Research Obstetrics| Volume 206, ISSUE 4, P327.e1-327.e8, April 2012

Download started.


Occupational exposures among nurses and risk of spontaneous abortion

Published:January 03, 2012DOI:


      We investigated self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays and the risk of spontaneous abortion in US nurses.

      Study Design

      Pregnancy outcome and occupational exposures were collected retrospectively from 8461 participants of the Nurses' Health Study II. Of these, 7482 were eligible for analysis using logistic regression.


      Participants reported 6707 live births, and 775 (10%) spontaneous abortions (<20 weeks). After adjusting for age, parity, shift work, and hours worked, antineoplastic drug exposure was associated with a 2-fold increased risk of spontaneous abortion, particularly with early spontaneous abortion before the 12th week, and 3.5-fold increased risk among nulliparous women. Exposure to sterilizing agents was associated with a 2-fold increased risk of late spontaneous abortion (12-20 weeks), but not with early spontaneous abortion.


      This study suggests that certain occupational exposures common to nurses are related to risks of spontaneous abortion.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • US Department of Health and Human Services Health Resources and Services Administration
        The Registered Nurse Population Initial Findings from the 2008 National Sample Survey of Registered Nurses.
        March 2010 (Accessed Jan. 26, 2012)
        • United States Bureau of Labor Statistics
        The employment situation: December 2004.
        2005 (Accessed Jan. 26, 2012)
        • Olfert S.M.
        Reproductive outcomes among dental personnel: a review of selected exposures.
        J Can Dent Assoc. 2006; 72: 821-825
        • Ahlborg Jr, G.
        • Hemminki K.
        Reproductive effects of chemical exposures in health professions.
        J Occup Environ Med. 1995; 37: 957-961
        • Babich H.
        Reproductive and carcinogenic health risks to hospital personnel from chemical exposure—a literature review.
        J Environ Health. 1985; 48: 52-56
        • Figa-Talamanca I.
        Reproductive problems among women health care workers: epidemiologic evidence and preventive strategies.
        Epidemiol Rev. 2000; 22: 249-260
        • Shortridge-McCauley L.A.
        Reproductive hazards: an overview of exposures to health care workers.
        AAOHN J. 1995; 43: 614-621
        • Vainio H.
        Inhalation anesthetics, anticancer drugs and sterilants as chemical hazards in hospitals.
        Scand J Work Environ Health. 1982; 8: 94-107
        • Vecchio D.
        • Sasco A.J.
        • Cann C.I.
        Occupational risk in health care and research.
        Am J Ind Med. 2003; 43: 369-397
        • Connor T.H.
        • DeBord D.G.
        • Pretty J.R.
        • et al.
        Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers.
        J Occup Environ Med. 2010; 52: 1019-1027
        • Gambrell J.
        • Moore S.
        Assessing workplace compliance with handling of antineoplastic agents.
        Clin J Oncol Nurs. 2006; 10: 473-477
        • Wilcox A.J.
        Fertility and pregnancy: an epidemiologic perspective.
        in: Oxford University Press, New York, NY2010: 149-163
        • Burgoyne P.S.
        • Holland K.
        • Stephens R.
        Incidence of numerical chromosome anomalies in human pregnancy estimation from induced and spontaneous abortion data.
        Hum Reprod. 1991; 6: 555-565
        • Whelan E.A.
        • Lawson C.C.
        • Grajewski B.
        • Hibert E.N.
        • Spiegelman D.
        • Rich-Edwards J.W.
        Work schedule during pregnancy and spontaneous abortion.
        Epidemiology. 2007; 18: 350-355
        • National Institute for Occupational Safety and Health (NIOSH)
