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Guideline Summary
Guideline Title
Physical and shift work in pregnancy: occupational aspects of management. A national guideline.
Bibliographic Source(s)
NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine. Physical and shift work in pregnancy: occupational aspects of management. A national guideline. London (UK): Royal College of Physicians (RCP); 2009. 94 p. [173 references]
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)

Pregnancy

Guideline Category
Counseling
Management
Prevention
Risk Assessment
Clinical Specialty
Family Practice
Obstetrics and Gynecology
Preventive Medicine
Intended Users
Advanced Practice Nurses
Health Care Providers
Nurses
Other
Physician Assistants
Public Health Departments
Utilization Management
Guideline Objective(s)

To provide evidence-based advice for health professionals advising pregnant women and employers with respect to identifiable hazards in the workplace. The scope of the document comprises the following specific hazards:

  • Manual handling/lifting/heavy physical work
  • Prolonged standing
  • Long weekly working hours (typically >40 per week)
  • Shift work including night work
Target Population
  • Pregnant women at work
  • Employers of pregnant workers

Note: The evidence considered in this guideline applies to women who are well during their pregnancy; those with pregnancy-related complications need to be considered on an individual basis.

Interventions and Practices Considered
  1. Informing pregnant workers that heavy physical work, lifting, prolonged standing, and long working hours carry a small to moderate risk of low birthweight, intra-uterine growth restriction (IUGR), and preterm birth
  2. Reducing very heavy physical activities and lifting
  3. Reducing prolonged standing or providing alternative work
  4. Reducing long working hours

Note: The following interventions were considered but not recommended due to insufficient evidence: restricting shift work and using a fatigue score.

Major Outcomes Considered
  • Adverse fetal outcomes (fetal morbidity)
    • Spontaneous miscarriage
    • Low birth weight
    • Intra-uterine growth retardation/small for gestational age (IUGR/SGA)
    • Preterm birth
    • Stillbirth
  • Adverse maternal outcomes (maternal morbidity)
    • Gestational hypertension/pre-eclampsia
    • Preterm delivery to include threatened preterm labour and preterm prelabour rupture of membranes
  • Sickness absence

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Literature Search

To form the evidence base, a systematic literature search was undertaken. The terms in the key questions were used as the basis of the literature search.

The search terms and the databases to be searched were defined in collaboration with a Department of Health (DH) librarian. An initial search was carried out in 2004. A repeat search was undertaken the following year (2005) by another librarian to update the evidence base. In addition, the Guideline Development Group (GDG) was made aware of a high quality meta-analysis that had been submitted for publication in 2006 (published 2007) which it was decided should be included in the evidence base. The terms were searched as both text and Medical Subject Headings terms (MeSH)®, www.nlm.nih.gov External Web Site Policy). The numbered list was searched with all the other terms/phrases in the subsequent list. (See Appendix 1 in the original guideline document for complete search strategy.)

Databases and Journals Searched

  • BNI
  • CINAHL
  • Cochrane Library
  • Embase
  • Evidence Based Periodicals Database (BMJ)
  • Health Periodicals Database
  • HSE Line
  • Medline
  • New England Journal of Medicine
  • PsycINFO
  • Scisearch

A comprehensive evidence-based policy on the management of expectant women from John Lewis Partnership was hand searched. Other papers identified from this search were included if relevant. The following sources were searched for grey literature:

  1. Royal Free Hampstead National Health Service (NHS) Trust Research and Development database
  2. Faculty of Occupational Medicine Database of Membership of the Faculty of Occupational Medicine (MFOM) dissertations
  3. Institute of Occupational Safety and Health (IOSH) website
  4. Specifically searching for articles authored by Linda Tapp (manual handling and ergonomics expert as advised by the GDG)
  5. General enquiries made to other colleagues

Inclusion Criteria

  • 1980–2006 (a high quality meta-analysis that had been submitted for publication in 2006 was included in the evidence base for the guideline)
  • Observational studies, intervention studies and literature reviews
  • Human only
  • Randomised controlled trials (RCTs), case-control studies, longitudinal studies, meta-analyses, review articles

Exclusion Criteria

  • Does not answer key questions
  • Multiple pregnancies
  • Data collected prior to 1980
  • History of chronic illness
  • Women not employed during pregnancy

Following the literature searches, 270 abstracts were found to be relevant to the key questions and fitted the above inclusion criteria. All of the abstracts were read by two GDG members to reduce bias in literature collection and to ensure consistency in selection of the papers for full appraisal. Having identified papers relevant to the key questions, all were read by the GDG Leader to determine whether they should be included as part of the critical appraisal. Papers that were not considered to be relevant to the key questions were excluded, and the remainder were critically appraised. Although some papers were not included as evidence, they still contained some useful/interesting material, and have therefore been included in the introduction.

One paper was included as evidence, even though data was collected prior to 1980, because it was referenced in a number of credible papers and also formed the basis of subsequent research by others. The consensus opinion of the GDG was that in order to help understand the evidence in subsequent papers using the same methodology, this paper should be appraised and included as evidence. It is recognised that the inclusion of this paper may introduce some selection bias, however as there is an extensive body of papers involved in the review the GDG considered that the inclusion of this paper would not importantly affect the overall conclusions of the literature review.

Foreign language articles were included in the initial literature search; however these were excluded prior to the critical appraisal stage due to the variety of languages, resource and time limitations for translation.

Due to the nature of the key questions that were being considered, no randomised controlled trials were identified. This is not uncommon in the literature relating to occupational hazards, most of which comprises observational studies. The majority of papers identified in this literature search were case-control or cohort studies. One meta-analysis was identified, but this was excluded after critical appraisal. One systematic review, which has been included, also includes a meta-analysis of some of the exposure-outcome combinations. The majority of review articles that were identified did not follow systematic methodology, and therefore could not be included as evidence. However, relevant references cited in these narrative reviews were retrieved and appraised accordingly.

The number of excluded papers and reasons for exclusion are shown in Table 2 in the original guideline document.

Number of Source Documents
  • Final number of papers after reference checklists (n=150)
  • Papers meeting critical appraisal criteria for inclusion in evidence base (n=37)
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Levels of Evidence

1++ High-quality meta-analyses, systematic reviews of randomised controlled trials (RCTs) or RCTs with a very low risk of bias

1+ Well-conducted meta-analyses, systematic reviews of RCTs or RCTs with a low risk of bias

1- Meta-analyses, systematic reviews of RCTs or RCTs with a high risk of bias

2++ High-quality systematic reviews of case-control or cohort studies;
High-quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal

2+ Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal

2- Case control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal

3 Non-analytic studies, e.g., case reports, case series

4 Expert opinion

Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Critical Appraisal

Each included paper was critically appraised using a standard form (see Appendix 2 in the original guideline document). Each paper was appraised independently by two committee members, who then discussed the paper and agreed upon a final grade. A total of eight people were involved, to varying degrees, in appraising the evidence. All appraisers received training on critical appraisal techniques. The Guideline Development Group (GDG) leader reviewed the papers that were appraised by other GDG members, to ensure consistency and accuracy.

Assessing the Evidence

Various methods for assessing and grading the evidence in papers have been published. These include grading methods produced by:

  • The Health Evidence Network
  • Human Fertilisation and Embryology Authority (HFEA) executive
  • Scottish Intercollegiate Guidelines Network (SIGN)
  • US Government Agency
  • National Health Service (NHS) Research and Development Centre

All describe similar methods of grading papers based upon the type of paper, e.g., randomised controlled trial (RCT)/meta-analysis, and the quality of the study. The SIGN methodology was used to assess the evidence for this guideline, primarily because it is suitable for use when appraisal will be carried out by members of the GDG (rather than a dedicated academic team). All GDG members who participated in critical appraisal received standard training in critical appraisal techniques. The SIGN grading system is reproduced in the "Rating Scheme for the Strength of the Evidence and "Rating Scheme for the Strength of the Recommendations" fields.

