Prepregnancy handling of antineoplastic drugs and risk of miscarriage in female nurses

Feiby L Nassan; Jorge E Chavarro; Candice Y Johnson; James M Boiano; Carissa M Rocheleau; Janet W Rich-Edwards; Christina C Lawson

doi:10.1016/j.annepidem.2020.09.003

Prepregnancy handling of antineoplastic drugs and risk of miscarriage in female nurses

Ann Epidemiol. 2021 Jan:53:95-102.e2. doi: 10.1016/j.annepidem.2020.09.003. Epub 2020 Sep 11.

Authors

Feiby L Nassan¹, Jorge E Chavarro², Candice Y Johnson³, James M Boiano³, Carissa M Rocheleau³, Janet W Rich-Edwards⁴, Christina C Lawson³

Affiliations

¹ Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. Electronic address: fen769@mail.harvard.edu.
² Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
³ National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH.
⁴ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA; Connors Center for Women's Health and Gender Biology and Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Abstract

Purpose: To examine the association betweenantineoplastic drug (AD) handling and risk of miscarriage.

Methods: Nurses' Health Study-3 participants self-reported AD administration and engineering controls (ECs) and personal protective equipment (PPE) use at baseline. We estimated the hazard ratio (HR) of miscarriage in relation to baseline AD handling using multivariable Cox proportional regression.

Results: Overall, 2440 nurses reported 3327 pregnancies, with 550 (17%) ended in miscarriages. Twelve percent of nurses self-reported currently handling AD and 28% previously handling AD. Compared with nurses who never handled AD, nurses who handled AD at baseline had an adjusted HR of miscarriage of 1.26 (95% confidence interval [CI], 0.97-1.64). This association was stronger after 12-weeks gestation (HR=2.39 [95% CI, 1.13-5.07]). Nurses who did not always use gloves had HR of 1.51 (95% CI, 0.91-2.51) compared with 1.19 (95% CI, 0.89-1.60) for those always using gloves; nurses who did not always use gowns had HR of 1.32 (95% CI, 0.95-1.83) compared with 1.19 (95% CI, 0.81-1.75) for nurses always using gowns.

Conclusions: We observed a suggestive association between AD handling and miscarriage, particularly among nurses who did not consistently use PPE and EC with stronger associations for second trimester losses.

Keywords: Antineoplastic drugs; Exposure controls; Miscarriage; Nurses; Nurses' Health Study; Occupational exposure.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Abortion, Spontaneous* / epidemiology
Adult
Antineoplastic Agents* / adverse effects
Female
Gloves, Protective / statistics & numerical data
Humans
Nurses* / statistics & numerical data
Occupational Exposure* / adverse effects
Pregnancy
Protective Clothing / statistics & numerical data
Risk

Substances

Antineoplastic Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding