Web viewPregnant women are at greater risk of severe illness and death when they contract Ebola virus. Pregnant healthcare workers should not be required to care for patients

Appendix A. Occupational Exposures and Pregnancy

Table of ContentsForeword................................................................................................................................................... 2

Physical Agents……………………………………………………………………………………………………………………………………..3

Ionizing Radiation..................................................................................................................................3

Non-Ionizing Radiation..........................................................................................................................5

Temperature..........................................................................................................................................6

Noise and Vibration............................................................................................................................... 7

Chemicals.................................................................................................................................................. 9

Solvents................................................................................................................................................. 9

Plastics, Epoxies, and Resins................................................................................................................11

Formaldehyde......................................................................................................................................13

Chemotherapy drugs........................................................................................................................... 15

Anesthetic Gases................................................................................................................................. 16

Carbon Monoxide and Other Combustion Byproducts........................................................................18

Pesticides............................................................................................................................................. 19

Polychlorinated Biphenyls (PCBs)........................................................................................................20

Metals......................................................................................................................................................21

Lead..................................................................................................................................................... 21

Mercury............................................................................................................................................... 23

Cadmium............................................................................................................................................. 24

Cobalt.................................................................................................................................................. 25

Biological/Infectious Agents....................................................................................................................26

Other workplace factors..........................................................................................................................29

Shift Work and Long Working Hours....................................................................................................29

High physical demands........................................................................................................................30

References Cited………………………………………………………………………………………………………………………………….32

Website urls checked 2/26/2016

1


Foreword

All workers have the right to safe working conditions.

Regulations and guidance for workers concerned about their reproductive health have not kept pace

with the large number of potential reproductive hazards in workplaces.

Accurate information about occupational reproductive risks and workplace options are important

first steps to good reproductive health for both women and men. Workplace reproductive hazards

are relevant to preconceptional planning, pregnancy, and breastfeeding.

Workplace hazards should be eliminated or reduced to provide a safe working environment for

workers. Where this is not feasible, use of personal protective equipment (PPE), including

respirators, may be an option—but not all PPE can be used effectively during pregnancy. If neither

hazard elimination nor PPE are feasible, a worker may wish to consider avoiding hazardous duties

preconceptionally or during pregnancy or breastfeeding, depending on the hazard.

Appendices A and B provide information to share with patients who are pregnant, breastfeeding,

or planning a pregnancy. Information can also be found on our web pages:

http://www.cdc.gov/niosh/topics/repro/pregnancy.html. For assistance with specific questions

about occupational reproductive hazards, reproductive health, and many other health topics, CDC-

INFO may be able to help (https://wwwn.cdc.gov/dcs/ContactUs/Form; Phone 800-CDC-INFO

(800-232-4636) ).

Workplaces vary greatly. Informed discussion between a working patient and her health provider

can begin to determine the best actions for her situation. Speaking with the patient’s employer about

safer alternatives may also be useful.

2

https://wwwn.cdc.gov/dcs/ContactUs/Form

http://www.cdc.gov/niosh/topics/repro/pregnancy.html


Physical Agents

Ionizing Radiation

Potential Fetal/Maternal Complications Jobs where Exposures are Found

Recognized reproductive toxicant1

Effects include fertility problems, miscarriage,

certain birth defects (depending on timing and

dose)2-4

Healthcare/veterinary workers

Flight crew members

Certain industrial/laboratory applications

Tools and Prevention Strategies

Ionizing radiation is radiation with enough energy to remove tightly bound electrons from the orbit

of an atom, causing the atom to become charged or ionized.

Ionizing radiation exposure is well-regulated and guidelines are in place in most US workplaces.

Pregnant workers need to be aware of these guidelines and follow them closely. The best first step is

for employees to talk to their supervisor and their workplace Radiation Safety Officer.

o If a Radiation Safety Officer is not available, consult with your state’s department of radiation

protection.

