Pregnant Workers Research Articles

Towards Reasonable: The Rise of State Pregnancy Accommodation Laws

In light of the recent Supreme Court decision Young v. UPS, pregnancy accommodation in the workplace is once again at the forefront of employment law. Pregnancy is not considered a disability under the ADA, nor is it within the scope of Title VII protections, but states are passing their own pregnancy accommodation laws. These laws will affect employers and employees alike, but exactly how is uncertain. Perhaps the most natural (and obvious) result of the explosion of state pregnancy accommodation laws will be a federal law, or an amendment to the ADA categorizing pregnancy as a disability. But there are reasons that the seemingly minimal accommodations for pregnant workers have not been met with overwhelming support. Some fear the increased cost to employers. Others fear the stigma of equating pregnancy with a disability. Nevertheless, employers will have to grapple with increased state protections supplementing the already-existing scheme of Title VII. Young adds another complication by lessening the burden to prove an employer’s duty to accommodate. For multinational corporations, tailoring their pregnancy policies to each state might prove costlier than uniformly implementing the plan of the most generous state. Employers are already accommodating disabled employees in the same manner. And these accommodations are by definition “reasonable.” Employers might not only avoid needless liability by providing accommodations to pregnant workers—even when not required—but might also gain numerous benefits, such as: increased morale; lower attrition rates; more productive workers; and better reputations. Accommodating pregnant workers seems uncontroversial, but every federal bill introduced to do so has been strongly opposed and stopped. States may now be leading the way and, ultimately, pregnancy accommodation laws will create positive benefits for women.

P-B20 Evaluation of the feasibility of incorporating HPV DNA- based cervical cancer screening into routine antenatal care in Nigeria

Introduction: Persistent high-risk HPV infection is a necessary cause of cervical cancer. HPV DNA testing is now the primary WHO recommended approach to cervical cancer screening. Cervical cancer screening uptake remains abysmally low in Nigeria and in other low and middle income countries (LMIC). Antenatal care-based HPV DNA testing is a largely unexplored strategy to increase uptake of cervical cancer screening in LMIC. Up to 70% of women in Africa attend ANC at least once during their pregnancy and many attend at least twice. We evaluated the acceptability of HPV DNA testing as part of routine antenatal care among pregnant women and healthcare workers in Nigeria. Methodology: We conducted focus group discussions (FGD) among pregnant women and Key Informant Interviews among healthcare providers at a hospital facility in Abuja, Nigeria. A total of 24 muslim and christian pregnant women were invited for the focus groups and each group comprised of 6–10 participants. Obstetric/Gynaecologists (O&G) and ANC nurses were interviewed. We used content analysis method for data analysis. Coding sheets were developed to summarize findings. Results: Our study showed fair level of knowledge and awareness of cervical cancer and cervical cancer screening among the pregnant women, however, practice was poor, as none of the women had ever been screened for cervical cancer. Lack of awareness about cervical cancer screening, costs, and fear of screening outcome were commonly cited as barriers to uptake. The nurses interviewed expressed reservations about the willingness of pregnant women to participate in screening but there was a high level of willingness among the pregnant women to be screened during the ANC period. Their religion and parity played no role in determining the acceptance of HPV DNA testing in ANC. The O&G specialists expressed full support for integrating HPV DNA testing into routine ANC services. Conclusions: Our results show the need to explore more innovative public health interventions to reduce cervical cancer burden in LMIC.

