Pregnant? Professionals Should Consider. By Shelly Van Dusen, LVT The NAVTA Journal

Reprinted with permission by The NAVTA Journal, a publication of the National Association of Veterinary Technicians in America.
Pregnant? There Are Risks Veterinary
Professionals Should Consider.
By Shelly Van Dusen, LVT
our dental x-ray I needed to be for minimal
exposure. My office manager and owner were
completely willing to do whatever was necessary to keep their staff safe. In a previous pregnancy, I had my toxoplasmosis titers checked,
which were negative, so I felt that there was
almost no chance that I would have been
exposed in such a short time. I felt that I was
safe because I had the knowledge needed to
keep my unborn baby away from danger.
Unfortunately, I did not always follow proper
precautions because it was too inconvenient, I
didn’t want to burden others, and I felt it could
never happen to me. I performed parasite
screens without gloves, ate lunch in the lab,
assisted with small animal exams without
gloves and mask, lifted animals that weighed
more than my weight limit, performed CPCR
on a bird, and other risky tasks.
Above: Shelly Van Dusen and her 2-and-a-half-year-old son, Caleb.
Before deciding to have a baby, I spent a
long time researching the dangers associated
with working at a veterinary clinic while being
pregnant. I talked with coworkers that had
children, talked to my OBGYN, and searched
the Veterinary Information Network and other
websites for any information I needed to know.
There were even more risks because my office
specialized in small animals and exotics.
Even before I was pregnant, I requested that
our anesthesia machines be inspected for
leaks and our x-ray machine technician came
in with a monitor to test how far away from
The NAVTA Journal | July/August 2012
My son was born full term on July 9, 2010,
and within 12 hours he had a seizure and
he could not keep his temperature up. He
was moved to the NICU and the doctors
started looking for any infectious disease
that could be causing an issue. The first
test for infectious disease in newborns is
the toxoplasmosis, rubella, cytomegalovirus,
and herpes virus (TORCH) test and he was
positive for toxoplasmosis. Over the next two
weeks, our lives fell apart as we found out
the parasite had caused severe brain and
spinal cord damage and destroyed one eye.
None of his doctors had ever seen a case of
congenital toxoplasmosis and they were very
pessimistic about his prognosis due to the
MRI images.
Even though it is more likely that I contracted
toxoplasmosis by not washing my veggies or
from undercooked meat, there will always be
the guilty feeling that I could have done more
to prevent it.
This article is an overview of some of the
risks associated with working in the veterinary field while pregnant. If the proper precautions are followed every time, a pregnant
staff member can feel confident that she has
done everything possible to keep her and
her baby healthy while at work.
Falling, Lifting, and Moving
Lifting restrictions in pregnancy are mostly
to protect the mother from injury. For most
pregnant women, lifting a moderate amount
is safe, if done properly. Their health care
professional will give them a lifting limit, and it
may change throughout pregnancy. This does
not mean she can lift the animal with another
person if half the animal’s weight is within her
limit. Animals can struggle and she may end
up with more of the weight than is safe. She
should let others lift heavy animals for her. If
there is a previous history of miscarriage, her
lifting may be even more restricted, or she
may not be able to lift at all. Ligaments loosen
during pregnancy, making them more prone
to injury, and weight has shifted the center
of gravity forward, possibly making balance
more difficult. Even though the fetus is well
protected, a fall could cause complications
to the pregnancy, or injury to the mother. Approximately 27 percent of women fall during
their pregnancy, and 20 percent of those falls
caused enough injury to need medical attention. Non-pregnant staff members can assist
by lifting heavy animals and knowing your
coworker’s weight limit. They can also take
over restraining large and rowdy animals.
Infectious diseases
Pregnant women have a compromised immune system, so are more susceptible to
zoonotic diseases. They are also more likely
to be more severely affected by a disease
that others may fight off easily. In general,
pregnant women should be vigilant about
washing their hands after touching each
animal or bodily fluid, and avoid eating around
animals or in the lab. They also should avoid
handling any tissues from an aborted fetus,
since several diseases that cause abortions
in animals have the same result in humans.
These are only a few of the zoonotic diseases
that can cause issues in unborn babies. Each
type of clinic has different risks for disease
transmission. A pregnant staff member in a
large animal clinic has a higher risk of contracting listeria while at work than at a small
animal clinic, and a pregnant woman working
at a small animal clinic has a higher risk of
contracting toxoplasmosis while at work than
a lab animal technician.
