More than half of the children in the United States are born to working mothers. Federal law prohibits employers from excluding women from job categories on the basis that they are or might become pregnant. he Family and Medical Leave Act of 1993 requires that covered employers must grant up to 12 work weeks of unpaid leave to an employee for the birth and care of a newborn child Qackson, 2015). In the absence of complications, most women can continue to work until the onset of labor (American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, 2017).
Some types of work, however, may increase pregnancy complication risks. Mozurkewich and colleagues (2000) reviewed 29 studies that involved more than 160,000 pregnancies. With physically demanding work, women had 20-to 60-percent higher rates of preterm birth, fetal-growth restriction, or gestational hypertension. In a prospective study of more than 900 healthy nulliparas, women who worked had a ivefold risk of preeclampsia (Higgins, 2002). Newman and coworkers (2001) reported outcomes in more than 2900 women with singleton pregnancies. Occupational fatigue-estimated by the number of hours standing, intensity of physical and mental demands, and environmental stressors-was associated with an increased risk of preterm premature membrane rupture. For women reporting the highest degrees of fatigue, the risk was 7.4 percent.
Thus, any occupation that subjects the gravida to severe physical strain should be avoided. Ideally, no work or play is continued to the extent that undue fatigue develops. Adequate periods of rest should be provided. It seems prudent to advise women with prior pregnancy complications that commonly recur to minimize physical work.
In general, pregnant women do not need to limit exercise, provided they do not become excessively fatigued or risk injury (Davenport, 2016). Clapp and associates (2000) reported that both placental size and birthweight were signiicantly greater in women who exercised. Duncombe and coworkers (2006) reported similar findings in 148 women. In contrast, vfagann and colleagues (2002) prospectively analyzed exercise behavior in 750 healthy women and found that working women who exercised had smaller infants and more dysfunctional labors.
The American College of Obstetricians and Gynecologists (2017 g) advises a thorough clinical evaluation before recommending an exercise program. In the absence of contraindications listed in Table 9-6, pregnant women are encouraged to engage in regular, moderate-intensity physical activity for at least 150 minutes each week. Each activity should be reviewed individually for its potential risk. Examples of safe activities are walking, running, swimming, stationary cycling, and low-impact aerobics. However, they should refrain from activities with a high risk of falling or abdominal trauma. Similarly, scuba diving is avoided because the fetus is at increased risk for decompression sickness.
In the setting of certain pregnancy complications, it is wise to abstain from exercise and even limit physical activity. For example, some women with pregnancy-associated hypertensive disorders, preterm labor, placenta previa, or severe cardiac or pulmonary disease may gain from being sedentary. Also, those with multiple or suspected growth-restricted fetuses may be served by greater rest.