Ventilation Rates during the Aggregate Daytime Activities of Working Females in Hospitals: Data before their Pregnancy and at their 9th, 22nd and 36th Week of Gestation

Working females in hospitals may inhale pharmaceutical agents, chirurgical smokes, organic solvents, bacteria and/or viruses. These inhaled agents may generate adverse effects in gravid females, their embryo or fetus. Therefore, minute ventilation rates (VE) during the aggregate daytime activities of under (n=68), normal (n=268), overweight (n=42), obese class 1 (n=68) and classes 2-3 (n=51) females working in hospitals were determined before and during their pregnancy using published measurements of energy expenditures. For comparison purposes, VE values were also calculated for the same females at rest. Activity energy expenditures were based on disappearance rates of oral doses of water isotopes (i.e. 2H2O, H2 18O) monitored in urine samples of free-living hospital workers during 175 days by gas-isotope-ratio mass spectrometry. Basal energy expenditures were obtained by indirect calorimetry, whereas energy costs for pregnancy were measured in a room calorimeter. Sleep durations (7.30 ± 1.59 to 8.09 ± 1.25 hours/ day; mean ± standard deviation) and ventilatory equivalents (31.7 ± 0.93 to 39.3 ± 3.3 L of air inhaled/L of oxygen consumed) during pregnancy were determined and integrated into the calculation process. Based on VE percentiles some non-pregnant and pregnant female workers inhale more air (thus more air pollutants), than the default VE value of 20.83 L/min (i.e. 10 m3 in an 8 hour workday) notably used for calculations of hygienic standards for airborne xenobiotics. Highest 99th percentiles of 34.28, 29.27 26.49 and 29.52 L/min were found in obese classes 2-3 female workers, before their pregnancy and at their 9th, 22nd and 36th week of gestation, respectively. Considering what precedes and the fact that the human chorionic gonadotropin is detected in the blood or urine samples of women after the implantation of their blastocyst, which occurs many days after fertilization, the non-exposure of female workers to teratogenic agents in hospitals is recommended before and during their pregnancy. The same applies for the exposure to carcinogens which may generate procarcinogenic DNA damage in the fetus.

Canadian Indigenous Womens Perspectives of Maternal Health and Health Care Services: A Systematic Review

Development of policies and interventions to address health disparities between Indigenous and non-Indigenous populations requires a comprehensive understanding of Indigenous people’s experiences and perspectives of healthcare services. We systematically reviewed the published literature on Canadian Indigenous women’s experiences and perspectives of maternal healthcare during pregnancy, childbirth, and the postpartum period. Major bibliographic databases (including PubMed, CINAHL, EMBASE, SCOPUS, and SSCI) were searched for published studies (1990–March 2015) in English. Reference lists of identified articles were searched to identify additional articles. 92 articles were retrieved for further review, of which 16 studies were included: 8 on maternal healthcare and/or medical evacuation; 3 on gestational diabetes mellitus; 3 on the impact of policies on maternal health; and 2 on maternal weight changes and/or breastfeeding. The included studies described 1043 participants: Indigenous peoples (n=918) and non-Indigenous peoples (n=125) who were mothers or pregnant women (n=814), healthcare providers or workers in a health-related field (n=132), and fathers, Elders, or other community members (n=97). Availability of healthcare resources, healthcare services’ consideration of socio-economic or lifestyle barriers to health, and the impact of colonization on interactions with healthcare providers were main factors that impacted Indigenous women’s maternal health experiences. Medical evacuation was often due to limited maternity care options available in remote communities, and was associated with emotional, physical, and financial stress. This review highlights the importance of consistent health policies and practices for maternal health in Canada and providing culturally safe and patient-centered maternity healthcare services within indigenous communities.

Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study.

BackgroundOutbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use.MethodsWe conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials.ResultsExercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI −33.5 % to −10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI −34.2 % to −15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO2) and carbon dioxide expired (VCO2) were also significantly reduced; VO2 by 13.8 % (95 % CI −24.2 % to −3 %, p = 0.013) and VCO2 by 17.7 %, (95 % CI −28.1 % to −8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: −4.1 % to −2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated.ConclusionsBreathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.Trial RegistrationThe study was registered at clinicaltrials.gov, identifier NCT00265926.

