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N95 Filtering Facepiece Respirator Use during Pregnancy: A Systematic ReviewFunding None.
30 April 2020
30 April 2020
21 May 2020 (online)
Objective This study was aimed to systematically review the use of filtering facepiece respirators, such asN95 masks, during pregnancy.
Study Design A comprehensive search for primary literature using Medline, Embase, Scopus, Web of Science, and ClinicalTrials.gov was conducted from inception until April 2020 to find articles reporting outcomes of pregnant women using filtering facepiece respirator (FFR). Studies were selected if they included the use of FFR in pregnant women and reported an outcome of interest including physiologic changes (heart rate, respiratory rate, pulse oximetry, and fetal heart rate tracing) or subjective measures (thermal or exertional discomfort or fit). The Newcastle-Ottawa Quality Assessment scale was used to assess the risk of bias. The main outcome was to describe the physiologic changes in pregnant women compared with nonpregnant women. Due to the small number of studies and heterogeneity of reported outcomes a meta-analysis was not conducted. Results of the studies were synthesized into a summary of evidence table.
Results We identified four studies, three cohort studies and one crossover study, comprising 42 women using FFR during pregnancy. Risk of bias was judged to be low. Studies were consistent in showing no significant increase in maternal heart rate, respiratory rate, oxygen saturation, and fetal heart rate between pregnant and nonpregnant women using N95 FFRs for short durations. Repeat fit testing was not supported for women gaining the recommended amount of weight during pregnancy. No evidence was found to reach conclusions about prolonged N95 FFR use in pregnancy.
Conclusion Limited duration N95 FFR use during pregnancy is unlikely to impart risk to the pregnant women or her fetus.
Limited N95 use unlikely to impart risk to pregnant woman/fetus.
Prolonged N95 use in pregnancy is unstudied.
Repeat fit testing in pregnancy likely unnecessary.
- 1 World Health Organization. Spotlight on statistics: a fact file on health workforce statistics. Gender and health workforce statistics. Available at: https://www.who.int/hrh/statistics/spotlight_2.pdf . Accessed April 20, 2020
- 2 Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Estimated pregnancy rates by outcome for the United States, 1990–2004. Natl Vital Stat Rep 2008; 56 (15) 1-25
- 3 Ventura SJ, Curtin SC, Abma JC, Henshaw SK. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. National vital statistics reports: From the centers for disease control and prevention, National Center for Health Statistics. Natl Vital Stat Syst 2012; 60 (07) 1-21
- 4 Mikulicz J. Das Operieren in sterilisierten Zwirn-handschuhen und mit Mundbinde. Centralblatt für Chirurgie 1897; 26: 714-717
- 5 Romney MG. Surgical face masks in the operating theatre: re-examining the evidence. J Hosp Infect 2001; 47 (04) 251-256
- 6 The National Personal Protective Technology Laboratory. 42 CFR Part 84 Respiratory Protective Devices. Available at: https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html . Accessed April 20, 2020
- 7 Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control 2008; 36 (04) 276-282
- 8 Wise RA, Polito AJ, Krishnan V. Respiratory physiologic changes in pregnancy. Immunol Allergy Clin North Am 2006; 26 (01) 1-12
- 9 Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016; 27 (02) 89-94
- 10 Liberati A, Altman DG, Tetzlaff J. , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62 (10) e1-e34
- 11 Bramer WM, Milic J, Mast F. Reviewing retrieved references for inclusion in systematic reviews using EndNote. J Med Libr Assoc 2017; 105 (01) 84-87
- 12 Wells GA, Shea B, O'Connell D. , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute; Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed May 5, 2020
- 13 Roberge RJ, Kim JH, Powell JB. N95 respirator use during advanced pregnancy. Am J Infect Control 2014; 42 (10) 1097-1100
- 14 Roberge RJ, Kim JH, Palmiero A, Powell JB. Effect of Pregnancy Upon Facial Anthropometrics and Respirator Fit Testing. J Occup Environ Hyg 2015; 12 (11) 761-766
- 15 Kim JH, Roberge RJ, Powell JB. Effect of external airflow resistive load on postural and exercise-associated cardiovascular and pulmonary responses in pregnancy: a case control study. BMC Pregnancy Childbirth 2015; 15: 45
- 16 Tong PS, Kale AS, Ng K. , et al. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study. Antimicrob Resist Infect Control 2015; 4: 48
- 17 Rasmussen KM, Yaktine AL. , eds; Institute of Medicine (US); National Research Council (US). Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2009
