Miscarriages are tied to antineoplastic drugs
January 1, 2000 3 minutes read
Miscarriages are tied to antineoplastic drugs
Valanis B, Vollmer WM, Steele P. Occupational exposure to antineoplastic agents: Self-reported miscarriages and stillbirths among nurses and pharmacists. JOEM 1999; 41:632-638.
In this study of the pregnancy outcomes of health care workers exposed to antineoplastic drugs (chemotherapy agents), researchers for the first time included wives of exposed men as well as female health care workers. The findings for both groups were similar, although the risk among wives of exposed men did not reach statistical significance.
As part of the National Surgical Adjuvant Breast and Bowel Project, 4,659 nurses, nurse’s aides, pharmacists, and pharmacy technicians at 200 different health care facilities responded to a survey during the fall of 1988 and the spring of 1989.
After ruling out respondents who had never been pregnant, had been treated with antineoplastic drugs, or provided incomplete information, researchers looked more closely at 7,392 pregnancies among 2,976 health care workers or their wives. Barbara Valanis, DrPH, of the Kaiser Permanente Center for Health Research in Portland, OR, was the lead investigator.
For each "handling activity" — mixing the drugs, administering them, or handling bodily waste of cancer patients — researchers collected information on dose, duration, use of protection, and skin contact. They also controlled for maternal smoking during pregnancy, age, gravidity during pregnancy, and prior poor pregnancy outcomes such as miscarriage or still birth.
Overall, miscarriage occurred in 11% of pregnancies and stillbirth in 1%. Eighty-three percent of the pregnancies resulted in a live birth, and 5% of the pregnancies ended due to an elective abortion.
Researchers distinguished between exposures that occurred two years before a pregnancy and those during a pregnancy. Men reported handling antineoplastic drugs during 35.6% of their wives’ pregnancies, while women reported drug handling during 20.1% of their pregnancies.
The only statistically significant variable related to exposure was "any reported exposure to antineoplastics" dose, duration, and patterns of skin contact were not significant.
The data showed:
• Women who handled antineoplastics had a significantly higher risk of miscarriage (with an odds ratio of 1.5) or of any loss (1.4 times more likely) but not of stillbirths alone.
• Women with a prior miscarriage or stillbirth had even higher risks of poor outcomes (with odds ratios of 2.3 and 2.9, respectively).
• Wives of men with exposure to antineoplastics in the two or three years prior to or during pregnancy showed a similar pattern of increased risk, but the odds ratios were not statistically significant. There were not enough stillbirths in this sample to allow for analysis.
"This analysis suggests the women who have been occupationally exposed to antineoplastic agents during or shortly prior to pregnancy are at an increased risk to have a miscarriage compared with those who were not exposed," the researchers concluded.
That finding is consistent with an earlier study on occupational exposure.1 As exposures decline with the use of protective equipment, the risk of poor pregnancy outcomes may be lower, the researchers noted. (OSHA guidelines, published in 1986, call for protection against exposure.)
Still, the researchers noted, "The presence of any increased risk should concern workers who are planning a pregnancy. They need to weigh the risks of handling antineoplastic agents during the time of conception and during the pregnancy and whether they should continue in the work setting. If they decide to continue handling these drugs, careful adherence to recommendations for protection will be essential."
Reference
1. Selevan S, Lindbohm M, Hornung K, et al. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med 1985; 313:1,173-1,177.
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