Retrait préventif du travail, exposition aux contraintes psychosociales au travail et symptômes dépressifs majeurs

AimOur study objectives were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work. MethodologyKarasek's abbreviated scale was used to measure psychosocial work demands (Job strain and “Iso-strain”) and CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score≥23), at 24–26 weeks of pregnancy, among 3043 pregnant women in Montreal (Quebec) who worked at paid jobs at least 15h/week and at least four consecutive weeks since the beginning of their pregnancy. Multivariate logistic regression models were built. ResultsAt 24–26weeks of pregnancy, 31.4% (956/3043) of pregnant women were on preventive withdrawal from work. They were more in “high-strain” (31.1% vs. 21.1%) and “Iso-strain” groups (21.0% vs. 14.2%) than those who continued to work (P<0.0001). The prevalence of major depressive symptoms was higher in women on preventive withdrawal from work (10.8%; CI 95%: 8.9 to 12.9) compared to working women (7.1%; CI 95%: 6.1–8.3). After adjustment for personal and professional risk factors, “Iso-strain” remained significantly associated with major depressive symptoms in working women (adjusted OR=1.75; CI 95%: [1.05 to 2.92]) and women on preventive withdrawal from work, regardless of duration of activity before withdrawal: 4 to 12 weeks (adjusted OR=2.72; CI 95%: [1.19–6.12]), 13 to 20 weeks (adjusted OR=3.51; CI 95%: [1.54–7.97]), and ≥21 weeks (adjusted OR=2.39; CI 95%: [1.10–5.20]). ConclusionPsychosocial work demands are an important risk factor for the mental health of pregnant workers and require that preventive actions be put forward.

Effect of Pregnancy Upon Facial Anthropometrics and Respirator Fit Testing

Workers required to wear respirators must undergo additional respirator fit testing if a significant change in body weight occurs. Approximately 10% of working women of reproductive age will be pregnant and experience a significant change in weight, yet the effect of pregnancy-associated weight gain on respirator fit is unknown. Cephalo-facial anthropometric measurements and quantitative fit testing of N95 filtering facepiece respirators (N95 FFR) of 15 pregnant women and 15 matched, non-pregnant women were undertaken for comparisons between the groups. There were no significant differences between pregnant and non-pregnant women with respect to cephalo-facial anthropometric measurements or N95 FFR quantitative fit tests. Healthy pregnant workers, who adhere to the recommended weight gain limits of pregnancy, are unlikely to experience an increase in cephalo-facial dimensions that would mandate additional N95 FFR fit testing above that which is normally required on an annual basis.

Pregnant Employee Protection Program in a Large Chemical Company.

To assess whether a structured employee protection program for pregnant workers at a chemical company has an impact on pregnancy outcomes. Reported pregnancies (n = 1402) between 2003 and 2010 and their outcomes were documented using questionnaires at the time of pregnancy report, end of pregnancy, and 1 year later. Potential maternal exposures were assessed using job histories, workplace inspections, and questionnaires. Participation was 86% overall and was consistently high across subgroups.Pregnancy losses (10.9%), pregnancy complications, and preterm births (8.1%) were in agreement with rates in the general population and were independent of type of work and maternal exposure category. Pregnancy complication rates in this chemical company are not statistically elevated than that in the general population, as suggested in a previous study. The protection program may play a role in preventing complications that may have occurred.

Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review

Maternal vaccination has been evaluated and found to be extremely effective at preventing illness in pregnant women and new-borns; however, uptake of such programmes has been low in some areas.To analyse factors contributing to uptake of vaccines globally, a systematic review on vaccine hesitancy was carried out by The Vaccine Confidence Project in 2012. In order to further analyse factors contributing to uptake of maternal immunisation, a further search within the broader systematic review was conducted using the terms ‘Pregnan*’ or ‘Matern*’. Forty-two articles were identified. Pregnancy-related articles were further screened to identify those focused on concerns, trust and access issues regarding maternal vaccination reported by pregnant women and healthcare workers. Thirty-five relevant articles were included which were then searched using the snowballing technique to identify additional relevant references cited in these articles. A search alert was also conducted from February to April 2015 in PubMed to ensure that no new relevant articles were missed. A total of 155 relevant articles were included.Most of the literature which was identified on hesitancy surrounding vaccination during pregnancy reports on determinants of influenza vaccine uptake in North America. Research conducted in low-income countries focused primarily on tetanus vaccine acceptance. The main barriers cited were related to vaccine safety, belief that vaccine not needed or effective, not recommended by healthcare worker, low knowledge about vaacines, access issues, cost, conflicting advice. From the point of view of healthcare workers, barriers included inadequate training, inadequate reimbursement and increased workload. Twenty-seven out of 46 (59%) articles mentioning ethnicity reported lower rates of coverage among ethnic minorities.Barriers to vaccination in pregnancy are complex and vary depending on context and population. There are wide gaps in knowledge regarding the attitudes of healthcare workers and how ethnicity and gender dynamics influence a pregnant woman's decision to vaccinate.

The pregnant healthcare worker: fact and fiction.

A pregnant healthcare worker (HCW) may be at risk of occupational exposure to pathogens associated with increased maternal morbidity and mortality as well as perinatal complications. In this article, we review recent literature on infectious diseases commonly encountered in the healthcare setting and of highest concern for a pregnant HCW, focusing on prevention and management of exposures. Pregnancy does not seem to be an independent risk factor for occupationally acquired infectious diseases. Vaccination and standard precautions continue to be the most effective means of preventing transmission to HCWs. Pandemic 2009 influenza A (H1N1) is associated with increased risk of fetal death, highlighting the importance of influenza vaccination. A recent meta-analysis highlights the safety of influenza vaccination during pregnancy. New treatments for hepatitis C have not been studied in pregnancy but pose an important area for research and advancement. Cytomegalovirus immunoglobulin may play a role in postexposure prophylaxis but recent results are inconclusive. Primary prevention with vaccination and use of appropriate infection control precautions is imperative for prevention of occupationally acquired infectious diseases. Pregnant HCWs with occupational exposure to communicable diseases should be evaluated immediately for appropriate postexposure prophylaxis and followed for development of active infection.

FDA Requests More Data on Antiseptics

The Food and Drug Administration has requested more scientific data on the safety and effectiveness of the active ingredients in antiseptic products used in hospitals, physician's offices, and other health care settings in a recently proposed rule. Alcohol and iodine are among the most common active ingredients in these products, which include hand washes and rubs, surgical hand scrubs and rubs, and preoperative skin preparations used on patients. These products are marketed under an over-the-counter drug monograph and are different than antibacterial soaps, hand sanitizers, and other consumer antiseptic products, which are not included in this proposed rule. To continue to market these products under the monograph, manufacturers must provide the FDA with more data on the safety and effectiveness of the active ingredients, including absorption, hormonal effects, and bacterial resistance, according to an FDA statement. “Emerging science” suggests that, for at least some active ingredients used in these products, “systemic exposure … is higher than previously thought, and existing data raise potential concerns about the effects of repeated daily human exposure to some antiseptic active ingredients,” the statement said. The agency “is particularly interested in gathering additional data on the long-term safety of daily, repeated exposure to these ingredients in the health care setting and on the use of these products by certain populations, including pregnant and breastfeeding health care workers, for which topical absorption of the active ingredients may be important.” The proposed rule is available at www.federalregister.gov. Public comments can be submitted until Oct. 27. Elizabeth Mechcatie is a reporter with Frontline Medical News.