Certain workplace radiation exposures may incur a higher level of risk during pregnancy, including:

o caring for patients who have been administered nuclear medicine radioactive materials,

especially Iodine-131

o portable x-ray machines

o fluoroscopy procedures.

Flight attendants and pilots are exposed to cosmic ionizing radiation at levels which may be of

concern for crewmembers during pregnancy. More information and suggestions for managing

cosmic radiation exposures are at the NIOSH website

(http://www.cdc.gov/niosh/topics/aircrew/cosmicionizingradiation.html) or CDC-INFO for more

3

http://www.cdc.gov/niosh/topics/aircrew/cosmicionizingradiation.html


information.

4


Non-Ionizing Radiation


Non-ionizing radiation can cause localized

heating in tissues, which has caused birth defects

in animals5, 6

Adverse effects are very dependent on source

frequency, intensity, duration, and location

Certain industries (plastic welding)

Specific healthcare workers (diathermy

operators)


Radiation that has enough energy to move atoms around or cause them to vibrate, but not enough to

remove electrons, is referred to as "non-ionizing radiation".

o Common examples of this kind of radiation are radio waves, visible light, and microwaves.

o The small amount of non-ionizing radiation from current computer screens, microwave ovens in

good condition, and cell phones are considered safe.

Certain occupational sources can emit higher levels of nonionizing radiation in a non-uniform

distribution. Resonant frequencies (30-300MHz) are considered especially hazardous7 and can occur

in plastic welding, diathermy, and other jobs.

Because information on frequency, intensity, and location are necessary to estimate exposure,

consultation with a Safety Officer is recommended.

5


Temperature


Pregnant women may be less tolerant of hot

working environments8

Heat exhaustion and heat stroke can cause

maternal body temperature to increase

Increased maternal body temperature is known

to increase risks of birth defects6, 9

Some warehouse workers

Outdoor workers

Some factory workers: metal fabrication, glass

or plastics manufacture

Greenhouse workers

Healthcare (diathermy therapy)

Cooking and dishwashing areas of commercial

kitchens


If possible, pregnant workers should avoid hot work environments which do not provide for adequate

cooling and hydration breaks.

When working in a hot environment, workers should take cooling breaks and avoid dehydration by

drinking plenty of fluids. Share information on preventing heat stress in the workplace:

http://www.cdc.gov/niosh/docs/wp-solutions/2013-143/pdfs/2013-143.pdf

Share information on symptoms of heat stress: http://www.cdc.gov/niosh/topics/heatstress/

Pregnant women should also avoid specific sources of heat to the fetus: very hot/prolonged saunas,

hot tubs,10 and diathermy treatments.6

6

http://www.cdc.gov/niosh/topics/heatstress/

http://www.cdc.gov/niosh/docs/wp-solutions/2013-143/pdfs/2013-143.pdf


Noise and Vibration

Potential Fetal/Maternal ComplicationsJobs where Exposures are

Found

Sound is transmitted through the uterus, and very loud noise may

damage the fetus’ developing ear structures and cause

permanent hearing loss11

There are no human reproductive studies of low frequency noise

(less than 100 Hz) or loud impulse noise, but these might affect

the fetus due to maternal effects--changes in EEG pattern, heart

rate, and blood pressure have been reported in humans at low-

frequency noise levels below the hearing threshold12

Stress responses, including increased blood pressure and heart

rate, have also been reported in adults exposed to loud impulse

or impact noises13

Many occupations are

exposed to loud noise

and/or vibration

Any occupation where the

pregnant worker is required

to wear earplugs or other

hearing protection


Hearing protection should be used by pregnant women exposed to 85 decibels (dB) or more to

protect the mother’s hearing and prevent maternal cardiovascular and endocrine stress which could

harm both mother and fetus.

Providing hearing protection to the mother does not decrease the amount of noise transmitted to

the fetus. To protect fetal hearing, The American Council of Government Industrial Hygienists

(ACGIH) recommends that pregnant women should not be exposed to noise at or above 115 dBC,

TWA (115 decibels, C weighting, Time-Weighted Average).14 This is about as loud as a jackhammer

or a rock concert from the middle of the stadium.

