][8][9][10][21][22][23][24] El desarrollo de una identificación de los factores de riesgo de la salud y calidad de vida de embarazadas permite reducir una sobrecarga de la mujer, poniendo en riesgo su desarrollo tanto laboral como en su embarazo. [25][26][27][28] Por lo anterior, es necesario contextualizar desde el punto de vista del factor físico-biomecánico a que se encuentran sometidas las trabajadoras embarazadas, a través de la descripción de los mismos, determinar las dimensiones de la carga global de trabajo, presencia de factores físico-ergonómicos y la percepción de molestias músculo-esqueléticas de trabajadoras en situación de embarazo, que puedan servir de base para determinar recomendaciones iniciales que ayuden en el autocuidado de las embarazadas.…”

A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial (Preprint)

“…In this component, midwives will deliver health education based on the clinical guidelines for occupational lifting in pregnancy by MacDonald et al [24]. Topics for the education will include possible implications of heavy lifting during pregnancy, avoid lifting any object that weighs more Receive routine antenatal care…”

“…Besides, there are several occupational guidelines formulated by various institutions [19,23] aimed at protecting pregnant employees against physical stress in their respective countries. More recent are the provisional clinical guidelines for occupational lifting in pregnancy by MacDonald et al [24] but none of such guidelines exist in Ghana and other LMICs. Moreover, a recent systematic review revealed that no trial has investigated the usefulness of such guidelines aimed at reducing heavy lifting among pregnant women to increase gestational age [22].…”

“…Moreover, a recent systematic review revealed that no trial has investigated the usefulness of such guidelines aimed at reducing heavy lifting among pregnant women to increase gestational age [22]. The 3-component lift-less intervention (LLI) consisting of clinical guidelines of occupational lifting in pregnancy by MacDonald et al [24] coupled with a shopping voucher will be implemented. The rationale for the shopping voucher is to augment uptake of the other intervention components [25,26] and to be administered during the third trimester with intention to reduce moderate preterm birth which is common in Sub-Saharan Africa [2].…”