Nitrous oxide–induced reproductive risks: Should recreational nitrous oxide users worry?

Abstract

Background: Nitrous oxide (N2O) is a frequently used anaesthetic. Since the year 2000, recreational use of N2O, also known as ‘laughing gas’, became popular as a recreational drug due to its mild psychedelic effect. In the 1980s, several reports warned against N2O-induced reproductive risks among healthcare personnel, questioning the occupational safety of N2O in health care. Methods: Data about the reproductive risks of N2O were collected from literature. Results: Particularly in the past, professionals working in dental and midwifery practices, operating theatres and ambulance transport were exposed to high levels of N2O. Adverse reproduction effects included congenital anomalies, spontaneous abortion and reduced fertility rates in females. Following occupational measures, like maximal exposure limits for ambient N2O, this occupational risk was considerably reduced. Recreational users of N2O, however, voluntarily and repeatedly expose themselves to (very) high doses of N2O. As such, they exceed the health exposure limits some hundred times, but they are fully unaware of the related reproductive risks. Conclusion: We advocate to increase the awareness in recreational N2O-users about its potential reproductive risks, especially in heavy users, pregnant users or those who intend to become pregnant.