Handling chemo drugs raises miscarriage rate

Study also shows risk for sterilizing agents

Despite workplace protections, pregnant nurses may still be at risk from exposure to chemotherapy and sterilizing agents.

An analysis of information from almost 7,500 pregnant nurses in the Nurses' Health Study found a significantly higher risk of spontaneous abortion in the first trimester among nurses who handled antineoplastic drugs and in the second trimester among nurses who worked with sterilizing agents.1

"The women exposed to anti-neoplastic drugs had twice as high of risk as those who did not report that [exposure]," says Christina Lawson, PhD, epidemiologist with the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.

There was a similar two-fold increase related to sterilizing agents, including ethylene oxide, formaldehyde and glutaraldehyde.

"We caution women that if something is termed a carcinogen, it's probably also a reproductive hazard," says Lawson. "Generally, you should stay away from carcinogens during pregnancy."

The study is significant because it didn't ask nurses only about known exposures, such as spills, says Martha Polovich, PhD, RN, AOCN, director of clinical practice at the Duke Oncology Network in Durham, NC. "They merely asked the nurses to report the number of hours they worked with these chemicals," she says. "Nurses working with the chemicals had a higher rate of miscarriage."

The Oncology Nursing Society has long been concerned about the potential for reproductive risk for women working with hazardous drugs. ONS recommends employers provide alternative duty for nurses who request it due to pregnancy, breastfeeding or the desire to conceive.

"Those of us who are in the business were not surprised by the findings," Polovich says. "People report those adverse outcomes to us all the time."

Based on the study, the time of greatest vulnerability is the first trimester of pregnancy, says Lawson. "We would like to encourage nurses to protect themselves throughout pregnancy as well as in breastfeeding, but [taking precautions] during the first trimester is really important," she says.

The Nurses' Health Study did not collect information about personal protective equipment. However, other studies of the handling of antineoplastic agents have found surface contamination even with the use of safety precautions. The outside of vials may be contaminated, and dirty gloves can spread residue. A recent NIOSH evaluation of an inpatient oncology unit in Wisconsin found small amounts of chemotherapy agents in the family area. (See HEH, February 2012, p.17.)

"We've been trying to promote a universal precautions approach to handling hazardous drugs," says Polovich. "[Nurses should] just assume it's there."

Reference

1. Lawson, C.C., Rocheleau, C.M., Whelan, E.A., Lividoti Hibert, E.N., Grajewski, B., Spiegelman, D., Rich-Edwards, J.W., Occupational exposures among nurses and risk of spontaneous abortion, Am J Obstet Gyn 2011;doi: 10.1016/j.ajog.2011.12.030.