Document NGewQ5ovm7q3GMar1e8gnrKRV

734 THE LANCET, APRIL 3, 1976 Occasional Survey GENETIC RISKS OF VINYL CHLORIDE Peter F. Infante Joseph K. Wagoner Anthony J. McMichael Richard J. Waxweiler Henry Falk Division ofSurveillance, Hazard Evaluations and Field Studies, National Institutefor Occupational Safety and Health, and Bureau ofEpidemiology, Center for Disease Control; and School of Public Health, University of North Carolina Summary A study of pregnancy outcome among wives of workers exposed to vinyl-chlor ide monomer (v.c.M.) indicated that, in comparison with controls, there was a significant excess fetal loss in the group whose husbands had a primary exposure to v.c.M., whereas no differences between the groups were observed before the husbands' exposures. The difference in fetal death-rates for the post-exposure comparisons was a reflection of a greater fetal loss associated with the wives younger-aged husbands. The significant excess did not seem to be the result of bias from interviewers, re spondents, nor from women who had experienced chronic abortions weighting the results. These findings, in conjunction with the demonstration of a mutagenic response via microbial test systems and with observa tions of significant excesses of chromosomal aberrations among workers exposed to v.c.M., raise scientific and public-health concern for the possible genetic risks of v.c.M. to man. In the past year, several reports have indicated that vinyl-chloride monomer (v.c.M.) is mutagenic in micro bial test systems.1-3 v.c.M. metabolites also have in duced mutations in mammalian cells.4 Likewise, reports from four countries have shown an excess of chromoso mal aberrations in lymphocytes of workers exposed to v.c.M. compared with controls.5~* However, Purchase et al,7 have stated (though no animal data were presented), that the mutagenic effects of v.c.M. expressed as chro mosomal aberrations in lymphocytes in humans do not occur in germ cells in mice; they concluded that the potential danger of mutagenic effects on the fetus via sperm seemed unlikely to exist. In a study without con trols, Selikoff observed fetal death-rates among wives of v.c.M. workers that ranged from 7 to 14 per 100 preg nancies.9 These rates appear to have been higher than expected.10 To develop further data on this question, pregnancy outcome has been studied among the wives of workers exposed to v.c.M. All current v.c.M. polymerisation and polyvinyl-chloride (p.v.c.) fabrication workers were in cluded for study together with a similar number of cur rent rubber workers (8% of all such workers) selected from work areas relatively free from known toxic materials and matched as a group to the v.c.M. workers by age. Group-participation rates ranged from 62 to 11%. Data for the wives of v.c.M. polymerisation workers (primary v.c.M. group) were contrasted with data for the wives of p.v.c. fabrication and rubber workers ("controls"), who were known to have had very low or no v.c.M. exposure, respectively. A total of 95 v.c.M. polymerisation and 158 rubber and p.v.c. fabri cation workers were interviewed. Paternal age, preg nancy outcome, and estimates for the time of conception of all pregnancies were ascertained by interview in Oct ober, 1974, from males employed at a rubber manufac turing, p.v.c. fabricating, and v.c.M. polymerising facil ity. As part of a larger survey of worker health, date of first employment in the job categories was determined from company records. Mean paternal age, total number of conceptions, total number of fetal deaths (defined as any product of conception not born alive), and fetal deaths per 100 conceptions were then computed for each group prior to and subsequent to the worker's date of employment. No interviews were conducted with workers' wives and no data were obtained concerning maternal age, except indirectly through paternal age. Since fetal loss is known to increase with ascending parental age, the fetal death-rates for the primary v.c.M. exposure group were age-adjusted to the control group. Table I shows the age-adjusted fetal death-rates for wives of the primary v.c.M, exposure group U r j KuM* r versus the control group, both prior to and subsequent to each group's respective exposures. Among pregnan cies occurring prior to exposure, fetal death-rates were 