Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
Ann Epidemiol. 2021 Jan;53:95-102.e2. doi: 10.1016/j.annepidem.2020.09.003. Epub 2020 Sep 11.
To examine the association betweenantineoplastic drug (AD) handling and risk of miscarriage.
Nurses' Health Study-3 participants self-reported AD administration and engineering controls (ECs) and personal protective equipment (PPE) use at baseline. We estimated the hazard ratio (HR) of miscarriage in relation to baseline AD handling using multivariable Cox proportional regression.
Overall, 2440 nurses reported 3327 pregnancies, with 550 (17%) ended in miscarriages. Twelve percent of nurses self-reported currently handling AD and 28% previously handling AD. Compared with nurses who never handled AD, nurses who handled AD at baseline had an adjusted HR of miscarriage of 1.26 (95% confidence interval [CI], 0.97-1.64). This association was stronger after 12-weeks gestation (HR=2.39 [95% CI, 1.13-5.07]). Nurses who did not always use gloves had HR of 1.51 (95% CI, 0.91-2.51) compared with 1.19 (95% CI, 0.89-1.60) for those always using gloves; nurses who did not always use gowns had HR of 1.32 (95% CI, 0.95-1.83) compared with 1.19 (95% CI, 0.81-1.75) for nurses always using gowns.
We observed a suggestive association between AD handling and miscarriage, particularly among nurses who did not consistently use PPE and EC with stronger associations for second trimester losses.
研究抗肿瘤药物（AD）处理与流产风险之间的关联。
护士健康研究-3 的参与者在基线时自我报告 AD 给药和工程控制（EC）以及个人防护设备（PPE）的使用情况。我们使用多变量 Cox 比例风险回归估计与基线 AD 处理相关的流产风险比（HR）。
总体而言，2440 名护士报告了 3327 次妊娠，其中 550 次（17%）流产。12%的护士自我报告目前正在处理 AD，28%的护士以前处理过 AD。与从未处理过 AD 的护士相比，基线时处理过 AD 的护士流产的调整 HR 为 1.26（95%置信区间 [CI]，0.97-1.64）。这种关联在妊娠 12 周后更强（HR=2.39 [95% CI，1.13-5.07]）。与始终戴手套的护士相比，从不戴手套的护士的 HR 为 1.51（95% CI，0.91-2.51）；与始终穿手术服的护士相比，从不穿手术服的护士的 HR 为 1.32（95% CI，0.95-1.83）。
我们观察到 AD 处理与流产之间存在关联，尤其是在未始终使用 PPE 和 EC 的护士中，对于第二个三个月的流产风险关联更强。