One of the concerns about the SIGN methodology is the relative lack of transparency of the simple quality scoring system, which does not state in detail the rules for assessment of major methodological issues such as bias and confounding. Therefore, in addition to the SIGN rating, a scoring system was devised for use in assessing the evidence for this guideline. The purpose of this system was to demonstrate more clearly the consistent application of the SIGN quality rating. This additional scoring system was applied to all of the papers that were included as evidence. The detailed scoring tables can be found in Appendix 5 of the original guideline document.

Synthesis of the Evidence and Recommendations

In making recommendations for each of the exposures of interest, a number of factors were taken into account. The quality and consistency of the evidence for similar exposures and outcomes were considered. High quality studies and large studies (high number of pregnancies observed) were given more weight than lower quality or smaller investigations. Statistical significance was not considered in isolation; the magnitude of the associations (size of the risk estimates) and the likely clinical importance influenced the synthesis of evidence strongly. The GDG was cautious not to give too much weight to risk estimates that were rather close to unity (1.3 or less), as it is recognised that associations of this order in observational studies are often due to unrecognised bias or confounding.

In deciding how to approach the uncertainties in the evidence base, the GDG took into account the fact that many of the exposures of interest (for example lifting) are common in the normal daily life of mothers, particularly if they already have young children at home. It would be inappropriate to alarm women about normal everyday activities unless the evidence of harm is compelling. Moreover, it is possible that remaining active during pregnancy, even if it involves, for example, prolonged standing or lifting, may actually be beneficial. Clearly a high level of certainty is required before recommendations are made to exclude pregnant women from activities if these restrictions might actually be bad for health.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

In order to define which hazards and outcomes would be addressed, key questions were formulated by the Guideline Development Group (GDG) Leader. After discussion amongst GDG members, a list of possible adverse outcomes was considered. By consensus, a number of outcomes including caesarean section, instrumental delivery, psychological symptoms and stress were omitted. An initial literature search was undertaken to assess the potential volume of available literature for the remaining questions and outcomes of interest. Following this scoping search, the list of questions was revised and agreed by the GDG. The final key questions were as follows:

  1. What is the effect on mother and fetus of manual handling and prolonged standing?
  2. What is the effect on mother and fetus of the mother working more than eight hours on a shift, more than 37 hours a week, or shift work (to include any shift pattern)?
  3. What is the effect on mother and fetus of the mother working might shifts?

For each of these hazards, the evidence base was assessed to explore the level of risk for each adverse pregnancy outcome. The volume, strength and consistency of the evidence was considered with a view to suggesting recommendations for appropriate adjustments in the workplace.

The GDG agreed upon standard definitions for maternal and fetal outcomes using standard texts, and sought the opinion of the obstetric consultant on the GDG if any definitions were unclear.

Draft recommendations were produced by the GDG Leader and then circulated to the GDG members for comments and feedback.

Rating Scheme for the Strength of the Recommendations

Grading System for Recommendations

A At least one meta-analysis, systematic review or randomised controlled trial (RCT) rated as 1++, and directly applicable to the target population; or
A systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results.

B A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 1++ or 1+

C A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 2++

D Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+

Good Practice Points (GPPs)

GPPs are practical points that the Guideline Development Group (GDG) wishes to emphasise but for which there is not, nor is there likely to be, any research evidence – for example, some aspect of management or treatment that is regarded as such sound clinical practice that nobody is likely to question it. These are not alternatives to evidence-based recommendations, and are only used where there is no other way of highlighting the issue.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

Draft recommendations were produced by the Guideline Development Group (GDG) Leader and then circulated to the GDG members for comments and feedback. The draft guideline document was reviewed by three external assessors and the steering group of the Occupational Health Clinical Effectiveness Unit (OHCEU), and revised in response to their comments.

Recommendations

Major Recommendations

Definitions for the level of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4), grade of recommendation (A-D), and good practice points (GPP) are presented at the end of the "Major Recommendations" field.