New aspects from legislation, guidelines and safety standards for MRI

Many aspects of magnetic resonance (MR) operation are not directly regulated by law but in standards, guidelines and the operating instructions of the MR scanner. The mandatory contents of the operating instructions are regulated in a central standard of the International Electrotechnical Commission (IEC) 60601-2-33. In this standard, the application of static magnetic fields in MRI up to 8 Tesla (T) in the clinical routine (first level controlled mode) has recently been approved. Furthermore, the equally necessary CE certification of ultra-high field scanners (7-8 T) in Europe is expected for future devices. The existing installations will not be automatically certified but will retain their experimental status. The current extension of IEC 60601-2-33 introduces a new add-on option, the so-called fixed parameter option (FPO). This option might also be switched on in addition to the established operating modes and defines a fixed device constellation and certain parameters of the energy output of MR scanners designed to simplify the testing of patients with implants in the future.The employment of pregnant workers in an MRI environment is still not generally regulated in Europe. In parts of Germany and Austria pregnant and lactating employees were prohibited from working in the MR control zone (0.5 mT) in 2014. This is based on the mostly unresolved question of the applicability of limits for employees (exposure of extremities to static magnetic fields up to 8 T allowed) or the thresholds for the general population (maximum 400 mT). According to the European Society of Urogenital Radiology (ESUR), the discarding of breast milk after i.v. administration of gadolinium-based contrast agents in the case of a breastfeeding woman is only recommended when using contrast agents in the nephrogenic systemic fibrosis (NSF) high-risk category.

Non work-related sickness absence in 2013 in a Spanish banking sector company

To describe the incidence and duration of episodes of non work-related temporary sickness absence (SA) between January and December of 2013, by diagnostic groups, in a banking sector company. Cross-sectional study of 3.193 episodes of SA (≥ day), excluding work-related injuries and illnesses. The distribution of the duration of SA episodes by medical diagnosis was analyzed by calculating the median duration, 25th and 75th percentiles, mean and standard deviation. The median duration of SA was 9 days for cases where there was a medical diagnosis (n=2.931, 91.8%); the 25th and 75th percentiles were 4 and 32 days, respectively. The most frequent pathologies were respiratory (19.9%), followed by musculoskeletal (19.1%) and pregnancy-related disorders (17.3%). Neoplasms had the longest median duration (49 days), followed by pregnancy-related disorders (39 days) and psychiatric disorders (23 days). Overall sickness absence incidence in our study population was lower, but had a longer duration, as compared to similar studies. The incidence and duration by diagnostic groups were very similar to that reported in the literature, except for pregnancy-related disorders, where both were clearly higher (incidence 4 to 11 times and duration 0.4 times larger) in our company (<0.001). This analysis is useful from a prevention perspective, and suggests the need to prioritize the study to the control of potential workplace exposures that might be affecting pregnant workers' health.

The pregnant workers directive: must do better: lessons to be learned from Strasbourg?

The rights related to pregnancy, maternity and parenthood in the workplace have significantly evolved in recent decades. Such evolution has been triggered by important social changes, such as the increasing involvement of men in caring activities as well as the development of new forms of families in which children are being raised. Yet, these changes are not always adequately addressed by the existing legal framework. The article examines the Pregnant Workers Directive (92/85/EEC) and its interpretation and application in the case law of the Court of Justice of the European Union, and concludes that it is in urgent need of reform. The conclusions are based on the evaluation of the related case law of the European Court of Human Rights, in the light of the pending accession of the EU to the European Convention on Human Rights.

Pregnant Laborers Should Expect Better: The Broken Pregnancy Discrimination Standard and How the Pregnant Workers Fairness Act Can Repair It

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Parity by Comparison: The Case for Comparing Pregnant and Disabled Workers

