Pregnant workers. A physician's guide to assessing safe employment.

The demographics of the workforce have changed dramatically in recent decades. Today women constitute nearly 50% of the workforce, and most are in their reproductive years. Women are employed in occupations with exposures to strenuous physical exertion, chemicals, ionizing radiation, heat, noise, vibration, infectious agents, and stress. These factors can, in some instances, pose risks to pregnant workers and their developing fetuses. Primary care physicians are at times asked to assess the work environment and the safety of employment during pregnancy. Physicians who evaluate pregnant workers should be aware of the available databases and understand the process for evaluating a possible reproductive risk. Physician certification that a worker is disabled due to pregnancy can result in a substantial financial burden to both employer and employee. In this article, we review pertinent legal and employment issues related to pregnancy, provide clues to obtaining an individual exposure history, identify categories of concern for pregnant workers, and provide an approach to assessing the risk for each of these categories.