8273616 Pregnancy at work, the protection program in the province of Québec (Canada) and the experience of putting in place processes for national guidelines elaboration

<h3>Objectives</h3> The Safe maternity experience program (SMEP) has existed since the 1979 Occupational Health and Safety Act in the province of Québec, Canada. Under SMEP, pregnant or breastfeeding workers can be assigned to another position or other tasks if exposed to an occupational risk factor. If such an assignment is not possible, the worker is entitled to preventive withdrawal with an income compensation. Specific preventive protocols, by occupational category, to be applied in the province are required by a law change since 2023. Our objective was to develop a valid and credible process to translate available knowledge into applicable recommendations to include in the protocols. <h3>Material and Methods</h3> Major limitations arising from the nature and quality of available epidemiological data were described from literature syntheses about, among others, pregnancy and standing position: discrepancies in study designs, exposure measurements, control of confounding factors and overall conclusions. Areas of consensus and discordance in current SMEP recommendations were identified with an inventory. Specific questions that require an answer for translating knowledge into recommendations were then formulated by our scientific team and validated by experts who wrote or used previous SMEP guidelines. Processes used by other organizations that make decisions in similar uncertainty context also were reviewed. <h3>Results</h3> Risk management approach based on predefined criteria was favored with a drafted deliberative process to make informed conclusions. A multidisciplinary committee was created including various clinical specialists, ethician, labor law lawyer, etc., and working women, to combine epidemiological data, prepared by the scientific team, with experiential and contextual information held by the committee members. A mechanism to refine questions and criteria after the first deliberations was established. <h3>Conclusion</h3> Risk management is a promising approach to combine all available data in a deliberative process pertaining complex questions such as translating knowledge into preventive guidelines for a safe maternity at work.