INVESTIGATION OF A SPONTANEOUS-ABORTION CLUSTER - LESSONS LEARNED

An investigation of a reported spontaneous abortion excess in an offic e environment was undertaken employing a multidisciplinary approach, i ncluding (1) an epidemiologic/validation step; (2) an industrial hygie ne survey, including electromagnetic field measurements and indoor air quality determinations; and (3) a risk perception/risk communication component. This approach was needed because there are numerous chemica l and physical agents and psychosocial stressors that may potentially impact the reproductive status of female office workers. Although vide o display terminals (VDTs) are typically the focus of spontaneous abor tion (SAB) investigations, one cannot ignore other stressors in the en vironment. Magnetic field exposures within a payroll area were determi ned using a hand-held survey meter and data logging dosimeter. On aver age, the full shift time-weighted average exposures of workers to extr emely low frequency (ELF) magnetic fields in the payroll office area r anged from 1.0 to 5.6 mG. Influencing the investigation's protocol des ign were the Centers for Disease Control's (CDC's) recent Guidelines f or Investigating Clusters of Health Events. Although these guidelines grew primarily out of cancer cluster investigations, we applied them i n this instance and found them to be generalizable to reproductive haz ards investigations. A spontaneous abortion excess was validated over a 2-year period among 26 women with 32 reproductive events, with rates 1.5-2.5 times the expected, depending on comparison figures used. Les sons learned in the investigation, including the applicability of the CDC's Cluster Investigation Protocol and the enormous importance of ri sk perception and risk communication, are described. (C) 1994 Wiley-Li ss, Inc.