A Study of Handling Cytotoxic Drugs and Risk of Birth Defects in Offspring of Female Veterinarians

Adeleh Shirangi,C Holman,David Preen,Carol Bower,Neville Bruce

doi:10.3390/ijerph110606216

Abstract

We examined the association of occupational exposure to handling cytotoxic drugs at work with risk of birth defects among a cohort of female veterinarians. This study is a follow up survey of 321 female participants (633 pregnancies) who participated in the Health Risks of Australian Veterinarian project. Data on pregnancies and exposure during each pregnancy was obtained by self-administered mailed questionnaire. Female veterinarians handling cytotoxic drugs during their pregnancy had a two-fold increased risk of birth defects in their offspring (RR = 2.08, 95% CI (1.05–4.15)). Results were consistent in subgroup analysis of those who graduated during the period of 1961 to 1980 (RR = 5.04, 95% CI (1.81, 14.03) and in those working specifically in small and large animal practice. There was no increased risk in the subgroup that graduated after 1980. Women with unplanned pregnancies were more likely to handle cytotoxic drugs on a daily basis (RR = 1.86, 95% CI, 1.00–3.48) and had a higher increased risk of birth defects than those who planned their pregnancies in recent graduates and in those who worked specifically in small animal practice (RR = 2.53, 95% CI, 1.18–5.42). This study suggests that the adverse effects of handling cytotoxic drugs in pregnant women may include an increased risk of birth defects. Pregnancy intention status is an important health behavior and should be considered in prenatal programs.

Highlights

Toxic drugs are defined as having specific health effects and health toxicity at low doses [1]
Main findings: We found a 2‒5 fold-increased risks of birth defects for occupational exposure in veterinary practice to cytotoxic drugs on a daily basis during pregnancy
Consistent with the animal and human data from previous survey, the results from this study suggest that the adverse effects of handling cytotoxic drugs in pregnant women may include an increased risk of birth defects

Summary

Introduction

Toxic drugs are defined as having specific health effects (such as skin rashes, cancer and reproductive effects) and health toxicity at low doses [1]. Many veterinarians treat small companion animals (primarily cats and dogs), and larger animals such as horses with cytotoxic and other drugs that may be hazardous to humans. Cytotoxic drugs, which are primarily used for oncology treatment, are known to be highly toxic to cells, principally through their action on cell reproduction [2,3]. Cytotoxic drugs are known to be teratogenic and given the mechanisms of their action that can inhibit the growth of tumors by killing actively growing cells, they can interference with cell division and cell formation in the fetus. Data on therapeutic exposure to these drugs indicate that pregnant women are most susceptible to fetal loss and teratogenicity effects of these agents during the first trimester, a time of rapid cell division and differentiation in the embryo/fetus [6,7]

Methods

Results

Discussion

Conclusion