        NIOSH alert: preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings.
        2004 (DHHS (NIOSH) publication no. 2004–165)
        • Azim Jr, H.A.
        • Peccatori F.A.
        • Pavlidis N.
        Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy.
        Cancer Treat Rev. 2010; 36: 101-109
        • Arnon J.
        • Meirow D.
        • Lewis-Roness H.
        • Ornoy A.
        Genetic and teratogenic effects of cancer treatments on gametes and embryos.
        Hum Reprod Update. 2001; 7: 394-403
        • Food and Drug Administration
        Food and Drug Administration Advisory Committee on Protocols for Safety Evaluations.
        Toxicol Appl Pharmacol. 1970; 16: 264-296
        • Stucker I.
        • Caillard J.F.
        • Collin R.
        • Gout M.
        • Poyen D.
        • Hemon D.
        Risk of spontaneous abortion among nurses handling antineoplastic drugs.
        Scand J Work Environ Health. 1990; 16: 102-107
        • Valanis B.
        • Vollmer W.M.
        • Steele P.
        Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists.
        J Occup Environ Med. 1999; 41: 632-638
        • Selevan S.G.
        • Lindbohm M.L.
        • Hornung R.W.
        • Hemminki K.
        A study of occupational exposure to antineoplastic drugs and fetal loss in nurses.
        N Engl J Med. 1985; 313: 1173-1178
        • Fransman W.
        • Roeleveld N.
        • Peelen S.
        • de Kort W.
        • Kromhout H.
        • Heederik D.
        Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes.
        Epidemiology. 2007; 18: 112-119
        • Hemminki K.
        • Kyyronen P.
        • Lindbohm M.L.
        Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome.
        J Epidemiol Community Health. 1985; 39: 141-147
        • Skov T.
        • Maarup B.
        • Olsen J.
        • Rorth M.
        • Winthereik H.
        • Lynge E.
        Leukaemia and reproductive outcome among nurses handling antineoplastic drugs.
        Br J Ind Med. 1992; 49: 855-861
        • Peelen S.
        • Heederik D.
        • Krombout H.
        • de Kort W.
        Toxic effects on reproduction in hospital personnel.
        Dutch Ministry of Social Affairs and Employment, 1999
        • Taskinen H.
        • Lindbohm M.L.
        • Hemminki K.
        Spontaneous abortions among women working in the pharmaceutical industry.
        Br J Ind Med. 1986; 43: 199-205
        • McDonald A.D.
        • Armstrong B.
        • Cherry N.M.
        • et al.
        Spontaneous abortion and occupation.
        J Occup Med. 1986; 28: 1232-1238
        • Dranitsaris G.
        • Johnston M.
        • Poirier S.
        • et al.
        Are health care providers who work with cancer drugs at an increased risk for toxic events?.
        J Oncol Pharm Pract. 2005; 11: 69-78
      1. Guidelines for handling parenteral antineoplastics.
        JAMA. 1985; 253: 1590-1592
        • Randall M.E.
        • Constable W.C.
        Guidelines for handling parenteral antineoplastics.
        JAMA. 1985; 254: 1033-1034
        • Connor T.H.
        • McDiarmid M.A.
        Preventing occupational exposures to antineoplastic drugs in health care settings.
        CA Cancer J Clin. 2006; 56: 354-365
        • National Institute for Occupational Safety and Health (NIOSH)
        NIOSH Hazardous Drug Exposure in Health Care. vol 2010. 2010
        • Lawson C.C.
        • Whelan E.A.
        • Hibert E.N.
        • Grajewski B.
        • Spiegelman D.
        • Rich-Edwards J.W.
        Occupational factors and risk of preterm birth in nurses.
        Am J Obstet Gynecol. 2009; 200: 51.e1-51.e8
        • Collins J.J.
        • Ness R.
        • Tyl R.W.
        • Krivanek N.
        • Esmen N.A.
        • Hall T.A.
        A review of adverse pregnancy outcomes and formaldehyde exposure in human and animal studies.
