{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:10:17Z","timestamp":1793257817335,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare professionals, particularly anesthesiologists, nurses, and dental staff, are routinely exposed to inhalational anesthetic agents such as nitrous oxide and halogenated gases. Although scavenging and ventilation systems have reduced ambient levels, concerns remain regarding reproductive risks associated with chronic exposure. Previous studies have yielded inconsistent results. A systematic review and meta-analysis of published observational studies was conducted to clarify the relationship, assessing reproductive outcomes among healthcare workers who were exposed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to clarify the association between occupational exposure to anesthetic gases and the risk of spontaneous abortion among healthcare workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic search was performed in PubMed, Scopus, and Web of Science up from inception until the end of July 2025. Observational studies assessing spontaneous abortion among female healthcare workers exposed to inhalational anesthetics were included. Two reviewers independently screened and extracted data and assessed study quality using the Newcastle\u2013Ottawa Scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic, and potential moderators were explored via subgroup and meta-regression analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen studies were included. The pooled analysis showed 1.29-fold higher odds of spontaneous abortion among exposed workers compared with unexposed controls (OR\u202f=\u202f1.29; 95% CI: 0.96\u20131.75; I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f87%). Subgroup analyses indicated stronger associations in North American studies and among high-exposure occupations. Meta-regression analysis indicated that exposure duration is a significant predictor (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.010), accounting for 73.6% of the heterogeneity. Sensitivity and Egger\u2019s tests revealed robust findings without evidence of publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Occupational exposure to anesthetic gases may increase the risk of spontaneous abortion, particularly in those who are at high exposure, emphasizing the need for stringent exposure control and improved workplace safety standards.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1766912","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:43:09Z","timestamp":1775022189000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Occupational exposure to inhalational anesthetics and the risk of spontaneous abortion: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Tang","family":"Ying","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Third People\u2019s Hospital of Deqing","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Yuanqing","sequence":"additional","affiliation":[{"name":"Health Management of Huzhou Health Service Center","place":["Huzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1136\/oem.54.8.541","article-title":"Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis","volume":"54","author":"Boivin","year":"1997","journal-title":"Occup Environ Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.2147\/ijwh.s376459","article-title":"Effect of inhalational anesthetics exposure on reproductive outcomes and its predictors among healthcare personnel in Jimma zone public hospitals: a comparative cross-sectional study","volume":"14","author":"Olika","year":"2022","journal-title":"Int J Women's Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/vaa.12014","article-title":"Inhalation anesthetics and the reproductive risk associated with occupational exposure among women working in veterinary anesthesia","volume":"40","author":"Allweiler","year":"2013","journal-title":"Vet Anaesth Analg"},{"key":"ref4","volume-title":"Engineering Controls for Post-Operatory Waste Anesthetic Gases\u2014Baseline Data Collection. National Institute for Occupational Safety and Health Division of Field Studies and Engineering Engineering and Physical Hazards Branch EPHB Report No. 2022","author":"Garcia","year":""},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11060883","article-title":"Occupational exposure to inhalational anesthetics and teratogenic effects: a systematic review","volume":"11","author":"Garc\u00eda-\u00c1lvarez","year":"2023","journal-title":"Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.toxrep.2023.06.007","article-title":"Exposure to anesthetic gases in the operating rooms and assessment of non-carcinogenic risk among health care workers","volume":"11","author":"Kiani","year":"2023","journal-title":"Toxicol Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"10436","DOI":"10.1007\/s11356-020-11684-1","article-title":"Spontaneous abortion in women occupationally exposed to inhalational anesthetics: a critical systematic review","volume":"28","author":"Oliveira","year":"2021","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s12978-023-01704-x","article-title":"Associations between maternal occupational exposures and pregnancy outcomes among Chinese nurses: a nationwide