Table 2.

Studies of Miscarriage, Stillbirth, Tubal Pregnancy Associated with Occupational Exposure to Antineoplastic Drugs

Reference	Exposure Period	Study Location	Population	Study Design	Overall Sample Size	Number of exposed cases	Results	Comments
Fransman et al. 2007	1990–1997	Netherlands	Oncology and other types of nurses	Survey	1,519	34, but divided into 3 categories	No significant associations; CIs were wide for miscarriage	Too many categories for small numbers; sample sizes were not clearly reported. Retrospective exposure assessment among nurses
Hemminki et al. 1985	<1985	Finland	Finnish hospital nurses	Case-control	169 cases + 469 controls	12	Adj OR, 0.8 (0.3–1.7) for miscarriage	50% Response rate
Lawson et al. 2011	1993–2001	U.S.	U.S. nurses	Survey	775 cases + 6,707 live births	48	Adj OR, 1.94 (1.32–2.86) for miscarriage
Peelen et al. 1999	<1985	Netherlands	Oncology nurses	Survey	249 exposed + 1,010 unexposed	Unclear	OR, 1.4 (0.8– 2.6) for miscarriage	Small numbers, limitations in study design. See Fransman study that replaces this study.
Selevan et al. 1985	<1985	Finland	Nurses	Case–control	124 cases +321 controls	18	OR, 2.3 (1.21– 4.39) for miscarriage	First-trimester exposure to hazardous drugs more than once per week
Skov et al. 1992	1985	Denmark	Oncology nurses	Retrospective cohort	281 exposed + 809 unexposed	18	Adj OR, 0.74 (0.40–1.38) for miscarriage	Prepared or administered hazardous drugs anytime during pregnancy
Stücker et al. 1990	1985	France	Hospital personnel	Survey	139 exposed +357 unexposed	36	Adj OR, 1.7 (1.03–2.80) for miscarriage	Prepared hazardous drugs
Valanis et al. 1999	1985	U.S.	Nurses and pharmacists	Survey	1,448 exposed + 5,297 unexposed	223	Adj OR, 1.50 (1.25–1.80) for miscarriage	Exposure to hazardous drugs during pregnancy
McDonald et al. 1988	1982–1984	Montreal	Population based	In-person survey	22,613	13	13 observed /13.4 expected miscarriages and stillbirths	Administered hazardous drugs during 1st trimester
McAbee et al. 1993	1985	U.S.	Nurses and university employees	Cross- sectional survey	663 women (1,133 pregnancies)	3	Adj OR of 0.67 for miscarriage and stillbirth	Low response rates (<30%)
Rogers and Emmett 1987	<1985	U.S.	Oncology and community health nurses	Survey	233	13	OR, 2.5 (p < 0.04) for miscarriage and stillbirth	OR didn’t change with adjustment for age
Fransman et al. 2007	1990–1997	Netherlands	Oncology & other types of nurses	Survey	1,519	1 in the highest category	No significant associations; CIs were wide for stillbirth	Retrospective exposure assessment of frequency of tasks, dermal exposure
Peelen et al. 1999	1990–1997	Netherlands	Oncology nurses	Survey	249 exposed + 1,010 unexposed	2	OR, 1.2 (0.65– 2.20) for still- birth	Small numbers
Valanis et al. 1999	1985	U.S.	Nurses and pharmacists	Survey	7,094	12	Adj OR, 1.10 (0.55–2.20) for stillbirth
Ratner et al. 2010	1974–2000	Canada	RNs	Cohort	147/23,222	3	Adj OR, 0.67 (0.21–2.13) for stillbirth
Bouyer et al. 1998	1993–1994	France	Hospital personnel	Case–control	104 cases/ 279 controls	10	Adj OR, 0.95 (0.39–2.31) for tubal pregnancy	Studied only preconception exposures. Update of Saurel- Cubizolles 1993 article. Could have over- adjusted; included previous SA in analysis. CIs were wide, so power is a question.
Saurel- Cubizolles et al. 1993	1985	Paris	Hospital nurses	Self- administered survey	85 exposed and 599 unexposed	6	Adj OR, 11.4 (2.7–17.6) for tubal pregnancy	Exposure to hazardous drugs during 1st trimester. See Bouyer update from 1998.