Segmental vibration can cause circulatory problems in the affected region.12 To decrease the

amount of vibration reaching the fetus, increase distance between the mother and the vibration

7


source.

Additional information on noise can be found at http://www.cdc.gov/niosh/topics/noise/

8

http://www.cdc.gov/niosh/topics/noise/


Chemicals

Organic Solvents


Many solvents have been associated with

adverse reproductive effects: fertility problems,

chromosomal aberrations, miscarriages,

stillbirth, and/or birth defects15-18

Many solvents can enter breastmilk

Because multiple solvents are often used in

commercial products, effects of a single solvent

cannot always be distinguished

Trichloroethylene, chloroform, benzene, toluene,

and other solvents may be in:

Petrochemicals

Metalworking fluids

Drycleaning fluids

Paint thinners, mineral spirits

Degreasers

Laboratory chemicals

Printing inks


Pregnant workers may wish to consider talking to their employers to avoid these duties on a

temporary basis during pregnancy and breastfeeding. If avoidance is not feasible, workers can:

o Increase ventilation if it does not interfere with other ventilation systems (e.g., negative

pressure systems in healthcare institutions or laboratories).

o Avoid eye, skin and respiratory contact. Use gloves and other protective clothing that are

appropriate for the specific chemical(s). Guidance on choosing gloves and other protective

equipment can be found at http://www.cdc.gov/niosh/topics/repro/ppe.html.

o Wash their skin or change clothes as soon as possible after getting solvents on themselves.

Consider and prevent take-home exposures. NIOSH take-home resources are at

http://www.cdc.gov/niosh/topics/repro/takehome.html.

Avoid home/hobby contact with dry cleaning fluids, degreasers, paints, paint strippers and thinners.

9

http://www.cdc.gov/niosh/topics/repro/takehome.html

http://www.cdc.gov/niosh/topics/repro/ppe.html


Household cleaners may or may not contain solvents.

Keep in mind that harmful levels of chemicals cannot always be smelled, and some much less

hazardous chemicals have an odor.

10


Plastics, Epoxies, and Resins


May increase risk for fertility problems,

miscarriages, stillbirth, birth defects19-21

Plastic manufacturing

Beauty/nail salons

Healthcare workers, especially orthopedics and

dental laboratories

Boat building (fiberglass/styrene)


These chemicals include styrene, methyl methacrylate, epoxy resins, and vinyl chloride. FDA has

banned the use of methyl methacrylate in nail salons.

Pregnant workers may wish to consider talking to their employers to avoid duties involving these

chemicals on a temporary basis during pregnancy and breastfeeding.

If avoidance during pregnancy/breastfeeding is not feasible:

o Avoid directly mixing resins if at all possible. After mixing, the toxic monomers turn into

polymers, which are usually less toxic.

o Increase ventilation as much as possible if it does not interfere with other ventilation systems

(e.g., negative pressure systems in healthcare institutions or laboratories).

o Avoid eye, skin and respiratory contact. Use PPE for the specific chemical (NIOSH PPE resources

are at http://www.cdc.gov/niosh/topics/repro/ppe.html).

o If these chemicals get on skin or clothes, wash the skin or change clothing as soon as possible.

o Read the Current Intelligence Bulletin on Glycidyl Ethers, a common component of epoxy resins:

http://www.cdc.gov/niosh/docs/1970/79104_29.html.

o Share information about working safely with epoxy resin systems in construction:

http://www.elcosh.org/record/document/2088/d001103.pdf.

11

http://www.elcosh.org/record/document/2088/d001103.pdf

http://www.cdc.gov/niosh/docs/1970/79104_29.html





12



Formaldehyde


May cause:

o Fertility problems

o Miscarriage22, 23

Formaldehyde is a recognized carcinogen.24

Healthcare workers

Pathology/cytology laboratory personnel

Anatomy and mortuary science students

Funeral home employees/embalmers

Beauticians


Formaldehyde is also present in formalin (aqueous form). Glutaraldehyde, a similar chemical, may

have health effects similar to formaldehyde.

