SUMMARY: Chemotherapeutic agents used in the management of malignant disease and as immunosuppressants are cytotoxic and therefore potentially hazardous substances which may be mutagenic, carcinogenic and teratogenic.

 

Epidemiological evidence suggests that substantial systemic absorption occurs in non-pregnant health professionals exposed to chemotherapeutic agents, therefore concerns exist regarding possible adverse fetal effects following maternal occupational exposure in pregnancy.

 

The available data which investigate the risks of occupational exposure amongst pregnant women provide conflicting findings and may also be confounded due to differences in workplace health and safety measures both between studies and in comparison with the standards of the modern workplace.  Increased risk of congenital malformation and spontaneous abortion following in-utero occupational cytotoxic exposure have been suggested in the literature, however data are conflicting.  It is therefore difficult to attribute causality of adverse pregnancy outcomes to occupational chemotherapeutic exposure in pregnancy, and firm conclusions regarding the risk posed to the developing fetus cannot currently be made.

 

Due to the lack of evidence proving safety of occupational exposure to cytotoxic chemotherapeutic agents, caution is advised where continued exposure during pregnancy is being considered or cannot be avoided.  In all cases women are advised to notify their occupational health departments as soon as pregnancy is suspected.  Inadvertent occupational chemotherapeutic exposure in pregnancy alone is not considered medical grounds for termination.  Following occupational exposure during pregnancy additional fetal monitoring may be required.  Discussion with UKTIS is recommended in all cases.

 Please report ALL cases of drug and/or chemical exposure in pregnancy to UKTIS by telephoning the service on 0844 892 0909 or by printing and completing a pregnancy reporting form, providing as many patient identifiers as possible to enable follow up of pregnancy outcome. This vital information enables UKTIS to provide evidence based advice for future enquiries and to conduct surveillance of potential and known teratogens. For case specific advice please contact UKTIS on 0844 892 0909.