OCCUPATIONAL CYTOTOXIC MEDICATION EXPOSURE IN PREGNANCY

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(Date of issue: March 2017, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Cytotoxic medications are generally used in the chemotherapeutic management of cancer and some autoimmune conditions. These medications act through a variety of pharmacological mechanisms which can include the inhibition of cell division and/or induction of cellular apoptosis.

As studies have shown that occupational exposure to some cytotoxic agents can result in systemic absorption, such exposure during pregnancy could theoretically result in fetal exposure. The available data concerning occupational cytotoxic medication exposure in human pregnancy currently consists of 15 controlled studies and two meta-analyses which collectively provide the outcomes of more than 9,000 unique exposed pregnancies. Much of these data are provided from studies of occupational exposure undertaken prior to current workplace health and safety legislation relating to handling of cytotoxic medication. As such, the available data may serve as a poor predictor of fetal exposure risks when current legislation regarding appropriate precautionary measures is adhered to.

Although some studies have described increased risks of congenital malformation, spontaneous abortion, ectopic pregnancy, preterm delivery and low birth weight, the data are conflicting and often confounded. As such, the available data are not considered to provide sufficient evidence of an increased risk of adverse pregnancy outcomes following occupational exposure.

Due to a lack of evidence indicating that occupational exposure to cytotoxic medication during pregnancy is without risk, caution is advised where possible or continued exposure during pregnancy may occur. In such cases use of personal protective equipment and adherence to standard handling precautions is advised.

Inadvertent occupational exposure to cytotoxic medication at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or additional monitoring where PPE has been used and procedures to limit exposure have been followed. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments. Where systemic maternal absorption is thought likely, an individual case assessment by UKTIS is advised.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.