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• Pregnancy-related sick leave is common. • Cluster-randomised trial evaluated occupational midwifery support. • Intervention focused on risk assessment and work adjusment. • Pregnancy-related sick leave was not reduced. Sick leave during pregnancy is common and associated with strenuous working conditions and multiple occupational exposures. The aim of this study was to evaluate the effect of midwifery facilitation of sessions with pregnant employees and managers focusing on work adjustment, to reduce discomfort and occupational risks. A cluster randomised controlled trial was conducted. Hospital employees were randomised to intervention or reference. The intervention group received midwifery support in addition to the standard hospital pregnancy policy provided to the reference group. Outcomes were pregnancy-related sick leave and general sick leave. Intention-to-treat analysis was performed with mixed-effect models. Sick leave was similar between the intervention and reference groups, and 51 % of pregnant employees did not take any days of full pregnancy related sick leave, while approximately 21 % took more than 30 days. Group differences in mean estimates for partial sick leave were −0.5 (CI −2.3;1.3) days. Differences in full sick leave was 1.2 (CI −2.9;5.2) days, and 0.6 (CI −1.0;2.1) days for general sick leave. Midwifery support as an add-on to usual pregnancy policy did not decrease sick leave during pregnancy compared to usual practice in a study population of Danish healthcare professionals. Midwifery support tailored towards the specific work environment may perhaps provide better results. [ABSTRACT FROM AUTHOR]