Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Sickness Absence in Pregnancy: A Danish Cohort Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Sickness Absence in Pregnancy: A Danish Cohort Study

Article excerpt

Sickness absence among pregnant women is frequent (1-5). A number of studies indicate that the amount of sickness absence in pregnancy has increased over the past decades, yet without clear medical explanations (5-8). Factors such as course of pregnancy (9), occupational exposures (10), levels of social benefits (8, 11), and attitudes towards sickness absence, experiences and worries (2) have been associated with levels of sickness absence. However, a number of other factors could potentially also influence sickness absence levels.

The combination of work outside the home, domestic duties, and natural physical fatigue increases the total strain among pregnant women, and this may particularly affect sickness absence among multiparous women (9, 12). Body mass index (BMI) could be hypothesized as a risk factor for sickness absence in pregnancy, as BMI is positively associated with pregnancy-related pelvic pain (13), and high BMI has been suggested to reduce the capability to perform manual work during pregnancy (14). BMI among European women has increased in the past decades, which also affects an increasing number of pregnant women (15).

The number of assisted reproductive therapy (ART) treatments has increased steadily during the past 15 years, and today 8% of childbirths arise from ART (16). ART is often linked to prolonged waiting time to pregnancy (TTP), and women who become pregnant after ART experience more pregnancy-focused anxiety compared to women conceiving spontaneously (17, 18). We hypothesize that this could lower thresholds for sickness notification among ART-pregnant women and women with prolonged TTP.

Physical exertion at work and risk of adverse pregnancy outcome has been investigated in numerous stud- ies with conflicting results (19-24). In consequence, precautionary principles are followed, and pregnant women are advised to reduce occupational exposures like heavy lifting as well as prolonged walking and standing, especially late in pregnancy (22, 25, 26). On the other hand, pregnant women are not discouraged from leisure time physical activity - hereafter referred to as physical exercise - and the Danish Health and Medicines Authority currently recommends physical exercise at a moderate intensity level for a minimum of 30 minutes per day for women with uncomplicated pregnancies (25).

On the basis of limited knowledge about how these factors are associated with sickness absence, we aimed to investigate associations between parity, pre-pregnancy BMI, ART, TTP and engagement in physical exercise and the risk of sickness absence in pregnancy from 10-29 completed pregnancy weeks.


Study population

We used data from the Danish National Birth Cohort (DNBC), a population-based pregnancy cohort, including 100 418 pregnancies enrolled between 1996-2002. Women were invited to participate at the first antenatal visit with their general practitioner. Inclusion criteria were: (i) Danish residency, (ii) an intention to complete pregnancy, and (iii) sufficient fluency in Danish to participate in four telephone-based interviews. The basic data collection in DNBC included four computer-assisted telephone-based interviews, three blood samples, and a food frequency questionnaire. Two interviews were conducted during pregnancy (around pregnancy week 17 and 30) and two postpartum (6 and 18 months). The cohort is described in detail elsewhere (27). In this study, we included pregnancies where information was collected in the first pregnancy interview (N=92 891). For definition of the studied pregnancies, see (figure 1). The final number of pregnancies studied was 51 874 among 49 708 women, as some women contributed with more than one pregnancy. The Scientific Ethical Committee approved the cohort, and the Danish Data Protection Agency and the DNBC Steering Committee approved storage, handling, and linkage of data for the current study (approval number 2012-41-0086 and 2012-06).


All independent variables came from the first pregnancy interview (in completed pregnancy weeks: 18 (mean); 17 (median); 25th percentile: 14, and 75th percentile: 20). …

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