Abstract In 2008, Congress enacted amendments to the Americans with Disabilities Act ("ADA") that expanded the ADA's definition of "disability," requiring employers to provide reasonable accommodations to workers with temporary impairments. This Article argues that the expansion of the protections of the ADA effectively expanded the protections of the Pregnancy Discrimination Act ("PDA"), too. As the Supreme Court recently reinforced in Young v. United Parcel Service, the PDA generally requires employers to treat pregnant workers "the same" as non-pregnant workers who are similar in their ability or inability to work. Therefore, to the extent that pregnancy-related impairments mirror impairments that are accommodated under the expanded ADA, pregnant workers, too, should be entitled to reasonable accommodations. Although some scholars and courts have suggested that ADA-covered employees cannot be proper comparators for PDA plaintiffs, I make the case that these workers can, and should, be compared. First, I argue that PDA precedent requiring employers to treat pregnant workers the same as other impaired workers, as well as the legislative history of the PDA, compel this comparison. Second, I draw on two theoretical approaches-intersectionality theory and "disruption" theory--to demonstrate that denying ADA comparators to PDA plaintiffs ignores the unique intersectional nature of pregnancy, and would invite stereotyping, segregation, and discrimination. In conclusion, I note that the Supreme Court signaled in Young that courts should take a more expansive view of the types of evidence that can support a PDA claim, opening the door to a broader approach to the comparator question. INTRODUCTION In the last two decades, the United States has seen an explosion in pregnancy discrimination claims. The number of pregnancy-related charges filed with the EEOC nearly doubled from 1992 to 2010,' even though the number of antidiscrimination cases as a whole has declined every year since 1998. (2) Congress enacted the PDA in 1978 to clarify that pregnancy discrimination constituted prohibited discrimination on the basis of sex under Title VII. (3) Yet the prevailing interpretation of the PDA has made it difficult for plaintiffs to establish a successful claim. (4) Moreover, many pregnant workers could work later into their pregnancies if their employers made even simple accommodations--but these accommodations are not currently required by law. (5) Pregnant employees have lost their jobs for reasons directly related to their pregnancies. For example, pregnant workers have been fired for needing extra bathroom breaks (6) or to drink water on the job, (7) and have been denied light duty assignments despite doctor-ordered heavy-lifting restrictions. (8) The difficulties facing pregnant women (9) on the job have increasingly gained the attention of the EEOC, (10) the media, (11) legal scholars, (12) advocacy organizations, (13) and, most recently, the Supreme Court of the United States. (14) On March 25, 2015, the Supreme Court clarified the meaning of the PDA in Young v. United Parcel Service, (15) handing pregnant workers both a victory and a challenge. Young was a victory for pregnant employees because it announced an interpretation of the PDA that has the potential to reinvigorate the Act's protections. It presented a challenge, however, because it reinforced the primacy of the McDonnell Douglas burden-shifting framework as the method for proving most pregnancy discrimination claims. (16) Historically, pregnancy discrimination plaintiffs have found it difficult to prove their cases under McDonnell Douglas because success through that framework almost always depends on the ability to identify a "comparator"--a similarly situated non-pregnant worker who was treated better. (17) Workers seeking accommodations for the temporary impairments that can arise out of pregnancy have been hard-pressed to find comparators because the law has not required employers to provide accommodations to workers with temporary, non-pregnancy-related impairments, either, especially when the source of the impairment is unrelated to the worker's job. …

