1. Barbara Mihevc Ponikvar, Tit Albreht, Marjan Bilban EUMASS Congress, Ljubljana, June 2016 Factors associated with sick leave during pregnancy in Slovenia

4. In Slovenia fertility rate is low, total fertility rate in last years is approximately 1,5 children per woman. Average age of women at the time of delivery is over 30 years. Slovenian women are employed in high percent (women represent almost 45 % of work force). Women mostly work full time and stay employed when they get pregnant and have children. Paid maternity leave in Slovenia usually starts 4 weeks before estimated date of delivery. Some facts

5. Pregnancy is a specific physiological state which may (together with relatively frequent medical problems) affect pregnant woman's capacity for work. Approximately 15 % of pregnancies are high risk. Pregnancy and capacity for work

6. Absence from work during pregnancy is common in many countries. In Slovenia in public opinion sick leave of pregnant women has often been presented as a problem. The aim of our study was to investigate this phenomenon in more detail and to identify factors associated with long-term sick leave in pregnancy. Sick leave during pregnancy days

7. We computer linked two routine medical databases operated by NIPH: Perinatal Information System of the Republic of Slovenia and The Record of Temporary and Permanent Absence from Work due to Illness, Injury, Nursing, and Other Causes. Linking key was the unique health insurance number. This process gave us combined data on pregnant women characteristics, pregnancy and pregnancy outcome together with details of pregnant women’s sick leave in the year prior to delivery. Multiple logistic regression was used to determine the impact of selected demographic and health related factors on long term sick leave during pregnancy (sick leave episode longer than 30 days). Methodology

8. SL ML D D 36 gw LMP Hyperemesis gravidarum, 10 days Influenza, 5 days Cervical incompetence, 40 days Pregnancy Before pregnancy

9. The study included 12.935 (97.1 %) employed pregnant women, who gave birth in 2003 in Slovenia. Before pregnancy the observed population of women was relatively rarely on sick leave (on average 3 % every day, including cases of nursing). Very soon after becoming pregnant sick leave increased over basal levels. There was a peak in frequency of sick leave in the 30 th week of pregnancy when every other pregnant woman was absent from work. Results

10. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Percent of sick leave by pregnancy week

11. 74 % of employed pregnant women were on sick leave at least once during pregnancy. 53 % of employed pregnant women had an episode of sick leave longer than 30 days. The average length of sick leave during pregnancy, without cases of nursing, was 78.5 calendar days. The predominant reason for sick leave were conditions associated with pregnancy. Results

12. Odds for sick leave episode longer than 30 days (multivariate analysis) ORp95 % CI Age < 35 35 + 1,13 0,034 1,01 1,26 Education tertiary secondary1,39< 0,0011,271,52 primary1,90< 0,0011,712,12 unknown1,22< 0,0011,101,36 Unemployment in the area high low 1,25 < 0,001 1,12 1,39 Sector of employment other sectors manufacturing1,45< 0,0011,321,58 health and social care1,62< 0,0011,431,84 catering1,51< 0,0011,271,79 BMI < 30 30 + 1,30 0,001 1,12 1,51 Chronic disease no yes 1,34 < 0,001 1,16 1,54 Poor obstetric history (preterm birth, miscarriage, …) no yes 1,70 < 0,001 1,55 1,86 Infertility treatment no yes 1,97 < 0,001 1,66 2,34 Multiple pregnancy no yes 1,75 < 0,001 1,30 2,36

13. Age 35+ Education - primary BMI 30+ Chronic disease Multiple pregnancy Poor obstetric history Infertility treatment Sector of employment – manufacturing, health and social care, catering Area with low unemploy- ment Risk score for sick leave episode longer than 30 days 93 % 92 % 91 % 91 % 90 % 90 % 90 % 90 % 89 % 89 % …. 34 % Results – risk scores for combinations of risk factors

14. Sick leave in pregnancy is common and causes are very diverse and complex. But sick leave in pregnancy is significantly related to pregnant women’s health. It is most prevalent in those women who have a combination of several factors that increase the risk of complications during pregnancy. There is also correlation of long-term sick leave in pregnancy and workplace conditions. In addition to factors that were included in our research the causes of long-term sick leave must also be sought elsewhere, that is why further investigation of associated factors is needed to elucidate this issue. Conclusions

15. Contact: barbara.mihevc@nijz.si Thank you for your attention!