A landmark Danish study published this month has sent ripples through the healthcare sector with a striking finding: each extra hour of bending forward at work during early pregnancy may raise the risk of miscarriage by 36%. Walking, too, showed an association, with an 18% increased risk per additional hour per day.
For aged care providers and their staff, these numbers deserve careful attention. Personal care assistants, nurses, and other aged care workers bend, lift, walk, and stand for the vast majority of every shift. If anyone needs to understand what this research means in practice, it’s the aged care sector.
But the picture is more nuanced than the headlines suggest, and miscarriage risk in aged care goes well beyond posture.
The research, published in the journal Occupational and Environmental Medicine, tracked more than 800,000 pregnancies across Denmark between 2004 and 2018. Researchers linked each woman’s job title to a database built from motion sensors worn by pregnant workers, then looked at how occupational physical activity correlated with miscarriage rates.
The headline findings, 36% increased risk per additional hour of bending, 18% for walking, and 3% for standing, sound alarming. But context matters enormously here.
First, these are relative risks applied to each additional hour of activity above a baseline. The average worker in the study bent forward for only around 24 minutes across an eight-hour shift. An extra hour of daily bending above that baseline might shift a baseline miscarriage risk of roughly 10 in 100 pregnancies to around 13 in 100.
Second, the study had significant blind spots. Smoking, one of the strongest known risk factors for miscarriage, was far more common among women in physically demanding jobs, with nearly 10% of workers in the highest-exposure roles smoking during pregnancy compared to around 4% in the lowest-exposure roles. The researchers had no individual-level smoking data for most women who miscarried, meaning the effect of physical activity and the effect of smoking could not be cleanly separated. When researchers attempted to adjust for smoking using population-level estimates, the risk associations weakened substantially, most notably for standing, which nearly disappeared.
Third, the study could not separate forward bending from heavy lifting, which other research has more clearly tied to miscarriage. And oddly, women in the very highest-exposure jobs did not actually have the highest miscarriage rates, which is the opposite of what you’d expect if physical work were truly the primary driver.
The study’s authors are clear that replication in comparable populations, with better individual health data, is needed before firm conclusions can be drawn.
The most important point, one that bears repeating: the majority of miscarriages are caused by random chromosomal abnormalities in the embryo, events that are entirely unrelated to what a woman does at work.
With those caveats in mind, the Danish study still raises legitimate questions for aged care employers, because the job description of a personal care assistant maps almost directly onto the activities flagged as concerning.
Aged care work is among the most physically demanding in the Australian workforce. Lifting and repositioning residents, assisting with transfers from bed to chair, bending to provide personal care, and walking constantly across large facilities are not incidental; they are the core of the job. WorkSafe Victoria identifies manual handling as one of the most common hazard categories in aged care, noting that tasks like lifting, transferring, repositioning, and supporting residents place workers at high risk of musculoskeletal injury.
A 2023 peer-reviewed analysis of residential aged care work described it as characterised by high physical demands driven by the activities of daily resident life, bathing, dressing, and moving about, combined with significant psychosocial pressures including high workloads, low job control, and resident aggression.
And the workforce is overwhelmingly female. The majority of personal care assistants are women, many of childbearing age. The question of pregnancy safety in aged care is therefore not a niche concern; it is a systemic one.
Forward bending and walking are the risks receiving attention this week. But for a pregnant aged care worker, they sit alongside a constellation of other hazards that are arguably more clearly established.
Infection exposure is a serious concern in aged care settings, where residents often have weakened immune systems and infectious diseases can spread rapidly. Cytomegalovirus (CMV), for example, is found in bodily fluids including saliva and urine, and a primary CMV infection during pregnancy can cause congenital hearing loss or developmental delays in the baby. Influenza and COVID-19 carry elevated risks for pregnant women, including higher rates of preterm birth. Varicella (chickenpox) and rubella can cause serious foetal harm if a worker lacks immunity.
Hazardous medications are another underappreciated risk. Aged care facilities regularly dispense powerful drugs that are dangerous in pregnancy, and the common practice of crushing tablets for residents with swallowing difficulties creates inhalation risks. Methotrexate, used for conditions like rheumatoid arthritis and common in aged care populations, is a known teratogen that can cause miscarriage or foetal malformations. Hormonal agents such as finasteride, used for prostate conditions, can harm male foetal development even through skin absorption from a broken tablet.
