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Objective This study evaluates whether the working conditions of Dutch women in two different groups, with low risk and with multiple pregnancies, have been adjusted to legislations and the guidelines of The Netherlands Society of Occupational Medicine (NVAB) and the Social Economic Council (SER).Material and Methods We performed two prospective cohort studies, in a group women with low risk pregnancies, and another group women with multiple pregnancies. In both groups women with paid work completed three questionnaires concerning demographics, education, general health and working conditions between 10–16 and 20–24 weeks and 30-34 weeks pregnancy. We calculated the proportion of participants with work-related risk factors not in accordance with legislation and/or guidelines.Results 50% of working pregnant women with low-risk pregnancies and nearly 60% of women with multiple pregnancies continue to work not in accordance with legislation and guidelines. Many of these women had to deal with physically demanding work, job strain and long and irregular working hours. Successfully implementing MPL and guidelines is a challenge, given the diversity of stakeholders and their interests. The absence of financial incentives for employers, limited access to occupational health care for all working pregnant women and the lack of knowledge and communication about the importance of work adjustment among working pregnant women and their obstetric healthcare providers appear to be the main cause of poor adherence to MPL and guidelines.Conclusion 50% of the pregnant women and 60% of women with multiple pregnancies worked under hazardous conditions. Reasons for this limited implementation and areas for improvement are discussed. Given the impact on adverse pregnancy outcomes as well as on the public purse, action to improve compliance must be taken by all stakeholders.