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Jiang Z, Chen J, Feng L, Jin M, Liu S, Wang L, Wang J, Yu C, Zhou J, Ye Y, Mei L, Yu W, Zhang X, Lou J. Associations between maternal occupational exposures and pregnancy outcomes among Chinese nurses: a nationwide study. Reprod Health 2023; 20:161. [PMID: 37907929 PMCID: PMC10617240 DOI: 10.1186/s12978-023-01704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Several studies have provided evidence about adverse pregnancy outcomes of nurses involved in occupational exposure. However, the pregnancy outcomes among nurses in middle-income countries are not well demonstrated. The main aim of this study is to present the prevalence and influencing factors of pregnancy outcomes among female nurses in China. METHODS We included 2243 non-nurse health care workers, and 4230 nurses in this national cross-sectional study in China. Information on occupational exposures and pregnancy outcomes was collected using a face-to-face investigation. Odds ratios (ORs) were estimated through logistic regression. RESULTS The proportion of threatened abortion, spontaneous abortion, and stillbirth of female nurses was 2.6%, 7%, and 2.1%, respectively. We found an increased risk of threatened abortion among nurses with overtime work (OR = 1.719, 95% CI 1.158-2.550). The risk of threatened abortion and spontaneous abortion was elevated among nurses handling disinfectant (OR = 2.293 and 1.63, respectively). We found a nearly twofold increased risk of premature birth (OR = 2.169, 95% CI 1.36-3.459) among nurses handling anti-cancer drugs. CONCLUSIONS Our findings suggested that maternal occupational exposures might be associated with the risk of adverse pregnancy outcomes among female nurses in China. We recommend that policy-markers and hospital managers work together to reduce exposure to occupational hazards and improve pregnancy outcomes among female nurses.
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Affiliation(s)
- Zhaoqiang Jiang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Junfei Chen
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Lingfang Feng
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Mingying Jin
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Shuang Liu
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Lina Wang
- School of Medicine, The First Affiliated Hospital, Huzhou University, Huzhou, Zhejiang Province, China
| | - Jing Wang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Changyan Yu
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road, Hangzhou, 310006, China.
| | - Yan Ye
- Department of Occupational Health, Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Liangying Mei
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Wenlan Yu
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Xing Zhang
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China
| | - Jianlin Lou
- School of Public Health, Hangzhou Medical College, 182 Tianmushan Road, Hangzhou, 310013, China.
- School of Medicine, The First Affiliated Hospital, Huzhou University, Huzhou, Zhejiang Province, China.
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Okada N, Kawahara Y, Sanada Y, Hirata Y, Otomo S, Niijima H, Tanaka A, Morimoto A, Lefor AK, Urahashi T, Yasuda Y, Mizuta K, Sakuma Y, Sata N. Successful living donor liver transplantation for liver failure due to maternal T cell engraftment following cord blood transplantation in X-linked severe combined immunodeficiency disease: Case report. Am J Transplant 2021; 21:3184-3189. [PMID: 33793086 DOI: 10.1111/ajt.16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X-linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X-linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux-en-Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X-linked SCID and liver failure.
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Affiliation(s)
- Noriki Okada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Yukihiro Sanada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Hirata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Shinya Otomo
- Pharmacy, Jichi Medical University Hospital, Tochigi-ken, Japan
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Tanaka
- Department of Pathology, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Alan K Lefor
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Taizen Urahashi
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yoshikazu Yasuda
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Koichi Mizuta
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yasunaru Sakuma
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Naohiro Sata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
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Fischer HS, Staufner C, Sallmon H, Henning S, Bührer C. Early Exchange Transfusion to Treat Neonates With Gestational Alloimmune Liver Disease: An 11-Year Cohort Study. J Pediatr Gastroenterol Nutr 2020; 70:444-449. [PMID: 31880662 DOI: 10.1097/mpg.0000000000002593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Exchange transfusion (ET) and intravenous immunoglobulin are potentially life-saving treatment options in newborns with gestational alloimmune liver disease (GALD). Since 2008, early ET has been the standard of care for symptomatic neonates with suspected GALD in our unit. The present study's aim was to investigate the outcomes of this approach. METHODS From 2008 to 2018, all neonates who received ET for suspected GALD were identified, and their clinical course and outcomes were analyzed in a descriptive cohort study. In survivors, liver function parameters before ET and maximum values after ET and at discharge were compared. RESULTS During the 11-year period, 12 infants received ET for suspected GALD at a median (range) chronological age of 11 (1-23) days and gestational age of 38 (32-40) weeks. Signs of impaired liver function, most frequently postnatal hypoglycemia, hyperferritinemia, direct hyperbilirubinemia, and coagulopathy, were present in all infants. Survival without a liver transplant in the overall cohort was 10 of 12 (83.3%) and 7 of 9 (78%) in those fulfilling the criteria of acute liver failure. Two patients died, one of them after liver transplantation. Direct bilirubin typically increased after ET, even in survivors. All survivors recovered and were discharged from the pediatric hepatology outpatient clinic after 8 (3-11) months of follow-up. CONCLUSIONS In newborns with suspected GALD, a limited diagnostic work-up followed by early ET may lead to favorable outcomes. More data are required to develop an evidence-based clinical approach to GALD.
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Affiliation(s)
- Hendrik S Fischer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin
| | - Christian Staufner
- Department of General Pediatrics, Division of Neuropaediatrics and Metabolic Medicine, Universitätsklinikum Heidelberg, Heidelberg
| | - Hannes Sallmon
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin.,Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin
| | - Stephan Henning
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin
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