Occupational exposure to antineoplastic agents: Self-reported miscarriagesand stillbirths among nurses and pharmacists

Insult to the germ cells of an ovum or sperm prior to pregnancy! as well as exposures to a fetus during pregnancy can affect the outcome of a pregnanc y. Antineoplastic agents are mutagenic and teratogenic, so the potential ef fects of exposure on reproduction are of concern to the workers who handle them. This study investigates pregnancy loss associated with occupational e xposures to antineoplastic drugs by comparing rates of spontaneous abortion and stillbirths for pregnancies without antineoplastic exposure and expose d pregnancies in which the pregnant woman or the father handled antineoplas tic agents either before or during the pregnancy. A total of 7094 pregnanci es of 2976 pharmacy and nursing staff were examined. After age during pregn ancy, prior gravidity, maternal smoking du during the pregnancy, and occurr ence of a spontaneous abortion or stillbirth in a prior pregnancy were cont rolled for, exposure of the mother to or the handling of antineoplastic age nts during the pregnancy was associated with a significantly increased risk of spontaneous abortion (odds ratio = 1.5; 95% confidence interval, 1.2 to 1.8) and combined risk of spontaneous abortion and stillbirth (odds ratio = 1.4; 95% confidence interval 2.2 to 1.7) but not stillbirth alone. Among the wives of exposed men, too feu stillbirths occurred to allow analysis. H owever, for spontaneous abortion and a any loss, the patterns of increased risk were similar to those seen for women, although the odds ratios were no t statistically significant.