Chemical exposure through industrial cleaning products is also relevant. Compounds like glutaraldehyde and formaldehyde, used in some equipment sterilisation processes, should be avoided entirely during pregnancy. Even common bleach used in poorly ventilated spaces can cause respiratory distress.
Physical strain compounds all of this. Hormonal changes during pregnancy cause the ligament-relaxing hormone relaxin to increase, making the lower back and pelvis more vulnerable to injury from the kind of manual handling aged care work involves. Solo transfers and “boosting” residents up in bed are particularly high-risk activities.
Australian law is clear on the obligations of employers when a worker is pregnant. Under Work Health and Safety legislation, employers must provide a safe working environment for all workers, and that obligation does not diminish because the worker is pregnant.
Safe Work Australia guidelines and state-level regulators require employers to conduct a risk assessment specific to the pregnant worker’s role, and to review it as the pregnancy progresses. If a safe job cannot be found within the existing role, workers in Australia may be eligible for “Paid No Safe Job Leave” under the Fair Work Act.
SafeWork NSW advises that pregnant workers are entitled to have tasks and activities reassessed at different stages of pregnancy, and that employers must act on identified risks, not simply document them.
Pregnancy is also protected under anti-discrimination law. Employers cannot reduce a pregnant worker’s hours, change their duties unfairly, or treat them adversely because of their pregnancy.
The Danish study does not suggest that pregnant women cannot or should not work in aged care. It does suggest that the “business as usual” approach needs to be adjusted from the moment a worker discloses a pregnancy, and ideally earlier, through proactive planning.
Practical steps for aged care providers and pregnant workers include:
Early disclosure and early action. The sooner a provider knows about a pregnancy, the sooner risks can be assessed and duties adjusted. Workers should feel safe to disclose early without fear of negative consequences.
A comprehensive, individual risk audit. This means reviewing which residents on a worker’s floor have active infections or are on hazardous medications, and identifying which tasks involve the highest levels of bending, lifting, and walking.
Meaningful duty adjustment. This goes beyond token gestures. For personal care assistants whose entire role involves high-risk physical activity, a genuine discussion about transitioning to administrative, supervisory, or lower-physical-demand roles may be necessary, particularly in the first trimester.
Practical physical modifications. Sit-stand stools for tasks that don’t require standing, seating breaks, swapping the heaviest resident transfers with colleagues, and ensuring mechanical lifting aids are consistently available and used.
Infection management protocols specific to pregnancy. Pregnant workers should be proactively reassigned away from residents with active infections during outbreaks. Vaccination status should be reviewed early.
Medication handling policy. Pregnant workers should be excluded from medication rounds involving crushing or handling cytotoxic or hormonal agents without robust protective equipment, and ideally reassigned entirely from those tasks.
Amid the concern, it’s worth being clear about what the evidence does not say.
It does not say that working in aged care during pregnancy causes miscarriage. The vast majority of pregnancy losses are caused by genetic abnormalities that no workplace adjustment could prevent. The Danish study identifies associations in a very large dataset, not proof of direct causation, and its limitations are significant.
Australian guidelines still recommend 150 to 300 minutes of moderate physical activity per week during pregnancy, and the benefits of staying active are well established: reduced risk of gestational diabetes, excessive weight gain, hypertension, and depression. Walking is not the enemy of a healthy pregnancy; sustained occupational walking on hard floors across extended shifts, in combination with other risk factors, is a meaningfully different scenario.
And for workers worried about a past miscarriage, the evidence is clear: in most cases, nothing they did at work caused it, and nothing different at work would have prevented it.
The Danish study is a prompt for aged care providers to do something many should already be doing more systematically: treating pregnancy as a trigger for a thorough, genuine, individualised risk assessment, not a box-ticking exercise.
The physical demands of aged care work, combined with exposure to infections, hazardous medications, and chemicals, create a risk environment that warrants proactive management. The new evidence on bending and walking adds a further dimension to a picture that was already complex.
Pregnancy doesn’t mean the end of a career in aged care. It does mean the sector has a legal and moral obligation to ensure that no worker has to choose between their job and the safety of their pregnancy.