        Regul Toxicol Pharmacol. 2001; 34: 17-34
        • Rowland A.S.
        • Baird D.D.
        • Shore D.L.
        • Darden B.
        • Wilcox A.J.
        Ethylene oxide exposure may increase the risk of spontaneous abortion, preterm birth, and postterm birth.
        Epidemiology. 1996; 7: 363-368
        • De Santis M.
        • Di Gianantonio E.
        • Straface G.
        • et al.
        Ionizing radiations in pregnancy and teratogenesis: a review of literature.
        Reprod Toxicol. 2005; 20: 323-329
        • National Council on Radiation Protection and Measurements (NCRP)
        Limitation of exposure to ionizing raditation.
        NCRP report. 1993; 116: 37-39
        • Fucic A.
        • Merlo D.F.
        • Ceppi M.
        • Lucas J.N.
        Spontaneous abortions in female populations occupationally exposed to ionizing radiation.
        Int Arch Occup Environ Health. 2008; 81: 873-879
        • US Department of Labor Occupational Safety and Health Act (OSHA)
        Anesthetic gases: guidelines for workplace exposures.
        US Department of Labor, Washington, DC2000
        • Boivin J.F.
        Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis.
        Occup Environ Med. 1997; 54: 541-548
        • Rowland A.S.
        • Baird D.D.
        • Shore D.L.
        • Weinberg C.R.
        • Savitz D.A.
        • Wilcox A.J.
        Nitrous oxide and spontaneous abortion in female dental assistants.
        Am J Epidemiol. 1995; 141: 531-538
        • Shirangi A.
        • Fritschi L.
        • Holman C.D.J.
        Maternal occupational exposures and risk of spontaneous abortion in veterinary practice.
        Occup Environ Med. 2008; 65: 719-725
        • Gauger V.T.
        • Voepel-Lewis T.
        • Rubin P.
        • Kostrzewa A.
        • Tait A.R.
        A survey of obstetric complications and pregnancy outcomes in paediatric and nonpaediatric anaesthesiologists.
        Paediatr Anaesth. 2003; 13: 490-495
        • Shuhaiber S.
        • Einarson A.
        • Radde I.C.
        • Sarkar M.
        • Koren G.
        A prospective-controlled study of pregnant veterinary staff exposed to inhaled anesthetics and x-rays.
        Int J Occup Med Environ Health. 2002; 15: 363-373
      2. Assessing exposures of health-care personnel to aerosols of ribavirin—California.
        MMWR Morb Mortal Wkly Rep. 1988; 37: 5603
        • Coughlin S.S.
        Recall bias in epidemiologic studies.
        J Clin Epidemiol. 1990; 43: 87-91
        • Rich-Edwards J.W.
        • Goldman M.B.
        • Willett W.C.
        • et al.
        Adolescent body mass index and infertility caused by ovulatory disorder.
        Am J Obstet Gynecol. 1994; 171: 171-177
        • Colditz G.A.
        • Martin P.
        • Stampfer M.J.
        • et al.
        Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women.
        Am J Epidemiol. 1986; 123: 894-900
        • Colditz G.A.
        • Stampfer M.J.
        • Willett W.C.
        • et al.
        Reproducibility and validity of self-reported menopausal status in a prospective cohort study.
        Am J Epidemiol. 1987; 126: 319-325
        • McDiarmid M.A.
        • Kolodner K.
        • Humphrey F.
        • Putman D.
        • Jacobson-Kram D.
        Baseline and phosphoramide mustard-induced sister-chromatid exchanges in pharmacists handling anti-cancer drugs.
        Mutat Res. 1992; 279: 199-204
        • Savitz D.A.
        Interpreting epidemiologic evidence: strategies for study design and analysis.
        in: Oxford University Press, New York2003: 193-195
        • Weaver D.R.
        • Newman L.S.
        • Lezotte D.C.
        • Morley P.S.
        Perceptions regarding workplace hazards at a veterinary teaching hospital.
        J Am Vet Med Assoc. 2010; 237: 93-100

      Linked Article