Manual Handling, Lifting, Heavy Physical Work

Heavy Physical Effort

Recommendation Risk Grade Evidence
Pregnant workers should be informed that evidence suggests that heavy physical work carries no more than a moderate risk of low birth weight/intra-uterine growth restriction (IUGR)/small for gestational age (SGA), but there is only limited and inconsistent evidence of risk for preterm birth and pre-eclampsia.

Employers should reduce very heavy physical activities for pregnant workers where possible, particularly in late pregnancy. However, if a pregnant worker who has been informed of the possible risks wishes to continue then there are insufficient grounds upon which to impose restrictions against her will.
Large body of evidence with some conflicting findings, but reasonably consistent estimates of risk that tend to rule out more than a moderate risk of low birth weight/IUGR/SGA. B Spinillo et al., 1996; Saurel-Cubizolles & Kaminski, 1987; Lima et al., 1999; Bonzini, Coggon, & Palmer, 2007
Large body of studies, but inconsistent findings in relation to risk of preterm delivery. Koemeester, Broersen, & Treffers, 1995; McDonald et al., "Fetal death," 1988; Saurel-Cubizolles, Subtil, & Kaminski, 1991; Ritsmitchai, Geater, & Chonsuviwatvong, 1997; Bonzini, Coggon, & Palmer, 2007
Limited number of studies and inconsistent evidence of risk of pre-eclampsia or pregnancy-induced hypertension. Bonzini, Coggon, & Palmer, 2007

The exposure measures for heavy physical work are too heterogeneous to inform a recommendation specifying a level of physical work at which adjustments to work should be implemented.

Lifting

Recommendation Risk Grade Evidence
Pregnant employees should be informed about the generally consistent evidence suggesting that lifting carries no more than a moderate risk of preterm birth and low birth weight, but limited inconsistent evidence for pre-eclampsia.

Employers should reduce lifting for pregnant workers where possible, particularly in late pregnancy. However, if a pregnant worker who has been informed of the possible risks wishes to continue then there are insufficient grounds upon which to impose restrictions against her will.
Large and generally consistent body of evidence rules out more than a modest risk (relative risk <1.3) of preterm delivery B Ahlborg, Bodin, Hogstedt, 1990; Tuntiseranee et al., 1998; McDonald et al., "Prematurity," 1988; McDonald et al., 1986; McDonald, "Fetal death," 1988; Zhang & Bracken, 1996; Eskenazi et al., 1994; Bonzini, Coggon, & Palmer, 2007
Reasonable body of evidence, generally consistent in suggesting no effect for low birth weight/IUGR/SGA Armstrong, Nolin, & McDonald, 1989; McDonald et al., "Prematurity," 1988; Tuntiseranee et al., 1998; Ahlborg, Bodin, Hogstedt, 1990; Bonzini, Coggon, & Palmer, 2007
Very limited evidence for pre-eclampsia/pregnancy-induced hypertension Wergeland & Strand, 1997; Bonzini, Coggon, & Palmer, 2007

The exposure measures for lifting are too heterogeneous to inform a recommendation specifying the actual level of physical work at which adjustment to work should be implemented.

Prolonged Standing

Recommendation Risk Grade Evidence
Pregnant employees should be informed about the generally consistent evidence suggesting that prolonged standing (>3 hours) carries no more than a small risk of preterm birth and low birth weight/IUGR/SGA, and limited evidence for no effect for pre-eclampsia.

If employees stand for >3 hours/day, employers should consider reducing this or providing alternative work for that period of time, to reduce hours of standing to the minimum possible. However, if a pregnant worker who has been informed of the possible risks wishes to continue then there are insufficient grounds upon which to impose restrictions against her will.
Good evidence suggesting no more than a small risk of preterm birth A Ali, 2002; Eskenazi et al., 1994; Fenster et al., 1997; Henriksen et al., 1995; Mamelle, Laumon, & Lazar, 1984; McDonald et al., 1986; McDonald et al., "Fetal death," 1988; Ritsmitchai, Geater, & Chonsuviwatvong, 1997; Saurel-Cubizolles et al., 2004; Teitelman et al., 1990; Bonzini, Coggon, & Palmer, 2007
Large body of consistent evidence suggesting no risk or no more than a small risk of low birth weight Ha et al., 2002; Henriksen et al., 1995; Teitelman et al., 1990; Bonzini, Coggon, & Palmer, 2007
Limited evidence suggesting no effect for pre-eclampsia Bonzini, Coggon & Palmer, 2007

From current evidence, it cannot be stated conclusively at which stage of pregnancy these recommendations should be implemented. Most studies used three hours or more to define prolonged standing, so it seems reasonable to implement adjustments at this level.

Working Hours

Recommendation Risk Grade Evidence
Pregnant employees should be informed about the generally consistent evidence suggesting that long working hours carry no more than small to moderate risk of preterm birth, and low birth weight/SGA, but there is limited inconsistent evidence for pre-eclampsia.

Employers should reduce long working hours for pregnant workers, particularly in late pregnancy. Working hours should be limited as far as possible to a 'standard' working week of approximately 40 hours per week. However, if a pregnant worker who has been informed of the possible risks wishes to continue then there are insufficient grounds upon which to impose restrictions against her will.
No greater than a low risk of preterm birth, preterm labour or spontaneous miscarriage A Eskenazi et al., 1994; Klebanoff, Shiono, & Rhoads, 1990; Luke et al., 1995; Mamelle, Laumon, & Lazar, 1984; McDonald et al., 1986; McDonald et al., "Fetal death," 1988; McDonald et al., "Prematurity," 1988; Saurel-Cubizolles et al., 2004; Bonzini, Coggon, & Palmer, 2007
No more than a moderate risk of low birth weight McDonald et al., "Prematurity," 1988; Tuntiseranee et al., 1998; Bonzini, Coggon, & Palmer, 2007
Insufficient evidence for pre-eclampsia Klebanoff, Shiono & Rhoads, 1990; Bonzini, Coggon, & Palmer, 2007

Most studies about long working hours used >36 or >40 hours as a definition; therefore, it seems reasonable to use 40 hours as the threshold for applying adjustments to work. It is unclear form current evidence at which stage of pregnancy this is advisable.

Shift Work

There is insufficient evidence of a risk to pregnant women to make recommendations to restrict shift work, including rotating shifts or night/evening work.

Fatigue Score

Overall, based on just three studies, there is insufficient evidence to make recommendations about the use of the fatigue score to manage pregnant women at work. In addition, it is difficult to give advice on how a fatigue score would translate into work place restrictions.

Definitions:

Levels of Evidence

1++ High-quality meta-analyses, systematic reviews of randomised controlled trials (RCTs) or RCTs with a very low risk of bias

1+ Well-conducted meta-analyses, systematic reviews of RCTs or RCTs with a low risk of bias

1- Meta-analyses, systematic reviews of RCTs or RCTs with a high risk of bias

2++ High-quality systematic reviews of case-control or cohort studies;
High-quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal

2+ Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal

2- Case control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal

3 Non-analytic studies, e.g., case reports, case series

4 Expert opinion

Grading System for Recommendations

A - At least one meta-analysis, systematic review or RCT rated as 1++, and directly applicable to the target population; or
A systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B - A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 1++ or 1+

C - A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 2++

D - Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+

Good Practice Points (GPPs)

GPPs are practical points that the Guideline Development Group (GDG) wishes to emphasise but for which there is not, nor is there likely to be, any research evidence – for example, some aspect of management or treatment that is regarded as such sound clinical practice that nobody is likely to question it. These are not alternatives to evidence-based recommendations, and are only used where there is no other way of highlighting the issue.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Appropriate advice given to pregnant women exposed to hazards at work
  • Decreased fetal morbidity
  • Decreased maternal morbidity
  • Decreased sickness absence
Potential Harms