study","volume":"20","author":"Jiang","year":"2023","journal-title":"Reprod Health"},{"key":"ref9","volume-title":"Directive (EU) 2022\/431 of the European Parliament and of the Council of 9 March 2022 Amending Directive 2004\/37\/EC on the Protection of Workers from the Risks Related to Exposure to Carcinogens or Mutagens at work","year":"2022"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1213\/ANE.0000000000005504","article-title":"Environmental and occupational considerations of anesthesia: a narrative review and update","volume":"133","author":"Varughese","year":"2021","journal-title":"Anesth Analg"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.3390\/ijms262010031","article-title":"The consequences of DNA damage in the early embryo are important for practical procedures in assisted reproduction","volume":"26","author":"Baran","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3390\/ijerph20010514","article-title":"Occupational exposure to halogenated anaesthetic gases in hospitals: a systematic review of methods and techniques to assess air concentration levels","volume":"20","author":"Keller","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref13","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref14","volume-title":"Critiplot: A Critical Appraisal Plot Visualiser for Risk of Bias in Systematic Reviews and Meta-Analyses","author":"Sahu","year":"2025"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/00000542-197110000-00005","article-title":"Anesthesia, pregnancy, and miscarriage: a study of operating room nurses and anesthetists","volume":"35","author":"Cohen","year":"1971","journal-title":"Anesthesiology"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.14219\/jada.archive.1980.0345","article-title":"Occupational disease in dentistry and chronic exposure to trace anesthetic gases","volume":"101","author":"Cohen","year":"1980","journal-title":"J Am Dent Assoc"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/BF00378441","article-title":"Anaesthetic health hazards among Belgian nurses and physicians","volume":"48","author":"Lauwerys","year":"1981","journal-title":"Int Arch Occup Environ Health"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1093\/ije\/11.3.250","article-title":"Exposure to anaesthetic gases and spontaneous abortion: response bias in a postal questionnaire study","volume":"11","author":"Axelsson","year":"1982","journal-title":"Int J Epidemiol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1136\/jech.38.2.149","article-title":"Spontaneous abortions among dental assistants, factory workers, painters, and gardening workers: a follow up study","volume":"38","author":"Heidam","year":"1984","journal-title":"J Epidemiol Community Health"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1136\/jech.39.2.141","article-title":"Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome","volume":"39","author":"Hemminki","year":"1985","journal-title":"J Epidemiol Community Health"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1136\/oem.47.7.490","article-title":"Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel","volume":"47","author":"Guirguis","year":"1990","journal-title":"Occup Environ Med"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/BF00454361","article-title":"Work in operating rooms and pregnancy outcome among nurses","volume":"66","author":"Saurel-Cubizolles","year":"1994","journal-title":"Int Arch Occup Environ Health"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/oxfordjournals.aje.a117468","article-title":"Nitrous oxide and spontaneous abortion in female dental assistants","volume":"141","author":"Rowland","year":"1995","journal-title":"Am J Epidemiol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1136\/oem.53.6.374","article-title":"Shift work, nitrous oxide exposure, and spontaneous abortion among Swedish midwives","volume":"53","author":"Axelsson","year":"1996","journal-title":"Occup Environ Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1136\/oem.2007.035246","article-title":"Maternal occupational exposures and risk of spontaneous abortion in veterinary practice","volume":"65","author":"Shirangi","year":"2008","journal-title":"Occup Environ Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"327.e1","DOI":"10.1016\/j.ajog.2011.12.030","article-title":"Occupational exposures among nurses and risk of spontaneous abortion","volume":"206","author":"Lawson","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5049.177883","article-title":"Anaesthesia practice and reproductive outcomes: facts unveiled","volume":"60","author":"Nagella","year":"2016","journal-title":"Indian J Anaesth"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"800","DOI":"10.3889\/oamjms.2017.185","article-title":"Health effects associated with exposure to anesthetic gas nitrous oxide-N(2)O in clinical hospital - Shtip Personel","volume":"5","author":"Eftimova","year":"2017","journal-title":"Open Access Maced J Med Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12905-024-02890-x","article-title":"Reproductive outcomes among female health care workers","volume":"24","author":"Izadi","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/em.22420","article-title":"Oxidative stress, DNA damage, inflammation and gene expression