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Original research
Occupational exposure to high-level disinfectants and risk of miscarriage among nurses
  1. Ming Ding1,
  2. Christina Lawson2,
  3. Candice Johnson3,
  4. Janet Rich-Edwards4,
  5. Audrey Jane Gaskins5,
  6. Jim Boiano2,
  7. Scott Henn2,
  8. Carissa Rocheleau2,
  9. Jorge E Chavarro1,6,7
  1. 1 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
  3. 3 Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
  4. 4 Connors Center for Women’s Health and Gender Biology and Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  6. 6 Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  7. 7 Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Ming Ding, Boston, Massachusetts, USA; mid829{at}


Objectives To examine the association of occupational exposure to high-level disinfectants (HLDs) with risk of miscarriage among nurses.

Methods Our study included women who enrolled in the Nurses’ Health Study 3 (2010–2020) and had at least one pregnancy during follow-up. Occupational exposure to HLDs was self-reported at baseline. Every 6 months, a follow-up questionnaire was sent to participants asking for detailed information on pregnancies. We used a discrete-time Cox model to calculate the HRs and 95% CIs of miscarriage according to exposure to HLDs.

Results Our study included 2579 nurses with a median of 5.6 years of follow-up (range: 1–9 years), and we documented 768 (19%) cases of miscarriage among 3974 pregnancies. Compared with women with no HLD exposure, the HRs of miscarriage were 1.08 (95% CI: 0.87 to 1.34) for past users and 0.84 (95% CI: 0.68 to 1.04) for HLD users. Compared with women with no HLD exposure, duration, frequency, and type of HLD and use of exposure controls were not associated with risk of miscarriage. When restricting to pregnancies that occurred within 12 months of HLD use, occupational exposure to unspecified types of HLD was significantly associated with higher risk of miscarriage (HR=1.78; 95% CI: 1.08 to 2.93).

Conclusions We observed no associations between occupational use of HLDs and miscarriage, except when we restricted to pregnancies occurring within 12 months of assessed baseline exposure. Given the observational design and limited sample size, results should be interpreted cautiously.

  • occupational health
  • reproductive medicine

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors MD, CL and JEC were involved in study concept and design and critical revision for important intellectual content of the manuscript and had a primary responsibility for final content; MD analysed the data and drafted the manuscript, and CJ, JR-E, AJG, JB, SH and CR contributed to data interpretation and manuscript editing and provided expertise in occupational health. All authors were involved in revisions of draft manuscripts and approval of the final manuscript.

  • Funding This work was supported by contract 200–2013 M-54978 from CDC/NIOSH to the Harvard T. H. Chan School of Public Health. The Nurse’s Health Study 3 is supported by grants R24-ES028521 and U01-HL145386-01 from the National Institutes of Health.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health and Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.