Is occupational exposure to chemotherapy contraindicated in pregnancy?

Occupational Exposure to Chemotherapy During Pregnancy

Occupational exposure to chemotherapy is contraindicated during pregnancy due to potential teratogenic effects, particularly during the first trimester when the risk of fetal malformations is highest. 1, 2

Risks by Trimester

• First trimester exposure to chemotherapy agents carries a 10-20% risk of major malformations due to interference with organogenesis 1, 2
• While second and third trimester occupational exposure presents lower risks of malformations, it remains associated with potential complications including intrauterine growth restriction, premature labor, and low birth weight 1, 3
• Certain chemotherapeutic agents like methotrexate, thalidomide, lenalidomide, and pomalidomide are absolutely contraindicated throughout pregnancy due to severe teratogenic effects 1, 4

Specific Agents of Concern

• Alkylating agents like cyclophosphamide can cause fetal harm, birth defects, miscarriage, and fetal growth retardation 5
• Anthracyclines, while relatively safer during the second and third trimesters for therapeutic use, still pose risks through occupational exposure 6
• Targeted therapies and antiangiogenic drugs (anti-VEGF) are contraindicated during pregnancy and should be avoided in occupational settings 1, 6
• Hormonal agents like tamoxifen are contraindicated throughout pregnancy 6

Occupational Safety Recommendations

• Healthcare workers who are pregnant should avoid preparing or administering chemotherapy agents, particularly during the first trimester 2
• Proper personal protective equipment and engineering controls should be used by all staff handling chemotherapy, with additional precautions for pregnant workers 1, 2
• Early collaboration between occupational health, pharmacy, and obstetrics is essential when managing pregnant healthcare workers with potential chemotherapy exposure 1

Alternative Work Arrangements

• Pregnant healthcare workers should be reassigned to duties that do not involve handling, preparing, or administering chemotherapy agents 1, 2
• If reassignment is not possible, strict adherence to safety protocols with enhanced protective measures should be implemented 1
• Return to regular duties involving chemotherapy handling should only occur after delivery and completion of breastfeeding 2

Special Considerations

• Even trace occupational exposure to certain agents (like methotrexate, thalidomide) should be strictly avoided throughout pregnancy 1, 4
• Radiation therapy departments also pose risks, as radiation is contraindicated during pregnancy and pregnant staff should avoid areas where radiation exposure is possible 1
• Breastfeeding healthcare workers should also avoid handling chemotherapy due to potential transfer through breast milk 1, 2

Monitoring Recommendations

• Healthcare workers with known occupational exposure to chemotherapy during pregnancy should receive enhanced fetal monitoring 1
• Ultrasound monitoring for fetal growth and development is recommended following any significant exposure 3
• Long-term follow-up of children with prenatal exposure to chemotherapy is important to monitor for potential developmental effects 3