All of this isn’t to say that you live in a
plastic bubble during your pregnancy, but
rather to take proper precautions and have
as much knowledge to make your risk as
low as possible.
Q fever
It is recommended that pregnant women do
not assist in cattle, sheep, and goat births due
to the risk of Q fever. Q fever can cause miscarriage, stillbirth, and low birth weight. The
disease causes severe flu-like symptoms with
high fever, weight loss, and pneumonia. It also
has the risk of becoming a persistent infection
and causing hepatitis and endocarditis.
Influenza
Pregnant women are more than five times
as likely to be hospitalized for influenza as a
woman who isn’t pregnant. This is most likely
due to a compromised immune system and
a decreased ability to expand their lungs,
leading to secondary pneumonia. Ferrets are
capable of transmitting many strains of influenza to humans and the H1N1 flu has been
reported in dogs, cats, pigs, turkeys, and other animals. Symptoms of influenza in animals
are similar to humans, such as fever, lethargy,
nasal discharge, and decreased appetite.
Pregnant staff members may want to avoid
direct exposure to animals, especially ferrets,
with these symptoms and get a flu shot. The
American Congress of Obstetricians and
Gynecologists recommends pregnant women
receive a flu vaccine.
Top: MRI of Shelly Van Dusens sons brain at 3
months old. The arrow indicates one of several toxoplasmosis lesions in the brain. Note the difference in
sizes of the eyes which is a typical manifestation of
the disease Lower: MRI of Calebs brain at 3 months
old severely effected by toxoplasmosis
Toxoplasmosis
Toxoplasmosis is the most common parasite,
infecting an estimated 2 to 3 billion people.
Toxoplasmosis causes miscarriage, stillbirth,
and many congenital abnormalities on surviving children. Those not diagnosed at birth
develop eye lesions, learning disabilities, and
other neurologic conditions such as seizures
later in childhood.
Many OBGYNs tell their pregnant patients to
avoid cleaning litter boxes, and unfortunately
some doctors may tell the patients to get rid of
their cats. The truth is a person is much more
likely to become infected by eating unwashed
Publication of the National Association of Veterinary Technicians in America
Reprinted with permission by The NAVTA Journal, a publication of the National Association of Veterinary Technicians in America.
Tips
Steps to decrease anesthetic exposure
to the pregnant employee:
§§ Check regularly for any leaks in the
anesthesia machine and for proper
functioning of the scavenger system.
§§ Have someone else fill the vaporizer.
§§ Attach the hose to the patient before
turning the anesthetic gas on.
§§ Leave the patient hooked to machine
for as long as possible after turning off
the gas, so that the scavenger system
removes the off-gassing from the patient.
§§ Recover patients only in well ventilated
areas.
§§ Masks with charcoal-activated filters
remove halogenated gases from the
air and can be used in high exposure
situations, such as boxing down a feral
cat or using uncuffed endotracheal tubes.
veggies or undercooked meat, or after coming
in contact with contaminated soil. Toxoplasmosis oocysts take more than 24 hours to
become infective to others, so as long as litter
boxes are thoroughly cleaned twice daily in
the veterinary hospital, there is no risk. The risk
to staff members comes from fecal samples
brought in by owners that are more than 24
hours old, and from cats that have feces on
their coats. All staff members should always
wear gloves and wash hands when handling
any type of feces. Unrelated to the work environment, pregnant women should cook meat,
especially pork, to 160 degrees Fahrenheit
and properly wash vegetables.
Dr. Rima McCleod, leading world expert
on toxoplasmosis, recommends the following: Pregnant women or those planning on
becoming pregnant should be tested for IgM
toxoplasmosis antibodies as early as possible,
and if positive, then test for IgG antibodies
for current infection. They should be tested
monthly for IgG antibodies throughout pregnancy. If any test is positive at any time during
pregnancy for toxoplasmosis, treatment can
begin immediately to prevent infection to the
fetus. This is the protocol currently used in
France. Healthcare professionals often know
only the minimum about toxoplasmosis, so
pregnant women will have to inform their
healthcare professionals more about the risks
and testing.
