Concediul medical pentru risc maternal: o intervenţie preventivă de medicină a muncii

Marina Ruxandra   Oţelea; Ramona Apostol; Cristina Dobre; Ana Maria Alexandra  Stănescu; Anca A.  Simionescu

The sick leave for maternal risk: a preventive occupational medicine intervention

First published: 24 mai 2022

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/ObsGin.70.1.2022.6506

Ultimele decade au adus cu sine şi o contribuţie importantă la cunoaşterea factorilor de risc ocupaţionali asupra funcţiei de reproducere umană. Reducerea expunerii la aceşti factori este o preocupare constantă pentru sănătatea publică. În acest articol sunt exemplificate principalele categorii de factori de risc pentru sănătatea mamei şi a fătului, alături de efectele descrise la persoanele expuse în timpul activităţii profesionale, precum şi posibilităţile de intervenţie pe care le prevede legislaţia actuală din România. Multitudinea de contexte ocupaţionale în care apar aceşti factori de risc şi necesitatea protejării faţă de efectele nocive determină intervenţia medicului de medicina muncii în momentul în care angajata anunţă angajatorului despre existenţa sarcinii. În urma acestei informări, medicul de medicina muncii va analiza împreună cu angajatorul existenţa elementelor din condiţiile de muncă care ar putea avea efecte nedorite asupra femeii însărcinate. Scopul acestei investigaţii este găsirea unor soluţii pentru sistarea expunerii la orice noxă potenţială. Dacă expunerea nu poate fi sistată în întregime, medicul de medicina muncii poate uza de dreptul gravidei la concediu de risc maternal, ca măsură de prevenţie primară. În concluzie, concediul de risc maternal nu este similar cu concediul medical de risc obstetrical sau cu concediul prenatal. Cunoaşterea cadrului legislativ şi stabilirea unei comunicări eficiente între medicul de medicina muncii, medicul obstetrician şi medicul de familie pot contribui la reducerea în ansamblu a riscului maternal.

Cuvinte cheie

concediu de risc maternal medicina muncii factori de risc ocupaţionali toxice pentru reproducere

Hazards present in the workplace can have various negative effects on the evolution of pregnancy and on the development of the design product. These effects may occur during pregnancy, the postnatal period or at a distance of pregnancy through influences on the development of the offspring.

In principle, occupational risk factors are classified into physical, chemical, biological, ergonomic and psychosocial factors, and any of these can impact the course of pregnancy. Therefore, without an exhaustive analysis of the risk factors to which a pregnant woman is exposed during pregnancy or in the pre-pregnancy period, Table 1 exemplifies each of the aforementioned categories with studies showing the importance of the professional environment on pregnancy.

Table 1. Occupational risk factors and their implications for pregnancy or offspring

A literature review has shown the need to prioritize research on drugs with reprotoxic potential, metals, pesticides, organic solvents, phthalates and fluorinated compounds⁽¹⁷⁾. However, in almost all professional contexts, there is a combination of risk factors.

The presence of these hazards in the workplace correlates with the number of days of sick leave during pregnancy. This has been confirmed by several studies published in recent years. For example, a study conducted in France on a population of 1495 pregnant women identified statistically significant differences for the following risk factors: prolonged orthostatism (above 1 hour), weight lifting (for more than 5 kg), climbing stairs, night shifts, exposure to chemicals, contact with patients or animals, or people who did not have a fixed-term employment contract⁽¹⁸⁾. An increase in absenteeism was directly correlated with the number of occupational risk factors⁽¹⁹⁾. In this study, also conducted in a high-income country, the occupational risk factors considered were ergonomic factors (prolonged orthostatic position, awkward positions, weight lifting) and psychosocial factors (workload, ability to control the activity). Postural constraints and the level of physical overload^(20,21) were directly correlated with the number of days of medical leave. It should be noted that no sector of activity is excluded, including the medical field⁽²¹⁾.

In general, women working in the industrial environment, generically called “blue-collars”, have an increased risk of sick leave compared to women working in services, administration, generically referred to as “white collars” ^(20,22). Studies showing that all occupational classes have a higher risk of sick leave than in the category of highly qualified professionals⁽²³⁾ or those with managerial positions⁽¹⁸⁾ are in the same direction.

Unfortunately, we do not have such official statistics in Romania. However, such an analysis would be extremely important, as maternity risk leave is included in the legislation of our country for more than 20 years. Maternity risk leave is the leave enjoyed by the pregnant worker or the one who has recently given birth/the breastfeeding employee to protect their health and safety and/or that of their fetus or child⁽²⁴⁾. According to the same government ordinance, the pregnant employee is considered the woman who notifies the employer in writing of her physiological state of pregnancy and attaches a medical document issued by the family doctor or specialist attesting to this condition. The employer and the occupational physician evaluate the risks to which the employee is subjected at her workplace, draws up and signs the Risk Assessment Report. The employee receives information on maternity protection at work, which sets out the assessment results of the risks she may be subjected to at work and the additional protection measures that both the employer and the employee must comply with.

The employee may request maternity risk leave from the occupational physician from the beginning of the pregnancy if the employer cannot, for objectively justified reasons, assure the modification of her working conditions and/or work schedule or her assignment to other job tasks which will not represent a risk to the health or safety of the child and/or the fetus or child (according to the Maternity Protection Information at Work). Therefore, the occupational physician recommends this type of leave only if, for objective and justified reasons, the employer cannot change the conditions and/or schedule and/or workplace to eliminate the risks to the employee’s health, of the fetus or, as the case may be, of the child. The O.U.G. no. 96/2003 provisions do not apply, even though the employee submits recommendations from the family doctor or the specialist regarding the limitation/avoidance of certain activities/factors, if in the Risk Assessment Report no such activities/factors are identified.

Given the complexity and variety of occupational exposure, as well as the very specific legislative provisions on preventing the negative effects of occupational activity on pregnancy, closer collaboration is needed between occupational medicine, obstetrics-gynecology and family medicine, specialties that should work together more effectively for the benefit of the pregnant woman. It is necessary to develop communication procedures and improve the way healthcare is provided, including ensuring the possibility of interdisciplinary consultation of these specialists.

Conflict of interests: The authors declare no conflict of interests.

Concediul medical pentru risc maternal: o intervenţie preventivă de medicină a muncii

The sick leave for maternal risk: a preventive occupational medicine intervention

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