- 18 Howard WR, Wong B, Yeager KSB. , et al. Submarine exposure guideline recommendations for carbon dioxide based on the prenatal developmental effects of exposure in rats. Birth Defects Res 2019; 111 (01) 26-33
- 19 Owolabi T, Kwolek S. Managing obstetrical patients during severe acute respiratory syndrome outbreak. J Obstet Gynaecol Can 2004; 26 (01) 35-41
- 20 Farquharson C, Baguley K. Responding to the severe acute respiratory syndrome (SARS) outbreak: lessons learned in a Toronto emergency department. J Emerg Nurs 2003; 29 (03) 222-228
- 21 Ofner-Agostini M, Gravel D, McDonald LC. , et al. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series. Infect Control Hosp Epidemiol 2006; 27 (05) 473-478
- 22 Roberge RJ, Bayer E, Powell JB, Coca A, Roberge MR, Benson SM. Effect of exhaled moisture on breathing resistance of N95 filtering facepiece respirators. Ann Occup Hyg 2010; 54 (06) 671-677
- 23 Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control 2013; 41 (12) 1218-1223
- 24 Beder A, Büyükkoçak U, Sabuncuoğlu H, Keskil ZA, Keskil S. Preliminary report on surgical mask induced deoxygenation during major surgery. Neurocirugia (Astur) 2008; 19 (02) 121-126
- 25 Kam JK, Chan E, Lee A. , et al. Student nurses' ethical views on responses to the severe acute respiratory syndrome outbreak. Nurs Ethics 2020; 27 (969733019895804): 969733019895804
- 26 Baracco G, Eisert S, Eagan A, Radonovich L. Comparative cost of stockpiling various types of respiratory protective devices to protect the health care workforce during an influenza pandemic. Disaster Med Public Health Prep 2015; 9 (03) 313-318
- 27 Patel A, Lee L, Pillai SK, Valderrama AL, Delaney LJ, Radonovich L. Approach to prioritizing respiratory protection when demand exceeds supplies during an influenza pandemic: a call to action. Health Secur 2019; 17 (02) 152-155
- 28 Elchalal U, Ezri T, Soroker D, Matzkel A, Weissman A. Gas mask during pregnancy and labour. Can J Anaesth 1992; 39 (08) 895-896
- 29 Roberge RJ, Coca A, Williams WJ, Powell JB, Palmiero AJ. Physiological impact of the N95 filtering facepiece respirator on healthcare workers. Respir Care 2010; 55 (05) 569-577
- 30 Roberge RJ, Kim JH, Benson SM. Absence of consequential changes in physiological, thermal and subjective responses from wearing a surgical mask. Respir Physiol Neurobiol 2012; 181 (01) 29-35
- 31 Radonovich Jr LJ, Simberkoff MS, Bessesen MT. , et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA 2019; 322 (09) 824-833
- 32 DiLeo T, Roberge RJ, Kim JH. Effect of wearing an N95 filtering facepiece respirator on superomedial orbital infrared indirect brain temperature measurements. J Clin Monit Comput 2017; 31 (01) 67-73
- 33 Laird IS, Goldsmith R, Pack RJ, Vitalis A. The effect on heart rate and facial skin temperature of wearing respiratory protection at work. Ann Occup Hyg 2002; 46 (02) 143-148
- 34 Roberge RJ, Kim JH, Powell JB, Shaffer RE, Ylitalo CM, Sebastian JM. Impact of low filter resistances on subjective and physiological responses to filtering facepiece respirators. PLoS One 2013; 8 (12) e84901
- 35 Li Y, Tokura H, Guo YP. , et al. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int Arch Occup Environ Health 2005; 78 (06) 501-509
- 36 Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand 2006; 113 (03) 199-202
- 37 Tan KT, Greaves MW. N95 acne. Int J Dermatol 2004; 43 (07) 522-523
- 38 Harber P, Bansal S, Santiago S. , et al. Multidomain subjective response to respirator use during simulated work. J Occup Environ Med 2009; 51 (01) 38-45
- 39 Lee HP, Wang Y. Objective assessment of increase in breathing resistance of N95 respirators on human subjects. Ann Occup Hyg 2011; 55 (08) 917-921
- 40 Nickell LA, Crighton EJ, Tracy CS. , et al. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ 2004; 170 (05) 793-798
- 41 Radonovich LJ, Wizner K, LaVela SL, Lee ML, Findley K, Yorio P. A tolerability assessment of new respiratory protective devices developed for health care personnel: A randomized simulated clinical study. PLoS One 2019; 14 (01) e0209559
- 42 Radonovich Jr LJ, Cheng J, Shenal BV, Hodgson M, Bender BS. Respirator tolerance in health care workers. JAMA 2009; 301 (01) 36-38
- 43 Gosch ME, Shaffer RE, Eagan AE, Roberge RJ, Davey VJ, Radonovich Jr LJ. B95: a new respirator for health care personnel. Am J Infect Control 2013; 41 (12) 1224-1230
- 44 The National Personal Protective Technology Laboratory; Centers for Disease Control and Prevention. NIOSH-approved N95 particulate filtering facepiece respirators. Available at: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html . Accessed April 24, 2020
- 45 Salter WB, Kinney K, Wallace WH, Lumley AE, Heimbuch BK, Wander JD. Analysis of residual chemicals on filtering facepiece respirators after decontamination. J Occup Environ Hyg 2010; 7 (08) 437-445