The Occupational Safety and Health Administration (OSHA) has set the permissible exposure limit

(PEL) at 0.75 parts per million (ppm) as a time-weighted average (TWA), with a short-term exposure

limit of 2 ppm. The NIOSH recommended exposure limit is 0.016 ppm (TWA), or 0.1 ppm (15-min

ceiling). Some workplaces might exceed these limits. For example, NIOSH measurements of

formaldehyde at one mortuary college averaged 1.4 ppm, and ranged from 0.5ppm-6.1ppm.25

Pregnant workers may wish to consider talking to their employers to avoid duties involving

formaldehyde on a temporary basis during pregnancy.

It is generally thought that formaldehyde will not affect breastmilk. However, because there is not

sufficient direct evidence to be certain, pregnant women may wish to consider avoiding duties

involving formaldehyde while breastfeeding.

If avoidance during pregnancy/breastfeeding is not feasible:

o Wear appropriate gloves when handling formaldehyde, since it can be absorbed through the

skin. Butyl rubber, neoprene rubber, or nitrile rubber gloves are generally recommended. Latex

rubber, natural rubber, polyethylene, or polyvinyl alcohol gloves do not offer adequate

protection against formaldehyde—formaldehyde can permeate in seconds to minutes.

13


Guidance on choosing gloves and other protective equipment can be found in Appendix B or at

http://www.cdc.gov/niosh/topics/repro/ppe.html .

o Wash any formaldehyde off skin and change clothes after work.

o Increase ventilations if it does not interfere with other ventilation systems (e.g., negative

pressure systems in healthcare institutions or laboratories.

o Clean drips and spills quickly using formaldehyde neutralization pads or sheets.

o If working with tissues, cadavers, or animal specimens preserved using formalin, rinse the

specimen in water to remove excess formalin before beginning dissection. Keep the formalin

solution under a chemical fume hood or in another room while in the lab.

o Some activities will have higher exposures than others. For example, dissections of the chest and

abdomen appear to have higher levels of formaldehyde exposure.

14



Chemotherapy drugs (including antineoplastic, cytotoxic, or hazardous drugs)


May cause fertility problems, miscarriages,

stillbirths, or birth defects26-28

Many of these drugs are known teratogens

and/or carcinogens29

Healthcare workers (including pharmacy,

nursing, and operating room personnel;

physicians)

Cleaning/maintenance workers in healthcare

facilities

Veterinary care workers

Caretakers or family members of patients

undergoing chemotherapy


Exposure can come from handling, mixing or administering chemotherapy; or from handling cancer

patients and their waste products.

Exposure to these drugs during mixing, administering, or caring for a treated patient can be difficult to

control to a level which could be considered safe for a pregnant woman.

Pregnant workers may consider talking to their employers to avoid these exposures on a temporary

basis during pregnancy and breastfeeding.

Hospital staff including shipping and receiving personnel, custodial workers, laundry workers, and

waste handlers might come into contact with these drugs by transporting the drugs, cleaning up spills,

or handling linens contaminated with bodily fluids from patients receiving antineoplastic drugs.

Guidelines for safe handling and PPE use can be found at NIOSH's Hazardous Drug Alert website,

http://www.cdc.gov/niosh/docs/2014-138/default.html.



15


http://www.cdc.gov/niosh/docs/2014-138/default.html


Anesthetic Gases


May cause impaired fertility, miscarriage, low

birthweight and/or preterm birth, birth

defects30-33

Healthcare workers in dental offices, hospitals,

and veterinary operating rooms


Agents include isoflurane, sevoflurane, desflurane, and nitrous oxide.

Historical studies have shown that women who have been exposed to waste anesthetic gases have an

increased risk of miscarriage. More recent studies suggest that hospitals may be getting better at

preventing anesthetic gases from leaking into operating rooms during surgery, which reduces the risk

to workers in operating rooms.

