Pregnant Women Often Take Unrelated Sick Leave

Emma Hitt, PhD

November 08, 2012

About three fourths of women take sick leave during pregnancy, according to a new study conducted in Norway. The reasons, which are often not related to pregnancy, include chronic pain before pregnancy, pelvic back pain, and insomnia.

Signe K. Dørheim, MD, PhD, from the MoodNet Research Group, Division of Psychiatry, Stavanger University Hospital in Norway, and colleagues report their findings in an article published online November 7 in BJOG.

According to the researchers, social welfare benefits vary greatly from country to country. In Norway, workers can receive fully paid sick leave for up to 52 weeks if a medical condition demands it.

Interestingly, one analysis found that countries compensating 80% of wages, such as Sweden and Slovakia, had a higher prevalence of sick leave compared with countries refunding 100% of salary, such as Austria, France, and Germany. In contrast, countries with little or no compensation for sick leave, such as the United States and the United Kingdom, had fewer days absent from work.

"Sick leave patterns may therefore be linked to sick leave entitlements in each country, but they are not fully explained by this," the authors note.

Also of note, the authors write, a Norwegian "employer is responsible for adjusting the work situation so that pregnant women may stay at work throughout their pregnancy, as pregnancy is in itself not a medical disorder. To obtain sick leave in Norway, a medical certificate from a doctor is needed, documenting that the reduced ability to work is due to sickness."

To evaluate sick leave patterns further, Dr. Dørheim and colleagues evaluated data from the Akershus Birth Cohort study, a population-based questionnaire study "with the aim of examining fear of childbirth, depression and insomnia during pregnancy."

A total of 2918 women scheduled to give birth at the Akershus University Hospital in Norway over the course of 18 months (from November 2008 to April 2010) responded to a questionnaire given at week 17 and week 32 of pregnancy. Of those women, 2197 (75.3%) reported that they had taken sick leave at some point during their pregnancy.

The median length of time taken for sick leave was 8 weeks and ranged from 1 to 50 weeks. Most needed from 4 to 16 weeks of leave.

Factors associated with sick leave varied according to trimester of pregnancy: More women required time off as time went on, and by 32 weeks of gestation, 63.2% of the women were on sick leave.

Fatigue/sleep problems and pelvic girdle pain were the 2 main reasons that pregnant women in Norway took sick leave (34.7% and 31.8%, respectively; each P < .001). Pregnant women were also more likely to take sick leave if they experienced hyperemesis, exercised less than once a week, had chronic pain before or during pregnancy, or had received infertility treatment (all P < .001).

In addition, younger age, workplace conflicts (both P < .01), a pregnancy with twins or more, previous depression, insomnia, and lower education (all P < .05) were linked to a higher likelihood of sick leave.

Women taking sick leave also had a higher chance of undergoing elective caesarean section and having a higher infant birthweight (P < .01).

Only 2.1% of women stated that anxiety and/or depression were the reasons for their sick leave, but the women who did state this as the reason took the longest amount of sick leave (median, 20 weeks).

Adjustments Keep Pregnant Women Working

The study also evaluated work adjustments made by the employer for pregnant women and found that 60.1% of all of the pregnant women reported having adjustments made to their working situation. On average, these women reported taking an average of 1 week less sick leave than those who went without job adjustments.

"While past medical history and socioeconomic conditions can influence the occurrence and length of time taken off as sick leave, women's working situations during pregnancy were significant contributors to our findings," Dr. Dørheim stated in a journal news release.

"Women who suffer from work-related fatigue, such as insomnia, are likely to require more time off, especially during late pregnancy," she added.

"Further studies are needed to evaluate whether treatment of [sleep disturbances, pain, hyperemesis, lack of exercise, etc], both by the health services and by work adjustment may lead to less sick leave and better quality of life among pregnant women.," Dr. Dørheim and colleagues conclude.

John M. Thorp, MD, the BJOG deputy-editor-in-chief and interim director of the University of North Carolina Center for Women's Health Research in Chapel Hill, noted in the news release that although "[p]regnancy is a normal physiological can affect women in different ways." He further states that "this study was conducted in Norway, where sick leave entitlements allow workers to receive very good compensation for time taken due to illness.... [T]his may impact the findings."

"However," Dr. Thorp continues, "the factors that affect pregnant women in the workplace are universal and this study shows a clear link between working conditions and the duration of sick leave, which highlights the potential benefits for employers to have a support system in place."

The study was funded by the Norwegian Research Council. The authors have disclosed no relevant financial relationships. Dr. Thorp has received consulting fees and honoraria from Adeza Biomedical, PPD Pharmaceuticals, and GlaxoSmithKline.

BJOG. Published online November 7, 2012. Abstract