title: Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes.
abstract: BACKGROUND
  Nurses and other hospital workers are exposed to antineoplastic drugs during daily activities. Previous studies suggest that antineoplastic drugs at occupational exposure levels may be toxic to reproduction, but these studies are not consistent or conclusive.
  
  
  METHODS
  Self-administered questionnaires were completed by 4393 exposed and nonexposed nurses employed between 1990 and 1997 (79% response). Questions were asked about pregnancy outcome, work-related exposures, and lifestyle. Exposure to antineoplastic drugs was estimated using task-based dermal exposure measurements and self-reported task frequencies. Time to pregnancy was modeled using survival analysis, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for other reproductive outcomes using multiple logistic regression analysis. Associations were further explored by nonparametric regression modeling.
  
  
  RESULTS
  Nurses highly exposed to antineoplastic drugs took longer to conceive than referent nurses (adjusted hazard ratio = 0.8; CI = 0.6-0.9). Exposure to antineoplastic drugs was associated with premature delivery (OR per unit increase in ln[exposure] = 1.08; CI = 1.00-1.17) and low birth weight (OR per unit increase in ln[exposure] = 1.11; 1.01-1.21). Penalized smoothed spline plots corroborated these log-linear relations. Spontaneous abortion, stillbirth, congenital anomalies, and sex of offspring appeared not to be related to exposure to antineoplastic drugs.
  
  
  CONCLUSIONS
  Antineoplastic drugs may reduce fertility and increase poor neonatal outcomes among occupationally exposed oncology nurses.
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. w.fransman@iras.uu.nl
authors.forename: Wouter
authors.initials: W
authors.lastname: Fransman
authors.forename: Nel
authors.initials: N
authors.lastname: Roeleveld
authors.forename: Susan
authors.initials: S
authors.lastname: Peelen
authors.forename: Wim
authors.initials: W
authors.lastname: de Kort
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D009726:Nurses; D016273:Occupational Exposure / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012869:Skin Absorption / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents