This material is taken directly from the US Nuclear Regulatory Guide 8.13 "Instruction Concerning Prenatal Radiation Exposure". It provides instructions about the health protection problems associated with prenatal radiation exposure. It is intended for female employees working in or frequenting any area where radioactive material or radiation producing equipment is used. Anyone who supervises employees who work with radioactive materials or radiation producing equipment will likewise be familiar with this guideline.
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A. Possible Health Risks To Children Of Women Who Are Exposed To Radiation During Pregnancy
During pregnancy, you should be aware of things in your surroundings or in your style of life that could affect your unborn child. For those of you who work in or visit areas designated as Restricted Areas (where access is controlled to protect individuals from being exposed to radiation and radioactive materials), it is desirable that you understand the biological risks of radiation to your unborn child.
1. Background Radiation
Everyone is exposed daily to various kinds of radiation: heat, light, ultraviolet, microwave, ionizing, and so on. For the purposes of this guide, only ionizing radiation (such as x‑rays, gamma rays, neutrons, and other high‑speed atomic particles) is considered. Actually, everything is radioactive and all human activities involve exposure to radiation. People are exposed to different amounts of natural "background" ionizing radiation depending on where they live. Radon gas in homes is a problem of growing concern. Background radiation comes from three sources:
Terrestrial ‑ radiation from soil and rocks
Cosmic ‑ radiation from outer space
Radioactivity normally found within the human body
a. The first two of these sources expose the body from the outside, and the last one exposes it from the inside. The average person is thus exposed to a total dose of about 125 millirem per year from natural background radiation.
2. Medical Procedures
In addition to exposure from normal background radiation, medical procedures may contribute to the dose people receive. The following table lists the average doses received by the bone marrow (the blood‑forming cells) from different medical applications.
X‑Ray Procedure Average Dose **
Normal chest examination 10 millirem
Normal dental examination 10 millirem
Rib cage examination 140 millirem
Gall bladder examination 170 millirem
Barium enema examination 500 millirem
Pelvic examination 600 millirem
**Variations by a factor of 2 (above and below) are not unusual.
3. NRC Position
NRC regulations and guidance are based on the conservative assumption that any amount of radiation, no matter how small, can have a harmful effect on an adult, child, or unborn child. This assumption is said to be conservative because there are no data showing ill effects from small doses; the National Academy of Sciences recently expressed "uncertainty as to whether a dose of, say, 1 rad would have any effect at all." Although it is known that the unborn child is more sensitive to radiation than adults, particularly during certain stages of development, the NRC has not established a special dose limit for protection of the unborn child. Such a limit could result in job discrimination for women of child‑bearing age and perhaps in the invasion of privacy (if pregnancy tests were required) if a separate regulatory dose limit were specified for the unborn child. Therefore, the NRC has taken the position that special protection of the unborn child should be voluntary and should be based on decisions made by workers and employers who are well informed about the risks involved.
a. For the NRC position to be effective, it is important that both the employee and the employer understand the risk to the unborn child from radiation received as a result of the occupational exposure of the mother. This document tries to explain the risk as clearly as possible and to compare it with other risks to the unborn child during pregnancy. It is hoped this will help pregnant employees balance the risk to the unborn child against the benefits of employment to decide if the risk is worth taking. This document also discusses methods of keeping the dose, and therefore the risk, to the unborn child as low as is reasonable achievable.
4. Radiation Dose Limits
The NRC’s present limit on the radiation dose that can be received on the job is 1,250 millirems per quarter (3 months). Working minors (those under 18) are limited to a dose equal to one‑tenth that of adults, 125 millirems per quarter. (See § 20.101 of 10 CFR Part 20.)
a. Because of the sensitivity of the unborn child, the National Council on Radiation Protection and Measurements (NCRP) has recommended that the dose equivalent to the unborn child from occupational exposure of the expectant mother be limited to 500 millirems for the entire pregnancy (Ref.2). The 1987 Presidential guidance (Ref. 1) specifies an effective dose equivalent limit of 500 millirems to the unborn child if the pregnancy has been declared by the mother; the guidance also recommends that substantial variations in the rate of exposure be avoided. The NRC (in § 20.208 of its proposed revision to Part 20) has proposed adoption of the above limits on dose and rate of exposure.