Lymphocytic Choriomeningitis
Virus
Lymphocytic Choriomeningitis Virus (LCMV)
is a relatively little known disease that is
transmitted by rodents and causes miscarriage or severe disease in unborn babies
similar to toxoplasmosis, but there is no treatment. Adults have only flu-like symptoms. Pet
rodents can be infected by coming in contact
with wild rodents, usually in a breeding facility.
Most cases of LCMV in people were from
coming in contact with wild rodent feces,
urine, saliva, or nesting material, but there
have been reports of pet mice, hamsters, and
guinea pigs causing infection. A pregnant
staff member should talk to their healthcare
professional for a recommendation on working around rodents at work.
X-rays
It is common for pregnant staff members to
avoid taking radiographs. Exposure to high
levels of radiation may cause a miscarriage,
a child’s reduced IQ, mental retardation,
increased cancer incidents later in life and
growth retardation. wThe greatest risk to the
fetus for survivable damage is between 2 and
15 weeks of pregnancy. After about 26 weeks
of pregnancy, the fetus is no more sensitive to
the effect of radiation than a newborn baby.8
The National Council on Radiation Protection
recommends limiting the dose of ionizing radiation (the type used in x-ray machines) in pregnant women to 500 mrems (0.5mSv), which is
equal to as little as 1 pelvis radiograph.
For those who take radiographs before they
know they were pregnant, it is recommended
to wear Personal Protective Equipment (PPE)
that reduces one’s exposure to radiation. If
proper protocols are used, staff members
should only be exposed to a very low amount
of scatter radiation.
The NAVTA Journal | July/August 2012
OSHA does not have a specific recommendation for occupational use of x-ray machines
while pregnant, but they defer to other expert
organizations in order for you to make an
informed decision on taking radiographs.
Human hospitals do not require that their
employees stop taking radiographs, but due
to the nature of our patients, we often need to
physically restrain them for proper views and
are much closer to the radiation source. To
have the best information in order to decide
whether or not to take radiographs, a pregnant staff member may want to check their
last 12 months of radiation badge reports,
which the employer is required to keep.
Remember that the badges are worn on the
outside of the lead apron, so they will have
higher doses than a fetus would receive. The
PPE should also be radiographed on a regular basis to make sure there is no damage allowing more radiation through. One may also
want to discuss with the veterinarian whether
to sedate patients or look into other restraint
devises while taking radiographs so no one
has to be exposed to any excess radiation.
A pregnant staff member should address any
questions about their work environment with
their healthcare provider.
Anesthetic Gases
There is some evidence that operating room
personnel who handle anesthesia while pregnant may be at increased risk for miscarriage
and low birth weight.
The National Institute of Health and Safety
recommends that exposure to anesthetic
gases not exceed 2 parts per million per hour
for all employees. If you can smell the gas, the
level is 5 to 300 ppm. To test the exposure
level of staff members, there are personal
monitoring badges available (VetEquip, Inc.
and others) that are worn for an 8-hour shift
and then evaluated by a laboratory. By doing
this on a regular basis, it will benefit all staff
members who may possibly be exposed to
anesthetic gases. (see Tips)
Your Career
Online Resources
Pharmaceuticals
Pregnant women should avoid all chemotherapy agents, and all patient body fluids that
contain chemotherapeutic agents or radioactive isotopes. Cancer drugs attack rapidly
dividing cells, and so it is especially harmful
to fetuses. Other drugs to avoid touching
include oxytocin, prostaglandins, streptomycin
and thyroid medications. Cats being treated
for hyperthyroidism may also excrete medication in their bodily fluids, so pregnant women
should wear gloves when cleaning vomit or
litter boxes of these cats.
Before my son was born, I had plans of
spending the rest of my life being the best
LVT that I could be, continuing to advance my
knowledge, and possibly even becoming an
anesthesia specialist. Because of my son’s
multiple impairments and medically fragile
state, I consider my new career to be as his
personal manager. Our days together consist
of therapy, tube feedings, doctors’ appointments and medications, but also include
constant smiles, laughs, playing and cuddling.
Even though Caleb has many challenges, he
has amazed every specialist at his abilities and
he has brought our family and friends closer
than I would have ever imagined. I am able to
get my technician-fix by volunteering regularly
at my local animal shelter and I hope someday
to be able to return to work at a clinic. Even
though I don’t know exactly how I contracted
toxoplasmosis, I still feel immense guilt that I
did something to cause Caleb’s disability that I
could have prevented. Know your environment
and your risks, and help others do the same.
