Pregnancy related sickness absence in a Swedish county, 1985-87

Sickness absence during pregnancy has increased in Sweden as well as in other countries. STUDY OBJECTIVE--The study aimed to describe pregnancy related sickness absence and its increase from 1985-87; to consider if the increase were parallel to an increase in sickness absence for all diagnoses or could be explained by a higher birth rate; and to compare different ways of presenting sickness absence data. DESIGN--The data from a prospective incidence study of all new sick leave spells exceeding seven days in 1985-87 were related to the population at risk through relevant data from different registers. SETTING--The county of Ostergötland, Sweden (about 400,000 inhabitants). PARTICIPANTS--Subjects were approximately 70,000 sick leave-insured women aged 16-44 years, of whom some 15,000 had sickness absences > seven days. Some 4600 women gave birth in 1985, approximately 1300 of whom were listed as having pregnancy related diagnoses. MAIN RESULTS--The number of women with sick leave associated with pregnancy related diagnoses increased by 24% (95% confidence interval (CI) 15, 33%) during the period. This diagnosis group was one of the very few with an increasing number of people listed as sick. The corresponding increase for all diagnoses in women aged 16-44 years was < 1% (95% CI 1, 3%). The increase in the number of women who gave birth was 9% (95% CI 5, 13%). The sick leave rate associated with pregnancy related disorders increased by 14% (95% CI 7, 21%) in 1985-87, while that in all women aged 16-44 years increased by 3% (95% 1, 5%). (p < 0.0001). The number of sick leave days associated with pregnancy related disorders increased by 49% (p < 0.0001) in the period--twice the equivalent increase (p < 0.0001) in the total number of sick leave days for all diagnoses taken together. The sick leave rate and duration, like the increase in these variables, varied with age. Different ways of presenting the length of absence proved complementary to each other. CONCLUSIONS--After correcting for changes in the overall sick leave rate and in the birth rate, there is still an 11% increase in the sick leave rate associated with pregnancy related disorders that needs to be explained. Medical factors cannot explain this increase but changes in attitudes and practice in relation to sickness insurance among pregnant women and their doctors merit further study.