5. Advice for Employee and Employer
Although the risks to the unborn child are small under normal working conditions, it is still advisable to limit the radiation dose from occupational exposure to no more than 500 millirems for the total pregnancy. Employee and employer should work together to decide the best method for accomplishing this goal. Some methods that might be used include reducing the time spent in radiation areas, wearing some shielding over the abdominal area, and keeping and extra distance from radiation sources when possible. The employer or health physicist will be able to estimate the probable dose to the unborn child during the normal nine‑month pregnancy period and to inform the employee of the amount. If the predicted dose exceeds 500 millirems, the employee and employer should work out schedules or procedures to limit the dose to the 500 millirem recommended limit.
a. It is important that the employee inform the employer of her condition as soon as she realizes she is pregnant if the dose to the unborn child is to be minimized.
6. Internal Hazards
This document has been directed primarily toward a discussion of radiation doses received from sources outside the body. Workers should also be aware that there is a risk of radioactive material entering the body in workplaces where unsealed radioactive material is used. Nuclear medicine clinics, laboratories, and certain manufacturers use radioactive material in bulk form, often as a liquid or a gas. A list of the commonly used materials and safety precautions for each is beyond the scope of this document, but certain general precautions might include the following:
a. Do not smoke, eat, drink, or apply cosmetics around radioactive material.
b. Do not pipette solutions by mouth.
c. Use disposable gloves while handling radioactive material when feasible.
d. Wash hands after working around radioactive material.
e. Wear lab coats or other protective clothing whenever there is a possibility of spills.
Remember that the employer is required to have demonstrated that it will have safe procedures and practices before the NRC issues it a license to use radioactive material. Workers are urged to follow established procedures and consult the employer's radiation safety officer or health physicist whenever problems or questions arise.
B. Effect On The Embryo / Fetus of Exposure To Radiation and Other Environmental Hazards
In order to decide whether to continue working while exposed to ionizing radiation during her pregnancy, a women should understand the potential effects on an embryo/fetus, including those that may be produced by various environmental risks such as smoking and drinking. This will allow her to compare these risks with those produced by exposure to ionizing radiation.
1. Radiation Risk
Table 1 provides information on the potential effects resulting from exposure of an embryo/fetus to radiation and non-radiation risks. The second column gives the rate at which the effect is produced by natural causes in terms of the number per thousand cases. The fourth column gives the number of additional effects per thousand cases believed to be produced by exposure to the specified amount of the risk factor.
The following section discusses the studies from which the information in Table 1 was derived. The results of exposure of the embryo/fetus to the risk factors and the dependence on the amount of exposure are explained.
a. Childhood Cancer
Numerous studies of radiation‑induced childhood cancer have been performed, but a number of them are controversial. The National Academy of Science (NAS) BEIR report reevaluated the data from these studies and even reanalyzed the results. Some of the strongest support for a causal relationship is provided by twin data from the Oxford survey (Ref. 4). For maternal radiation doses of 1,000 millirems, the excess number of deaths (above those occurring from natural causes) was found to be 0.6 deaths per thousand children (Ref. 4).
b. Mental Retardation and Abnormal Smallness of the Head (Microcephaly)
Studies of Japanese children who were exposed while in the womb to the atomic bomb radiation at Hiroshima and Nagasaki have shown evidence of both small head size and mental retardation. Most of the children were exposed to radiation doses in the range of 1 to 50 rads. The importance of the most recent study lies in the fact that investigators were able to show that the gestational age (age of the embryo/fetus after conception) at the time the children were exposed was a critical factor (Ref. 7). The approximate risk of small head size as a function of gestational age is shown in Table 1. For a radiation dose of 1,000 millirems at 4 to 7 weeks after conception, the excess cases of small head size was 5 per thousand; and 8 to 11 weeks, it was 9 per thousand (Ref. 7).
