Pregnancy and breastfeeding
Is it safe for nurses to administer chemotherapy if they are pregnant or trying to conceive?
The issue of whether nurses should prepare or administer chemotherapy or care for patients who are receiving chemotherapy while trying to conceive or while pregnant or nursing is one of the more controversial topics in chemotherapy administration. Several resources may be helpful.
ONS took a stance on this issue in the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice
Address HD handling around pregnancy. Even when all recommended precautions are used, the potential for exposure cannot be completely eliminated. Therefore, an additional level of protection is suggested for those most vulnerable to the reproductive and developmental effects of HDs. Employers should allow employees who are actively trying to conceive or are pregnant or breastfeeding to refrain from activities that may expose them and their infant to reproductive health hazards such as chemical, physical, or biologic agents. Alternate duty that does not include HD preparation or administration must be made available upon request to both men and women in the aforementioned situations or who have other medical reasons for not being exposed to HDs. The employee has the responsibility of notifying the employer of the specific situation (e.g., pregnancy, preconception, breastfeeding). The American College of Occupational and Environmental Medicine (1996) provides guidelines for managing reproductive hazard management (p. 82).
ONS’s Safe Handling of Hazardous Drugs
, (2nd ed.)(Polovich, 2011) does an excellent job of reviewing the current data related to exposure and related risks, as well as precautions to lower risk.
The American Society of Health-System Pharmacists (ASHP) Guidelines on Handling Hazardous Drugs
also addresses this issue in the “Background” section: "Two controlled surveys have reported significant increases in a number of symptoms, including sore throat, chronic cough, infections, dizziness, eye irritation, and headaches, among nurses, pharmacists, and pharmacy technicians routinely exposed to hazardous drugs in the workplace. Reproductive studies on health care workers have shown an increase in fetal abnormalities, fetal loss, and fertility impairment resulting from occupational exposure to these potent drugs" (p. 40).
The ASHP guidelines state the following in the “Alternative Duty and Medical Surveillance” section. "Such safety programs must be able to identify potentially exposed workers and those who might be at higher risk of adverse health effects due to this exposure. Because reproductive risks have been associated with exposure to hazardous drugs, alternative duty should be offered to individuals who are pregnant, breast-feeding, or attempting to conceive or father a child. Employees’ physicians should be involved in making these determinations" (p. 50).
The Occupational Safety and Health Administration (OSHA) Technical manual, Section VI: Chapter 2, “Controlling Occupational Exposure to Hazardous Drugs” doesn't make specific recommendations, but does address potential risks in some detail. For instance, III.C. ”Human Data at Therapeutic Levels” states the that “[m]any HD's are known human carcinogens, for which there is no safe level of exposure.” Furthermore, the report states the following.
Numerous case reports have linked chemotherapeutic treatment to adverse reproductive outcomes.7,88,91,98 Testicular and ovarian dysfunction, including permanent sterility, have occurred in male and female patients who have received CD's either singly or in combination.14 In addition, some antineoplastic agents are known or suspected to be transmitted to infants through breast milk.79"
In section VI.A. “Reproductive Issues,” the report states the following.
The examining physician should consider the reproductive status of employees and inform them regarding relevant reproductive issues. The reproductive toxicity of hazardous drugs should be carefully explained to all workers who will be exposed to these chemicals, and is required for those chemicals covered by the HCS. Unfortunately, no information is available regarding the reproductive risks of HD handling with the current use of BSC's and PPE. However, as discussed earlier, both spontaneous abortion and congenital malformation excesses have been documented among workers handling some of these drugs without currently recommended engineering controls and precautions. The facility should have a policy regarding reproductive toxicity of HD's and worker exposure in male and female employees and should follow that policy.
The OSHA manual
addresses reproductive issues in other sections as well.
The National Institute for Occupation Safety and Health (NIOSH) Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings
contains detailed information about safe-handling practices, including handling recommendations while pregnant or trying to become pregnant.