Scavenger systems, devices used to gather and remove waste anesthetic gases from treatment rooms,

must be maintained and monitored to make sure they are working properly.

Workers are most likely to be exposed to waste anesthetic gases in operating facilities with no

automatic ventilation or scavenging systems, operating facilities where these systems are in poor

condition, or recovery rooms where gases exhaled by recovering patients are not properly vented or

scavenged. It may be also harder to control anesthesia leakage if the patient moves (e.g., children,

animals).

Pregnant workers may consider talking to their employers to avoid exposure to these gases during

pregnancy. If this is not possible, patients can be advised that:

o Respirators can be worn to reduce the amount of certain chemicals that workers breathe in.

Charcoal masks or surgical masks will not protect a person from these chemicals. To be effective,

respirators must also be used correctly. Also, effective respiratory protection does not guarantee

a safe environment for the fetus. Learn about respirators and pregnancy at

16


http://www.cdc.gov/niosh/topics/repro/ppe.html .

o Share NIOSH guidance on waste anesthetic gases, which includes advice for employers on how

to reduce employee exposures: http://www.cdc.gov/niosh/docs/2007-151/ .

17

http://www.cdc.gov/niosh/docs/2007-151/



Carbon Monoxide and Other Combustion Byproducts


May cause reduced fetal growth, neurologic

damage, birth defects34, 35

Automobile exhaust in parking garages,

tollbooths, vehicle service facilities

Workplaces with tobacco smoke

Furnaces, kerosene heaters, boat exhaust

Polycyclic aromatic hydrocarbons (PAHs) are an

emerging concern, found in

o Restaurant kitchens

o Tobacco smoke

o Air pollution


Some combustion byproducts can be absorbed through the skin or swallowed as well as inhaled.

Reducing exposure to CO and PAHs when pregnant is advisable.

Increased ventilation may be helpful in some low-exposure situations if it does not interfere with

other ventilation systems (e.g., negative pressure systems in healthcare institutions or laboratories).

Pregnant workers may consider talking to their employers to reduce or avoid exposure on a

temporary basis during pregnancy. If occupational exposure cannot be avoided, respiratory protection

can be evaluated but does not guarantee a safe environment for the fetus.

NIOSH PPE resources are at http://www.cdc.gov/niosh/topics/repro/ppe.html.

New Jersey Fact Sheet on carbon monoxide available at:

http://nj.gov/health/eoh/rtkweb/documents/fs/0345.pdf.

Consider and prevent take-home smoke exposures. NIOSH take-home resources are at


18


http://nj.gov/health/eoh/rtkweb/documents/fs/0345.pdf



Be aware of local smog alerts and follow directions.

Pesticides


May cause miscarriages, birth defects, cognitive

deficits36-38

Some pesticides may also pass into breast milk.

Farm and greenhouse workers

Florists

Fruit/ vegetable handlers

Veterinarians and veterinary assistants

Landscapers

Anyone who performs pest or weed control.


Avoiding exposure to pesticides when pregnant is the safest option. If occupational exposure cannot

be avoided, reducing exposure is advisable.

Greenhouse and farm workers must observe re-entry times carefully. Every pesticide has a re-entry

time based on its chemical/s.

In the home, people may be exposed through the use of insect sprays in and around the house, lawn or

garden treatments, or the use of flea and tick treatments or preventatives on pets.



Use PPE gloves/clothing recommended for the specific pesticide. Guidance on choosing gloves and

other protective equipment can be found in Appendix B or at

http://www.cdc.gov/niosh/topics/repro/ppe.html.

Wash hands after handling pets wearing flea collars or who have received flea and tick drops, and

avoid skin contact with flea, tick, and mite treatments or preventatives.

Pregnant workers may wish to consider talking to their employers to reduce or avoid exposure on a

temporary basis during pregnancy. If occupational exposure cannot be avoided, respiratory

19




protection can be considered.