Parity by Comparison: The Case for Comparing Pregnant and Disabled Workers

Abstract In 2008, Congress enacted amendments to Americans with Disabilities Act (ADA) that expanded ADA's definition of disability, requiring employers to provide reasonable accommodations to workers with temporary impairments. This Article argues that expansion of protections of ADA effectively expanded protections of Pregnancy Discrimination Act (PDA), too. As Supreme Court recently reinforced in Young v. United Parcel Service, PDA generally requires employers to treat pregnant workers the as non-pregnant workers who are similar in their ability or inability to work. Therefore, to extent that pregnancy-related impairments mirror impairments that are accommodated under expanded ADA, pregnant workers, too, should be entitled to reasonable accommodations. Although some scholars and courts have suggested that ADA-covered employees cannot be proper comparators for PDA plaintiffs, I make case that these workers can, and should, be compared. First, I argue that PDA precedent requiring employers to treat pregnant workers same as other impaired workers, as well as legislative history of PDA, compel this comparison. Second, I draw on two theoretical approaches-intersectionality theory and disruption theory--to demonstrate that denying ADA comparators to PDA plaintiffs ignores unique intersectional nature of pregnancy, and would invite stereotyping, segregation, and discrimination. In conclusion, I note that Supreme Court signaled in Young that courts should take a more expansive view of types of evidence that can support a PDA claim, opening door to a broader approach to comparator question. INTRODUCTION In last two decades, United States has seen an explosion in pregnancy discrimination claims. The number of pregnancy-related charges filed with EEOC nearly doubled from 1992 to 2010,' even though number of antidiscrimination cases as a whole has declined every year since 1998. (2) Congress enacted PDA in 1978 to clarify that pregnancy discrimination constituted prohibited discrimination on basis of sex under Title VII. (3) Yet prevailing interpretation of PDA has made it difficult for plaintiffs to establish a successful claim. (4) Moreover, many pregnant workers could work later into their pregnancies if their employers made even simple accommodations--but these accommodations are not currently required by law. (5) Pregnant employees have lost their jobs for reasons directly related to their pregnancies. For example, pregnant workers have been fired for needing extra bathroom breaks (6) or to drink water on job, (7) and have been denied light duty assignments despite doctor-ordered heavy-lifting restrictions. (8) The difficulties facing pregnant women (9) on job have increasingly gained attention of EEOC, (10) media, (11) legal scholars, (12) advocacy organizations, (13) and, most recently, Supreme Court of United States. (14) On March 25, 2015, Supreme Court clarified meaning of PDA in Young v. United Parcel Service, (15) handing pregnant workers both a victory and a challenge. Young was a victory for pregnant employees because it announced an interpretation of PDA that has potential to reinvigorate Act's protections. It presented a challenge, however, because it reinforced primacy of McDonnell Douglas burden-shifting framework as method for proving most pregnancy discrimination claims. (16) Historically, pregnancy discrimination plaintiffs have found it difficult to prove their cases under McDonnell Douglas because success through that framework almost always depends on ability to identify a comparator--a similarly situated non-pregnant worker who was treated better. (17) Workers seeking accommodations for temporary impairments that can arise out of pregnancy have been hard-pressed to find comparators because law has not required employers to provide accommodations to workers with temporary, non-pregnancy-related impairments, either, especially when source of impairment is unrelated to worker's job. …

MO‐F‐CAMPUS‐I‐02: Occupational Conceptus Doses From Fluoroscopically‐Guided Interventional Procedures

Purpose:The aim of this method was to provide dosimetric data on conceptus dose for the pregnant employee who participates in fluoroscopically‐guided interventional procedures.Methods:Scattered air‐kerma dose rates were obtained for 17 fluoroscopic projections involved in interventional procedures. These projections were simulated on an anthropomorphic phantom placed on the examination table supine. The operating theater was divided into two grids relative to the long table sides. Each grid consisted of 33 cells spaced 0.50 m apart. During the simulated exposures, at each cell, scatter air‐kerma rate was measured at 110 cm from the floor i.e. at the height of the waist of the pregnant worker. Air‐kerma rates were divided by the dose area product (DAP) rate of each exposure to obtain normalized data. For each projection, measurements were performed for 3 kVp and 3 filtration values i.e. for 9 different x‐ray spectra. All measurements were performed by using a modern C‐arm angiographic system (Siemens Axiom Artis, Siemens, Germany) and a radiation meter equipped with an ionization chamber.Results:The results consist of 153 iso‐dose maps, which show the spatial distribution of DAP‐normalized scattered air‐kerma doses at the waist level of a pregnant worker. Conceptus dose estimation is possible using air‐kerma to embryo/fetal dose conversion coefficients published in a previous study (J Cardiovasc Electrophysiol, Vol. 16, pp. 1–8, July 2005). Using these maps, occupationally exposed pregnant personnel may select a working position for a certain projection that keeps abdominal dose as low as reasonably achievable. Taking into consideration the regulatory conceptus dose limit for occupational exposure, determination of the maximum workload allowed for the pregnant personnel is also possible.Conclusion:Data produced in this work allow for the anticipation of conceptus dose and the determination of the maximum workload for a pregnant worker from any fluoroscopically‐guided interventional procedure.This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT).

