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

Abstract

PurposeTo examine the association betweenantineoplastic drug (AD) handling and risk of miscarriage. MethodsNurses’ 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. ResultsOverall, 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. ConclusionsWe 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.