Polychlorinated Biphenyls (PCBs)


May cause low birthweight, stillbirth39-41 Waste management/recycling

Repair of older electrical capacitors


Production of PCBs was banned in the U.S. in 1977, but worker exposures continue where PCB

sources are recycled or repaired. PCB contamination of surface waters is widespread.

Pregnant workers may wish to consider talking to their employers to avoid duties with exposure

to PCBs on a temporary basis during pregnancy.

If avoidance during pregnancy is not feasible:

o Increase ventilation as much as possible if it does not interfere with other ventilation

systems (e.g., negative pressure systems in healthcare institutions or laboratories).

o Avoid eye, skin and respiratory contact.

o Use PPE recommended for PCBs. Guidance on choosing gloves and other protective

equipment can be found in Appendix B or at




New Jersey Fact Sheet on PCBs available at:


20





Metals

Lead


May cause abnormal sperm, menstrual

disorders, miscarriages, stillbirths, cognitive

defects in offspring.42, 43

Manufacturing/metal fabrication

Recyclers

Construction or maintenance

Battery, paint, ink, crystal, or ceramics

manufacture

Law enforcement

Potentially exposed hobbies include rifle

hunting/target shooting; welding; making

stained glass, jewelry, or ceramics.


Lead is stored in bone and can mobilize during pregnancy and breastfeeding, so both past and current

lead exposures are important. Ask about previous lead exposures.

Pregnant workers may wish to consider talking to their employers to avoid exposure on a temporary

basis during pregnancy. If occupational exposure cannot be avoided:

o Respiratory protection can be evaluated but does not guarantee a safe environment for the fetus.

o Avoid take-home exposure. Learn more at


o Use personal protective equipment (gloves and clothing). NIOSH PPE resources are at


Discuss hobbies with patients, as they may be unaware of potential for lead exposure. Choosing lead-

free products may be possible for some hobbies. Careful washing after engaging in hobby-work will

reduce exposure. Avoid solder, lead pipes, batteries, lead paints and lead painted surfaces, lead in

21




glazed ceramics, and smelter emissions.

Lead paint (particularly peeling or chipping) in older buildings/ structures is the most common

environmental source of exposure. Avoid sanding/refinishing painted surfaces/furniture unless it is

known that the paint is lead-free.

Cigarette smoke is a common environmental source of lead exposure. Avoid cigarette smoke (primary

or second-hand) during pregnancy.

CDC has comprehensive guidelines for lead exposure during pregnancy and breastfeeding: at

http://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf.

A NIOSH topic page on lead is available at: http://www.cdc.gov/niosh/topics/lead/.

A New Jersey Fact Sheet on lead is available at:


22


http://www.cdc.gov/niosh/topics/lead/

http://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf


Mercury


May cause impaired fetal motor development,

cognitive defects, deafness, blindness, other

neurological damage44, 45

Gold and silver mining or refining

Production of thermometers and gauges

Production of dental amalgam.








Avoid mercury in thermometers, mirror coating, dyes, and inks.

A New Jersey Fact Sheet on mercury is available at:


23





Cadmium


May cause birth defects, damage to male

reproductive system, menstrual disorders.46-48

Shipyards

Construction

Aircraft repair

Battery or plastics manufacture

Welding

Agriculture

Tools and Prevention Strategies Pregnant workers may wish to consider talking to their employers to avoid exposure on a temporary


o Respiratory protection can be evaluated but does not guarantee a safe fetal environment.





Cigarette smoke is the most common environmental source of exposure. Avoid cigarette smoke

(primary or second-hand) during pregnancy.

Hobbies involving metalcrafting, jewelry-making or beading, or welding create the potential for

exposure to cadmium. Inexpensive metal costume jewelry, jewelry-making products, or beads may

contain cadmium. Careful washing after hobby-work will reduce exposure.

