Formaldehyde use in the anatomy laboratory and the pregnant or breastfeeding student dissector navigating the challenges of toxicological uncertainty and institutional policy

Formaldehyde is essential for anatomical preservation but is associated with potential health risks. The evidence for reproductive toxicity at laboratory exposure levels remains uncertain, and institutional policies are characterized by inconsistency, creating a critical challenge for pregnant and breastfeeding medical students. A systematic review was conducted to synthesize evidence on two key areas: 1) the strength of evidence for adverse effects from anatomy laboratory-level formaldehyde exposure (typically 0.1–2.0 ppm) on pregnant individuals, fetuses, and breastfed infants, and 2) the current landscape of institutional policies and alternative educational approaches. Formaldehyde levels in dissection facilities were confirmed to frequently exceed current public health precautionary limits (0.1 ppm; will partially be lowered to 0.05 ppm in near future), with irritant symptoms being widely reported. Developmental toxicity is demonstrated in animal studies, though at doses vastly higher and durations much longer than those encountered in the anatomy laboratory. Human epidemiological data are limited by confounding, though an increased risk for spontaneous abortion is suggested. Furthermore, institutional policies were found to be largely absent or fragmented, with the burden of risk assessment often being shifted onto students. It is concluded that a risk-management model is the optimal path forward. This model prioritizes engineering controls to reduce exposure for all, coupled with supportive accommodations for pregnant students, thereby mitigating both physical and psychosocial risks. • No direct pregnancy outcome data exists for medical or dental students in dissection laboratories. • Irritant effects are clear; reproductive harm below TLVs lack human evidence. • Animal toxicity findings are conflicted and poorly scalable to the educational setting. • Formaldehyde exposure data demonstrates bias; true anatomy laboratory risk remains uncertain. • Scientific uncertainty warrants risk management, not exclusion or inaction. • Engineering controls and supported choice best protect health and equity.