in occupationally exposed university hospital anesthesia providers","volume":"62","author":"Souza","year":"2021","journal-title":"Environ Mol Mutagen"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.bjan.2017.05.001","article-title":"Riscos ocupacionais, danos no material gen\u00e9tico e estresse oxidativo frente \u00e0 exposi\u00e7\u00e3o aos res\u00edduos de gases anest\u00e9sicos","volume":"68","author":"Lucio","year":"2018","journal-title":"Braz J Anesthesiol"},{"key":"ref32","doi-asserted-by":"crossref","DOI":"10.1016\/j.etap.2024.104624","article-title":"From indoors to outdoors: impact of waste anesthetic gases on occupationally exposed professionals and related environmental hazards \u2013 a narrative review and update","volume":"113","author":"Silva","year":"2025","journal-title":"Environ Toxicol Pharmacol"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20010514","article-title":"Occupational exposure to halogenated anaesthetic gases in hospitals: a systematic review of methods and techniques to assess air concentration levels","volume":"20","author":"Keller","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s13643-023-02331-0","article-title":"Establishing a health-based recommended occupational exposure limit for isoflurane using experimental animal data: a systematic review protocol","volume":"12","author":"Struijs","year":"2023","journal-title":"Syst Rev"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.6859\/aja.202303_61(1).0001","article-title":"Occupational risks to pregnant anesthesia trainees and physicians: are we ignoring something important?","volume":"61","author":"Mangla","year":"2023","journal-title":"Asian J Anesthesiol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e19988","DOI":"10.1016\/j.heliyon.2023.e19988","article-title":"Waste anesthetic gases have a significant association with deoxyribonucleic acid (DNA) damage: a systematic review and meta-analysis of 2,732 participants","volume":"9","author":"Lestari","year":"2023","journal-title":"Heliyon"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"304","DOI":"10.4187\/respcare.11662","article-title":"Anesthetic gas scavenging system for gas evacuation in the ICU","volume":"70","author":"Collet","year":"2025","journal-title":"Respir Care"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.bjan.2017.02.001","article-title":"Comparison of waste anesthetic gases in operating rooms with or without an scavenging system in a Brazilian university hospital","volume":"67","author":"Braz","year":"2017","journal-title":"Rev Bras Anestesiol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1097\/00000539-200101000-00023","article-title":"High-level, but not low-level, occupational exposure to inhaled anesthetics is associated with genotoxicity in the micronucleus assay","volume":"92","author":"Wiesner","year":"2001","journal-title":"Anesth Analg"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.jclinane.2016.08.029","article-title":"Exposure to anesthetic gases among operating room personnel and risk of genotoxicity: a systematic review of the human biomonitoring studies","volume":"35","author":"Y\u0131lmaz","year":"2016","journal-title":"J Clin Anesth"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.bjane.2017.07.002","article-title":"Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases","volume":"68","author":"Lucio","year":"2018","journal-title":"Brazilian J Anesthesiol (English Edition)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1111\/ina.12643","article-title":"High concentrations of waste anesthetic gases induce genetic damage and inflammation in physicians exposed for three years: a cross-sectional study","volume":"30","author":"Braz","year":"2020","journal-title":"Indoor Air"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.mrfmmm.2011.10.010","article-title":"Oxidative DNA damage and oxidative stress in subjects occupationally exposed to nitrous oxide (N(2)O)","volume":"731","author":"Wro\u0144ska-Nofer","year":"2012","journal-title":"Mutat Res"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"14660","DOI":"10.1021\/acs.est.2c04345","article-title":"Time between sequential exposures to multiple stress turns antagonism into synergism","volume":"56","author":"Schunck","year":"2022","journal-title":"Environ Sci Technol"},{"key":"ref45","first-page":"95","article-title":"Urinary hexafluoroisopropanol in the assessment of occupational exposure to sevoflurane: methodologic features and critical points","volume":"25","author":"Barbic","year":"2003","journal-title":"G Ital Med Lav Ergon"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"8831535","DOI":"10.1155\/2021\/8831535","article-title":"Effects of occupational exposure to waste anesthetic gas on oxidative stress and DNA damage","volume":"2021","author":"Hua","year":"2021","journal-title":"Oxidative Med Cell Longev"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1766912\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:43:14Z","timestamp":1775022194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1766912\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1766912"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1766912","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1766912"}}