No one should have to ask him- or herself:
Could I have done more to protect my child?
References
1. Dunning K, Lemasters G, Bhattacharya
A. (2009, August 13) A Major Public Health
Issue: The High Incidence of Falls During
Pregnancy. Maternal and Child Health Journal.
Retrieved from http://www.ncbi.nlm.nih.gov/
pubmed/19672702
2. Fyksen, F., (2010, June 4) Zoonotic Diseases
in Cattle: Practice Good Hygiene. Published
in Agri-View, an agricultural newspaper in
Wisconsin.
www.acog.com
3. Center for Disease Control and Prevention.
(2009, January 11) Q Fever. Retrieved from
http://www.cdc.gov/ncidod/dvrd/qfever/index.
htm
The American College of Obstetrics
and Gynecologists provides a physician
directory, health columns and much more
through its website.
4. Palo Alto Medical Foundation. (2010) Pregnancy and the Flu. Retrieved from http://www.
pamf.org/flu/preg.html
http://acva.org/docs/Waste_Gas
5. American Veterinary Medical Association.
(2010, June 25) 2009 H1N1 Flu Virus Outbreak. Retrieved from http://www.avma.org/
public_health/influenza/new_virus/default.asp
6. McLeod, L., (2010) Ferret and Influenza:
Ferrets can catch the flu, too. Retrieved from
http://exoticpets.about.com/cs/ferrets/a/ferretsflu.htm
7. Center For Disease Control and Prevention.
(n.d.) Lymphocytic Choriomeningitis Virus from
Pet Rodents. Retrieved from http://www.cdc.
gov/healthypets/lcmv_rodents.htm
8. Center for Disease Control and Prevention. (2006, May 10) Radiation Emergencies:
Radiation and Pregnancy: A Fact Sheet for the
Public. Retrieved from http://www.bt.cdc.gov/
radiation/prenatalphysician.asp
9. Occupational Health and Safety Administration. (2008, October 14) Ionizing Radiation
Health Effects. Retrieved from http://www.
osha.gov/SLTC/radiationionizing/healtheffects.
html
10. Stabin PhD, CHP, Michael G. (2010, August 9) Doses from Medical Radiation Sources.
Retrieved from http://www.hps.org/hpspublications/articles/dosesfrommedicalradiation.html
11. Cornick-Seahorn, J., Cuvelliez, S., Gaynor,
J., McGrath, C., Hartsfield, S. (2006, March
17) Commentary and Recommendations on
Control of Waste Anesthetic Gases in the
Workplace. Retrieved from http://www.acva.
org/professional/Position/waste.htm
12. Dosch, M. P., (2009, June) The Anesthesia Gas Machine. Retrieved from http://www.
udmercy.edu/crna/agm/14.htm
13. University of Illinois at Chicago College
of Pharmacy. (n.d.) Occupational Exposure to
Hazardous Drugs—Recommendations for Oral
Dosage Forms. Retrieved from http://www.
uic.edu/pharmacy/services/di/faq/hazardous_drugs.php
14. Lau, E., (2010, February 10) New Feline
Thyroid Drug Raises Safe-handling Questions. Retrieved from http://www.vin.com/
MEMBERS/CMS/Misc/VINNews/Default.
aspx?id=14933
The American College of Veterinary
Anesthetists’ position paper on controlling waste anesthetic gases also covers
the health and performance of operating
room personnel, including complications
during pregnancy.
www.ama-assn.org
The American Medical Association’s
official website.
www.americanpregnancy.org
Whether trying to get pregnant, or
already pregnant, the American Pregnancy Association will likely have the
information you are seeking.
www.amazingpregnancy.com
Amazing Pregnancy is an online
source about conceiving and the
stages of pregnancy.
www.lalecheleague.org
La Leche League provides information
about breastfeeding.
www.mayohealth.org
Mayo Clinic is a well-respected,
nonprofit leader in medical care, research
and education. The clinic’s website has
an extensive women’s health section,
in addition to covering a wide-range of
medical topics.
www.nlm.nih.gov
The National Library of Medicine’s
website provides a diverse wealth of
health-related information.
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Journal, become a member at
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Publication of the National Association of Veterinary Technicians in America