During pregnancy, you should be aware of things in your surroundings or in your style of life that could affect your unborn child. If you 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.

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 four sources:

Average Annual Dose

Terrestrial - radiation from soil and rocks 28 mrem

Cosmic - radiation from outer space 28 mrem

Radon - inhaled from air 200 mrem

Radioactivity normally found within the human body 40 mrem

300 mrem

Variability (geographic and other factors) 100 to 5,000 mrem

The first two of these sources expose the body from the outside, and the last two sources expose the body from the inside. The average person is thus exposed to a total dose of about 300 mrem per year from natural background radiation

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.

Average X-Ray Procedure Dose

Normal chest examination 10 mrem

Normal dental examination 10 mrem

Rib cage examination 140 mrem

Gall bladder examination 170 mrem

Barium enema examination 500 mrem

Pelvic examination 600 mrem

Federal and State 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, 1,000 mrem would have any effect at all." Since it is known that the unborn child is more sensitive to radiation than adults, particularly during certain stages of development, the regulatory agencies have established a special dose limit for protection of the unborn child if the mother declares her pregnancy. Since this limit could result in job discrimination for women of child-bearing age and perhaps in the invasion of privacy (if pregnancy tests were required) it only applies to the unborn child of woman who declare their pregnancy. The regulatory agencies have 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.

For this 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 reasonably achievable.

The present limit on radiation dose that can be received on the job is 5,000 millirem per year. Working minors (those under 18) are limited to a dose equal to one-tenth that of adults, 500 millirem per year.

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 millirem 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 revision to Part 20, effective 1/1/94) requires the employer to ensure that the dose to an embryo/fetus during the entire pregnancy, due to occupational exposure of a "declared pregnant woman", does not exceed 0.5 rem (5 mSv)..

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 are, and keeping an extra distance from radiation sources when possible. The employer or medical 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.

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. By definitions (§ 20.1003), a "declared pregnant woman" means a woman who has voluntarily informed her employer, in writing, of her pregnancy and the estimated date of conception.

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 radiation therapy may 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:

1. Do not smoke, eat, drink, or apply cosmetics around radioactive material.

2. Do not pipette solutions by mouth

3. Use disposable gloves while handling radioactive material.

4. Wash hands after working around radioactive material.

5. Wear lab coats or other protective clothing whenever there is a possibility of spills.

Remember that the employer is required to have demonstrated safe procedures and practices are in before the Regulatory issues a license to use radioactive material or radiation producing devices. Workers are urged to follow established procedures and consult the employer's radiation safety officer or medical physicist whenever problems or questions arise.

In order to decide whether to continue working while exposed to ionizing radiation during her pregnancy, a woman 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.

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 the exposure are explained.
 

1. RADIATION RISKS

1.1 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 0.2 to 0.25 death per thousand children (Ref. 20).

1.2 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; at 8 to 11 weeks, it was 9 per thousand (Ref. 7).

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.

1.3 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 a negligible effect on descendants (Refs. 17 and 18)

2. NON RADIATION RISKS

2.1 Occupation

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 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.
 

2.2 Alcohol

It has been recognized since ancient times that alcohol consumption has 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).

For mothers who consume 2 to 4 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).
 

2.3 Smoking

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).
 

2.4 Miscellaneous

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).

This page last updated 8/28/00.