(1) In another study, the highest risk of mental retardation occurred during the 8 to 15 week period after conception (Ref. 8). A recent EPA study (Ref. 16) has calculated that excess cases of mental retardation per live birth lie between 0.5 and 4 per thousand per rad.
c. Genetic Effects
Radiation‑induced genetic effects have not been observed to date in humans. The largest source of material for genetic studies involves the survivors of Hiroshima and Nagasaki, but the 77,000 births that occurred among the survivors showed no evidence of genetic effects. For doses received by the pregnant worker in the course of employment considered in this guide, the dose received by the embryo/fetus apparently would have negligible effect on descendants (Refs. 17 and 18).
2. Non-radiation Risks
A recent study (Ref. 9) involving the birth records of 130,000 children in the State of Washington indicates that the risk of death to the unborn child is related to the occupation of the mother. Workers in the metal industry, the chemical industry, medical technology, the wood industry, the textile industry, and farms exhibited stillbirths or spontaneous abortions at a rate of 90 per thousand above that of workers in the control group, which consisted of workers in several other industries.
It has been recognized since ancient times that alcohol consumption had an effect on the unborn child. Carthaginian law forbade the consumption of wine on the wedding night so that a defective child might not be conceived. Recent studies have indicated that small amounts of alcohol consumption have only the minor effect of reducing the birth weight slightly, but when consumption increases to 2 to 4 drinks per day, a pattern of abnormalities called the fetal alcohol syndrome (FAS) begins to appear (Ref. 11). This syndrome consists of reduced growth in the unborn child, faulty brain function, and abnormal facial features. There is a syndrome that has the same symptoms as full‑blown FAS that occurs in children born to mothers who have not consumed alcohol. This naturally occurring syndrome occurs in about 1 to 2 cases per thousand (Ref. 10).
(1) For mothers who consume 2 to 4 drinks per day, the excess occurrences number about 100 per thousand; and for those who consume more than 4 drinks per day, excess occurrences number 200 per thousand. The most sensitive period for this effect of alcohol appears to be the first few weeks after conception, before the mother‑to‑be realizes she is pregnant (Refs. 10 and 11). Also, 17% or 170 per thousand of the embryo/fetuses of chronic alcoholics develop FAS and die before birth (Ref. 15). FAS was first identified in 1973 in the United States where less than full‑blown effects of the syndrome are now referred to as fetal alcohol effects (FAE) (Ref. 12).
Smoking during pregnancy causes reduced birth weights in babies amounting to 5 to 9 ounces on the average. In addition, there is an increased risk of 5 infant deaths per thousand for mothers who smoke less than one pack per day and 10 infant deaths per thousand for mothers who smoke one or more packs per day (Ref. 13).
Numerous other risks affect the embryo/fetus, only a few of which are touched upon here. Most people are familiar with the drug thalidomide (a sedative given to some pregnant women), which causes children to be born with missing limbs, and the more recent use of the drug diethylstilbestrol (DES), a synthetic estrogen given to some women to treat menstrual disorders, which produced vaginal cancers in the daughters born to women who took the drug. Living at high altitudes also gives rise to an increase in the number of low‑birth‑weight children born, while an increase in Down's Syndrome (mongolism) occurs in children born to mothers who are over 35 years of age. The rapid growth in the use of ultrasound in recent years has sparked an ongoing investigation into the risks of using ultrasound for diagnostic procedures (Ref. 19).
PRENATAL RADIATION EXPOSURE
I hereby certify that I have received a copy of "Possible Health Risks to children of Women Who are Exposed to Radiation During Pregnancy" and have been given an opportunity to ask questions concerning the health protection problems associated with prenatal radiation exposure.
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Please return to the R.S.O. at:
Office of Research Safety
114 Long Hall
Clemson, SC 29634