Reproductive Health Providers Should Discuss Environmental Exposure Risks with Patients

Pesticides

Simple recommendations help reduce harmful exposures for women


Remove your shoes at the door of your home to avoid tracking in pollutants. Decrease consumption of processed and canned foods. Avoid the use of plastics with recycling codes #3, #6 and #7. Don’t use chemical tick and flea collars or dips for pets. Reproductive health care providers should share these tips and more scientific information with women who want to become pregnant or who are pregnant, but that does not always happen.

A growing body of evidence suggests that preconception and prenatal exposure to certain environmental toxins can impact fetal development adversely and lead to potentially long-lasting health effects. However, most reproductive health providers are not trained in environmental health and do not have the tools to counsel patients on this topic. Now, a team of researchers, led by Sheela Sathyanarayana, MD, MPH, of Seattle Children’s Research Institute, have created a guide outlining exposure risks and reduction tips (see below) for some of the most common environmental toxins. The clinical opinion, “Environmental exposures: how to counsel preconception and prenatal patients in the clinical setting,” was published in advance online in the American Journal of Obstetrics & Gynecology.

“Reproductive health providers have an important role to play in counseling women on environmental health risks,” said Dr. Sathyanarayana of Seattle Children’s Research Institute and an assistant professor of pediatrics at the University of Washington. “Providers can be knowledgeable about these issues and empower patients to make positive decisions to reduce exposure and to prevent adverse health impacts to both mother and fetus.”

The guidelines include evidence-based recommendations on how to talk with patients about environmental toxins like lead, mercury, pesticides and other endocrine-disrupting chemicals such as bisphenol A (BPA), which is used in a variety of products including canned food linings and cash register receipts. It also includes resources for each toxin area, outlining an easy and consistent way to deliver these important messages to women and their partners.

The guidelines contain helpful information for patients, too. “Women and their partners should be aware that pregnancy is an important time for development, that environmental chemicals can cause harm to a developing fetus, and that this topic is important to discuss with health care providers,” said Dr. Sathyanarayana. “There are simple ways to reduce exposures to lead, mercury, pesticides and endocrine-disrupting chemicals such as BPA by following the guidelines we have outlined,” she said.

Dr. Sathyanarayana’s co-authors include: Susan Buchanan, MD, MPH, University of Illinois at Chicago School of Public Health; Tanya Dailey, MD, Alpert Medical School of Brown University; and Judith Focareta, MED, RN, Magee-Womens Hospital of UPMC.

Additional Resources

Environmental Exposures: Tips for Reproductive Health Care Providers, Preconception and Prenatal Women

Mercury

Lead

  • Risk factors: Risk factors for exposure include recent immigration to the U.S., occupational exposure, imported cosmetics, and renovating or remodeling a home built before 1970. Lead is neurotoxic to a developing fetus.
  • Reducing exposure: Never eat nonfood items (clay, soil, pottery or paint chips); avoid jobs or hobbies that may involve lead exposure; stay away from repair, repainting, renovation and remodeling work conducted in homes built before 1978; eat a balanced diet with adequate intakes of iron and calcium; avoid cosmetics, food additives and medicines imported from overseas; and remove shoes at the door to prevent tracking in lead and other pollutants.
  • Resources: http://www.cdc.gov/nceh/lead/publications/leadandpregnancy2010.pdf, http://www.aapcc.org/centers/

Pesticides

  • Risk factors: Exposure can come from eating some produce and from using pesticides in your home or on your pets. Exposure to pesticides in pregnancy has been shown to increase risk of intrauterine growth retardation, congenital anomalies, leukemia and poor performance on neurodevelopmental testing.
  • Reducing exposure: Do not use chemical tick and flea collars or dips; avoid application of pesticides indoors and outdoors; consider buying organic produce when possible; wash all fruits and vegetables before eating; and remove shoes at the door.
  • Resources: http://www.ewg.org/foodnews (focus on the “Dirty Dozen,” a list of the 12 most contaminated products published by the Environmental Working Group, http://www.spcpweb.org/resources/#factsheets

Endocrine-disrupting chemicals

  • Risk factors: Human prenatal phthalate exposure is associated with changes in male reproductive anatomy and behavioral changes primarily in young girls. Animal studies suggest prenatal exposure to BPA is associated with obesity, reproductive abnormalities and neurodevelopmental abnormalities in offspring. Endocrine-disrupting chemicals mimic or antagonize the effects of hormones in the endocrine system and can cause adverse health effects that can be passed on to future generations.
  • Reducing exposure: Decrease consumption of processed foods; increase fresh and/or frozen foods; reduce consumption of canned foods; avoid use of plastics with recycled codes #3, #6 and #7; be careful when removing old carpet because padding may contain chemicals; and use a vacuum machine fitted with a HEPA filter to get rid of dust that may contain chemicals.
  • Resources: http://www.niehs.nih.gov/news/sya/sya-bpa, http://www.atsdr.cdc.gov/toxprofiles/tp9-c1-b.pdf, http://www.epa.gov/oppt/pbde/

About Seattle Children’s

Seattle Children’s Hospital, Foundation and Research Institute together deliver superior patient care, advance new discoveries and treatments through pediatric research, and raise funds to create better futures for patients. Consistently ranked as one of the top 10 children’s hospitals in the country by U.S. News & World Report, Seattle Children’s Hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood. Through the collaboration of physicians in nearly 60 pediatric subspecialties, Seattle Children’s Hospital provides inpatient, outpatient, diagnostic, surgical, rehabilitative, behavioral, and emergency and outreach services to families from around the world.

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention, bioethics and much more.

Seattle Children’s Hospital and Research Foundation and Seattle Children’s Hospital Guild Association work together to gather community support and raise funds for uncompensated care, clinical care and research. The foundation receives nearly 80,000 gifts each year, from lemonade stand proceeds to corporate sponsorships. Seattle Children’s Hospital Guild Association is the largest all-volunteer fundraising network for any hospital in the country, serving as the umbrella organization for 450 groups of people who turn an activity they love into a fundraiser. Support from the foundation and guild association makes it possible for Seattle Children’s care and research teams to improve the health and well-being of all kids.

For more information, visit seattlechildrens.org or follow us on Twitter, Facebook and Instagram.