"You cannot know if it's a baby or not a baby": uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya.

BackgroundAntenatal care early in pregnancy enables service providers to identify and manage risks to mother and fetus. In the global north, ultrasound scans are routinely offered in pregnancy to provide an accurate estimate of gestational age and identify potential problems. In sub-Saharan Africa, such services are rarely available and women often delay initiating antenatal care. This study describes the uptake and provision of antenatal care in a rural Kenyan hospital and explores how pregnant women and healthcare providers perceived the provision of ultrasound scanning, following its introduction in an international foetal growth study.MethodsA descriptive study, using qualitative and quantitative methods, was conducted in Kilifi District Hospital, Kenya, between June 2011 and April 2012. In-depth interviews were conducted with 10 nurses working in the antenatal clinic (ANC) and 59 pregnant women attending ANC. Structured observations of 357 ANC consultations and 30 ultrasound scans were made.ResultsWomen sought antenatal care for information about the health of their baby and the protection provided by the ANC services. Uncertainty about pregnancy status contributed to delay in ANC attendance; more than 78 % of women were over 20 weeks’ gestation at their first visit. Healthcare workers found it difficult to detect pregnancies below 16 weeks gestation and, accurate assessment of gestational age below 20 weeks’ gestation could be problematic. Provision of services depended on the pregnancy being detected and gestational age assessed. The “seeing”, made possible through ultrasound scanning was perceived by pregnant women and healthcare workers to be beneficial: confirming the pregnancy, and providing reassurance about the fetus’ condition. Few participants raised concerns about ultrasound scanning.ConclusionsUncertainty about pregnancy status and gestational age for women and healthcare providers is a key factor influencing timing of ANC attendance, contributing to delays and restricting early provision of ANC services. Ultrasound scanning was perceived to enhance antenatal care through confirmation of pregnancy status and enabling more accurate estimation of gestational age and the health status of the fetus. There is a need to make available more affordable means of pregnancy testing as a strategy towards encouraging early attendance, and delivery of antenatal care.

Modifiable barriers to leisure-time physical activity during pregnancy: a qualitative study investigating first time mother's views and experiences.

BackgroundEvidence suggests physical activity often declines during pregnancy, however explanations for the decline are not well understood. The aim of this study was to identify modifiable barriers to leisure-time physical activity among women who did not meet physical activity guidelines during pregnancy.MethodsAnalyses were based on data from 133 mothers (~3-months postpartum) who were recruited from the Melbourne InFANT Extend study (2012/2013). Women completed a self-report survey at baseline in which they reported their leisure-time physical activity levels during pregnancy as well provided an open-ended written response regarding the key barriers that they perceived prevented them from meeting the physical activity guidelines during their pregnancy. Thematic analyses were conducted to identify key themes.ResultsThe qualitative data revealed six themes relating to the barriers of leisure-time physical activity during pregnancy. These included work-related factors (most commonly reported), tiredness, pregnancy-related symptoms, being active but not meeting the guidelines, lack of motivation, and a lack of knowledge of recommendations.ConclusionConsidering work-related barriers were suggested to be key factors to preventing women from meeting the physical activity guidelines during pregnancy, workplace interventions aimed at providing time management skills along with supporting physical activity programs for pregnant workers should be considered. Such interventions should also incorporate knowledge and education components, providing advice for undertaking leisure-time physical activity during pregnancy.