6-9% for the controls versus 6-1% (age-adjusted) for the primary v.c.M. exposure group. These rates were not significantly different by Mantel-Haenszel Chi-square testing.11 Among pregnancies occurring subsequent to the husband's exposure, the difference in frequency of fetal deaths between groups was significant at p<0-05 (^7=4-00, df=l).1J Although the underlying dis tributions differed, mean paternal ages were virtually the same--30-4 versus 30-2 years. The significant dif ference between the groups subsequent to exposure was a reflection of a relatively greater fetal mortality-rate as sociated with younger-aged husbands in the primary v.c.M. exposure group. Among pregnancies occurring subsequent to exposure, the fetal mortality-rates associ ated with husbands 30 years of age and older for the pri mary v.c.M. exposure and control groups were 9/69 (13-0%) and 17/142 (12-0%), respectively; whereas, for R & S 040564 H. < ftsv >4 . *, 1' i . Jar- TABLE I--`MEAN FATERNAL AGE, NUMBER OF PREGNANCIES, AND FETAL DEATH~RATES according to husband's v.c. exposure -- Primary "Controls"* v.c.M. eaposurrt r a.'. ' <:; J Jam ' .-.j r Prior to husband's exposure: Number of families Mean paternal age at conception (yr.) Number of fetal deaths among wives Number of pregnancies Agc-aJpuited fetal dcaths/100 preg4 Subie^uent to husband's exposure: Number of families Mean paternal age at Conception (yr.) Number of fetal Deaths among wives Number of pregnancies Age-adjusted fetal deaths^lOO prcg-J 95 23-0 11 159 69 113 304 24 273 8-8 ;. * 70 26-4 15 148 61 62 30-2 j o4 tr% i 23 ,139 I ' i * , 15*1 | A_ 5 ______________________________ I Rubber *nd P.v.c, fabrication workers, fv.c. polymerisation workeniRam agc*adiusicd to "control" group paternal age distribution. jSub*rqurnt to husband4* exposure, the frequency of fetal deaths among wai significantly greater in the primary v.c.M. exposure group than in the I troll 4 (r<0-05) or in the study group prior to husband's exposure (p<0 0* r I age-adjusted chi-square testing.13 rut lancet, APRIL 3, 1976 .__ mean paternal aoe, number of pregnancies, and fetal T',L TH-RATES according to husband's v.c. exposure EXCLUDING Dl A PREGNANCIES OF WOMEN with ^ 3 FETAL DEATHS Pnmary V.C-M. exposure! ,! ^ncepoon (yw Njn'N<t I*cI .L-jiM jmonR wives Nysit'crof ^n.ndel . \>c-*Jtiisieu lets! JfJllu'ioo png4 , l? ,,v., to kolbond-1 cipoitm: \l;,n paternal **e ,1 ,vn.-Tpuo" (yr.) Nj:nbrri>ffet*l J;jth imong wive* N.roNcrof pfr^anocJ V.TJJtucJ fetal ijthi lOOpreg-t 26-3 9 Ml 3-1 30-8 14 120 10-8 . i f.v,C* fabrication worken. ^mcmauon worken. afe-aJiusted * "control" paternal age distribution. husbands less lhan 30 years of age, fetal mortality was 14 70 (20-0%) for the primary v.c.m. exposure group compared with 7/131 (5-3%) for the control group these data are not shown in tables.) Furthermore, intragroup comparisons indicated an increase in age-adjusted rates for the primary v.c.m. exposure group from 6-1% before exposure to 15-8% t.: Sequent to the husband's exposure. This difference ,|v was significant, p<002 (^2=5-51, df=l).12 Similar nirtipjrison for rates in the control group, 6-9% versus S',', indicated no significant difference. To determine whether women who had chronically experienced abortions might have weighted the results in fax our of a higher fetal death-rate in the primary V.C.M. fioup subsequent to husband's exposure, pregnancies of women who had more than two abortions were elim inated from the analyses and the data were recalcu lated to determine whether or not the trend was mainnmcJ. The decision to exclude all pregnancies among families associated with more than two abortions was maJe without prior knowledge of how these families ere distributed among the exposure categories. The data in table n show that the trend was maintained. Trior to exposure, the fetal death-rates in the control R--J primary v.c.m. exposure groups were 6-9% and 1 I*! ''age-adjusted), respectively, whereas, after expo* urc, the rates were 6-8% and 10-8%, respectively. Sub sequently, data were eliminated for pregnancies of 'men who had experienced, firstly, more than one ''Minn, and, secondly, more than three abortions, and r*-h time the trend was maintained. No changes in rates !-< controls were observed, whereas a 2-3-fold increase * observed in the primary v.c.m. group subsequent to rxfxasure. 