Are handling chemotherapy drugs safe during pregnancy?

What does the evidence say about handling chemotherapy drugs during pregnancy?

1. In a study of about 7,500 pregnant nurses, those who handled chemotherapy drugs had a higher rate of miscarriage than those who didn't, even though most reported using personal protective equipment, which is part of why the Oncology Nursing Society recommends alternate duty that skips administering or handling cytotoxic drugs for any pregnant staff member who requests it, especially during the first 84 days of pregnancy when organ formation is underway. 1
2. Chemotherapy drugs are mutagenic, carcinogenic, or teratogenic by design and no safe level of occupational exposure has been established, which is why handling guidelines call for closed safety cabinets with outside ventilation, two layers of chemotherapy-rated gloves, impermeable gowns, and face-fitting respirators rather than routine precautions. 1
3. Occupational health guidance for handling hazardous chemotherapy drugs names infertility, fetal harm, miscarriage, and congenital abnormalities among the outcomes precautions are meant to reduce the chance of, and recommends chemotherapy-rated gloves and gowns, double gloving, a respirator when inhalation is possible, and eye protection when splashing is a risk. 2
4. Chemotherapy drugs are established reproductive hazards at therapeutic doses: MotherToBaby's review of chemotherapy given to a patient during her own pregnancy documents an increased chance of miscarriage, especially with first-trimester exposure, which is part of the reasoning behind approaching occupational handling by pregnant staff with real caution even though trace exposure from handling isn't the same as a therapeutic dose. 3
5. The clearest evidence of infant harm from a drug like cyclophosphamide reaching breast milk comes from mothers who received it as cancer therapy, not from occupational handling, which is a far lower exposure. Two infants breastfed by mothers receiving cyclophosphamide developed neutropenia, a finding that illustrates why hazardous-drug exposure during breastfeeding is still worth avoiding even though trace handling exposure differs from a therapeutic dose. 4

Is handling chemotherapy drugs safe in each trimester?

• First trimester. The first 84 days of pregnancy, when a baby's organs are forming, is the window occupational guidance flags as the highest priority to avoid handling cytotoxic drugs, so this is the trimester to raise reassignment with occupational health if you haven't already.
• Second trimester. If reassignment isn't available, this is when to confirm you're using the full recommended setup: a ventilated safety cabinet, two layers of chemotherapy-rated gloves, an impermeable gown, and a respirator for any task with inhalation risk, not just standard gloves.
• Third trimester. The same precautions apply through the third trimester. There's no point in pregnancy where trace occupational exposure to these drugs has been shown to become safe, so keep the same protective routine or reassignment in place until delivery.