A New Jersey Fact Sheet on cadmium is available at:


24





Cobalt


May cause damage to the male

reproductive system, including reduced

sperm count.49

Production of steel alloys (or manufacture of

products from those alloys)

Cigarette smoke in the workplace




o Respiratory protection can be evaluated but does not guarantee a safe environment for the fetus.





Cigarette smoke is the most common environmental source of cobalt exposure. Avoid cigarette smoke

(primary or second-hand) during pregnancy.

A New Jersey Fact Sheet on cobalt is available at:

http://nj.gov/health/eoh/rtkweb/documents/fs/0520.pdf .

25





Biological/Infectious Agents


The following infections can pass to the unborn

baby during pregnancy, or cause more severe

illness to a pregnant woman. Adverse

outcomes include miscarriage, stillbirth, and

birth defects.50-53

o Chicken pox/shingles (varicella zoster

virus; VZV)

o Coccidiodomycosis

o Cytomegalovirus (CMV)

o Ebola virus

o Hepatitis B, C, and E viruses

o Human Immunodeficiency Virus (HIV)

o Herpes

o Influenza/pneumonia

o Listeria

o Malaria

o Measles

o Parvovirus B19 (Fifth disease)

o Rubella (German measles)

o Toxoplasmosis

o Zika Virus

Healthcare workers

Childcare workers

Veterinary medicine and veterinary service

workers

Tattoo artists and body piercers

Laboratory workers

Workers traveling to areas where they

might acquire these infections

26


Tools and Prevention Strategies Review vaccination history with the patient:

o Pregnant women should get the inactivated (injected) influenza vaccine, instead of the live

attenuated nasal vaccine (LAIV).

o MMR vaccination is contraindicated during pregnancy. Non-immune health care workers (can

be determined by serology) should not work with rubella-infected patients.

o Hepatitis A and B vaccines can be administered during pregnancy

o See immunization recommendations for special HCW conditions, including pregnancy, on Table

3 of: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm.

Pregnant women who carefully follow infection control guidelines (i.e., standard precautions) are

generally at no higher risk of acquiring a harmful infection from a patient than other workers.

Exceptions exist for some pregnant women and some infectious agents:

o See appendix A of the 2007 Guidelines for Isolation Precautions:

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

o See Guidelines for Infection Control in Healthcare Workers, Table 6

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf.

o Pregnant women are at greater risk of severe illness and death when they contract Ebola virus.

Pregnant healthcare workers should not be required to care for patients with confirmed or

probable Ebola Virus Disease (EVD) or a person under investigation for EVD. They should not

be required to clean and disinfect items or surfaces that are possibly contaminated with Ebola

virus or the blood and/or body fluids of these patients.

o Risks and precautions for CMV can be found at:

http://www.cdc.gov/cmv/clinical/index.html

27

http://www.cdc.gov/cmv/clinical/index.html

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm


http://www.cdc.gov/cmv/risk/preg-women.html .

In 1-4% of pregnancies, a mother will develop a primary CMV infection; approximately

one-third will pass the infection to their fetus. Most fetal infections (85-90%) will resolve

prior to birth. These numbers and risks are even lower for seropositive women, but

seropositivity to CMV does not necessarily mean immunity.

o Following precautions for shingles/chicken pox carefully reduces the risk of a pregnant worker

contracting VZV infection. Based on the patient’s circumstances, consider recommending that

pregnant employees avoid working with patients with shingles or chicken pox due to the

potentially severe consequences:

Even among those people who previously contracted chicken pox or had varicella vaccine,

a small group are still not immune.

Approximately 10-20% of pregnant women who contract VZV may develop pneumonia

and, of those women, the chance of death can be as high as 40%.54, 55 Women who are

infected with varicella have a small risk of having a baby with congenital varicella

syndrome.56

o Zika virus is an emerging infectious disease which has been linked to birth defects in pregnant

women. Current guidance for Zika virus is at the CDC Zika website

http://www.cdc.gov/zika/index.html.

Observe safe practices in body modification studios: http://www.cdc.gov/niosh/topics/body_art/.

