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

BACKGROUND: Nitrous oxide (N(2)O) is a frequently used anaesthetic. Since the year 2000, recreational use of N(2)O, also known as ‘laughing gas’, became popular as a recreational drug due to its mild psychedelic effect. In the 1980s, several reports warned against N(2)O-induced reproductive risks among healthcare personnel, questioning the occupational safety of N(2)O in health care. METHODS: Data about the reproductive risks of N(2)O 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 N(2)O. Adverse reproduction effects included congenital anomalies, spontaneous abortion and reduced fertility rates in females. Following occupational measures, like maximal exposure limits for ambient N(2)O, this occupational risk was considerably reduced. Recreational users of N(2)O, however, voluntarily and repeatedly expose themselves to (very) high doses of N(2)O. 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.