7 o determine whether differences in fetal loss might R'c been the result of one or two interviewers weightf ihc results, the data were analysed by individual inTTirwer. The results demonstrated a general trend for mterviewer to report a higher ascenainment v.c.m. polymerisation workers than among the a ;,*urol group. f a.-thcr, the possibility was entertained that the inter- - between the date of interview and the date of fetal ** ~ have influenced the results through dif- 735 ferences in recall. The interval, however, was estimated to have been about two years less for controls, suggest ing that, if a bias did exist, it would have been towards a greater ascenainment in the control group. In some cases, the worker failed to indicate the ages of his children and in other cases he was unable to recall the approximate time of his wife's abonion; therefore, the data were analysed to determine the distribution of fetal death-rates among the respondents in each occupational group who did not complete the interview properly. The difference in fetal death-rates between groups was very slight. Finally, the workers may have been subject to bias resulting from prior knowledge of known hazards of vinyl chloride. However, the workers themselves did not always know into which of our employment categories they were being allocated. For example, several p.v.c. fabrication workers who were included in the control group thought that they had a primary v.c.m. exposure as a fabrication worker. In addition, the questions regarding pregnancy outcome were contained in a much larger interview-questionnaire, the results of which demonstrated very few significant differences with no consistent bias for the parameters ascertained between the workers with a primary v.c.m. exposure, and the other groups. This observation as well as several others presented above tend to support the validity of the study. In summary, a significant excess of fetal loss was observed among wives of workers following exposure to v.c.m. The excess did not appear to be the result of bias from interviewers or respondents, nor from women who experienced chronic abortions weighting the results. Several mechanisms by which such fetal loss may arise are suggested. Either fetal or maternal toxicity or germcell mutagenesis in the mother through indirect v.c.m. exposure from the father might be considered, although these mechanisms seem highly unlikely in view of the highly volatile nature of v.c.m.13 When the findings of the present study are taken in conjunction with the prior demonstration of a mutagenic response via microbial test systems and observations of significant excesses of chromosomal aberrations among workers exposed to v.c.m., the leading possibility is germ-cell damage in the father through direct v.c.m. exposure. The increased fetal mortality among wives of workers subsequent to v.c.m. exposure now raises serious scientific and publichealth concern for the possible genetic risks of vinyl chloride to man. Requests for reprints should be addressed to P.F.I., N.I.O.S.H., Post Office Building, Room 515, Cincinnati, Ohio 45202, U.S.A. REFERENCES 1. Baruch, H., Maiavicllc, C., Momesano, R. Int.J. Cancer, 1975,15, 429. 2. Lopneno, N., Barale, R., Varoncelli, $., et al. Muianon Res. (in the pro*). 3. Rannug, U., Jobanssoo, A., Ramcl, C., Wachmeister, C A. Ambto. 1974, 3, 194* 4. Hubcrman, E,, Bartsch, H., Sachs, 1_ Int.J. Cancer, 1975,14,639. 5* Ducaunan, A., Hirschhorn, K., Sdikoff, 1. J. Mutntion Res. 1975, 31, 163* 6. Fuftd-Cravioio, F,, Lambert, B,, Lwdsicn, J,t Ehrenberg, L., Natarajan, A, T., Osterman-Golkar. S, Lancet, 1975, i, 459. 7. Purchase, 1. F. H., Richardson, C. R., Anderson, D. ibid. 1975, ii, 410. 8. Hillcstad, L., Thiii-Evensen, E. Unpublished. 9. Sclikoff, I. J., N.l.E.H.S. Conference on Public Health Implications of Com ponents of Ptastia Manufacture, Pmehunt, North Carolina, July, 1974. 10. Infante, P. F. Ann. N.Y, Acad. Set. (in the press)., 11. Shapiro, S., Jones, E. W,, Densen, P, M. Milbank Q. 1962, 40, 7. 12. Mantel, N,, Haemzel, W.J. Natn. Cancer Inst. 1959, 22, 719. 13. United States Environmental Protection Agency, sampling and analysis of select toxic substances, task ill vinyl chloride. Contract no. 68-01-2646. Jan. 20, 1976. -A: T* !*