Guidelines for laboratory workers are intended to prevent laboratory-acquired infection in all

personnel when followed correctly. Some exceptions exist.

o For patient clinical samples, refer to the Guidelines for Safe Work Practices in Human and

Animal Medical Diagnostic Laboratories at: http://www.cdc.gov/mmwr/pdf/other/su6101.pdf.

o For laboratory work with concentrated cultures of pathogens, refer to the Biosafety Manual for

Biomedical Laboratories at: http://www.cdc.gov/biosafety/publications/bmbl5/BMBL.pdf.

28

http://www.cdc.gov/biosafety/publications/bmbl5/BMBL.pdf

http://www.cdc.gov/mmwr/pdf/other/su6101.pdf

http://www.cdc.gov/niosh/topics/body_art/

http://www.cdc.gov/zika/index.html%20

http://www.cdc.gov/cmv/risk/preg-women.html


o For work involving unusual pathogens, production quantities, emergent infections, or

genetically modified pathogens, CDC-INFO is available at 1-800-CDC-INFO.

Other workplace factors

Shift Work and Long Working Hours


Have been associated with menstrual

disorders, miscarriages, preterm birth.57-59

Health effects from shiftwork are also relevant

to any kind of work during normal sleep time,

including irregular shifts and jet lag, as well as

long hours of work

Health Care Workers

Law Enforcement and Firefighters

Cleaning/Building Services

Manufacturing Workers

Transportation Workers

Air Crew


If feasible, avoid working during normal sleep time during pregnancy.

The National Sleep Foundation’s shift work information is found at: http://sleepfoundation.org/shift-

work/content/shift-work-disorder.

Good sleep hygiene is always important, but especially for shiftworkers. General recommendations

can be found at http://www.sleepfoundation.org/article/ask-the-expert/sleep-hygiene.

Sleep hygiene tips for shift workers can be found at

http://my.clevelandclinic.org/disorders/sleep_disorders/hic_shift_work_sleep_disorder.aspx

Because the adverse health effects of long or irregular work schedules may be partially due to stress

responses, measures to reduce stress and improve resilience may help (relaxation, exercise, and

following a healthful diet).

29

http://my.clevelandclinic.org/disorders/sleep_disorders/hic_shift_work_sleep_disorder.aspx

http://www.sleepfoundation.org/article/ask-the-expert/sleep-hygiene

http://sleepfoundation.org/shift-work/content/shift-work-disorder

http://sleepfoundation.org/shift-work/content/shift-work-disorder


30


High physical demands


Pregnant women are at higher risk of an injury

while lifting due to ergonomic stresses

(including altered posture, impaired balance

and agility, and impaired ability to hold objects

close to the body due to the abdomen’s

changing size).60

Risk of injury can also increase in early

pregnancy due to hormonal changes that affect

spinal ligaments and joints.60

Prolonged standing or heavy lifting has been

associated with an increased chance of

miscarriage or preterm delivery57, 60-62

Healthcare workers

Childcare workers

Flight attendants

Construction

Manufacturing

Service workers

Housekeeping/janitorial

Farm and greenhouse workers

Many other jobs


Normal everyday physical activities aren’t a cause for concern, and moderate exercise during

pregnancy can help promote a healthy pregnancy. Very high physical demands are a concern.

Examples include the following:

o bending at the waist more than 20 times per day

o highly repetitive lifting (more than 3 times a minute)

o standing for many hours without a rest break

Reduce or avoid the following actions:

o Repeated stooping, bending, squatting

o Lifting heavy objects from the floor or below mid-shin, or lifting overhead

31


o Prolonged standing or sitting

Advise workers to get off their feet when on breaks.

A NIOSH infographic on provisional weight limits for lifting during pregnancy is at:

http://blogs.cdc.gov/niosh-science-blog/files/2013/05/ClinicalGuidelinesImg-NewLogoFinal.jpg.

32

http://blogs.cdc.gov/niosh-science-blog/files/2013/05/ClinicalGuidelinesImg-NewLogoFinal.jpg


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