Not stated

Qualifying Statements

Qualifying Statements
  • The key questions narrow the scope of the guidelines to a few hazards only, but the approach could be extended to incorporate other hazards if the guidelines were to be developed further in the future. Similarly the list of adverse outcomes could be expanded in future revisions of the guidelines.
  • Limitations of the evidence base (e.g., heterogeneity of included studies, bias, confounding, and others); refer to the original guideline document for detailed information on evidence base limitations.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Audit Criteria/Indicators
Patient Resources
Quick Reference Guides/Physician Guides
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine. Physical and shift work in pregnancy: occupational aspects of management. A national guideline. London (UK): Royal College of Physicians (RCP); 2009. 94 p. [173 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2009
Guideline Developer(s)
National Health Service Plus - National Government Agency [Non-U.S.]
Source(s) of Funding

Royal College of Physicians

Guideline Committee

Guideline Development Group

Composition of Group That Authored the Guideline

Guideline Development Group Leader: Dr Nadia Sheikh, Specialist Registrar in Occupational Medicine, Royal Free Hampstead NHS Trust, London

Guideline Editor: Dr Julia Smedley, Lead Consultant and Head of Occupational Health, Southampton University Hospitals NHS Trust

Director of Evidence-based Guideline Project, NHS Plus: Dr Ira Madan, Consultant and Senior Lecturer in Occupational Medicine, Guys' and St Thomas' NHS Foundation Trust and King's College London

External Assessors: Professor Keith Palmer, Professor of Occupational Medicine, Medical Research Council; Professor Khalid S Khan, Professor of Obstetrics-Gynaecology and Clinical Epidemiology, Birmingham Women's Hospital; Dr Susan Bewley, Consultant Obstetrician, Guy's and St Thomas' NHS Foundation Trust

Guideline Development Group Members: Dr Paul Grime, Director of Occupational Health, Royal Free Hampstead NHS Trust; Dr Laila Kapadia, Occupational Health Physician, St Georges Healthcare NHS Trust; Ms Amanda Mansfield, Consultant Midwife, Royal Free Hampstead NHS Trust; Ms Sharon O'Byrne, Assistant Director of Human Resources, Royal Free Hampstead NHS Trust; Ms Chris Perry, Domestic Services Manager, Royal Free Hampstead NHS Trust; Ms Lesley Purdie, Senior Back Care Advisor, HCA International; Miss Elaine Scott, Consultant Obstetrician, Royal Free Hampstead NHS Trust; Ms Maggi Smith, Senior Occupational Health Nurse, Royal Free Hampstead NHS Trust

Financial Disclosures/Conflicts of Interest

None declared

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the National Health Services (NHS) Plus Web site External Web Site Policy.

Print copies: Available from nhsplus@nhs.net.

Availability of Companion Documents

The following are available:

  • Physical and shift work in pregnancy. Occupational aspects of management: evidence-based guidance for healthcare professionals. Summary leaflet. London (England): National Health Services (NHS) Plus; 2009. 7 p. Electronic copies: Available in Portable Document Format (PDF) from the NHS Plus Web site External Web Site Policy.
  • Physical and shift work in pregnancy. Occupational aspects of management: evidence-based guidance for employers. Summary leaflet. London (England): National Health Services (NHS) Plus; 2009. 2 p. Electronic copies: Available in PDF from the NHS Plus Web site External Web Site Policy.

In addition, suggested audit criteria can be found in the original guideline document External Web Site Policy.

Patient Resources

The following is available:

  • Physical and shift work in pregnancy. Occupational aspects of management: evidence-based guidance for employees. Summary leaflet. London (England): National Health Services (NHS) Plus; 2009. 2 p. Electronic copies: Available in Portable Document Format (PDF) from the NHS Plus Web site External Web Site Policy.

Print copies: Available from nhsplus@nhs.net.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This NGC summary was completed by ECRI Institute on August 11, 2010.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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