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.

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.”

Reproductive health care providers should share these tips and more scientific information with women who want to become pregnant or who are pregnant.

  • 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, #4 and #7.
  • Don’t use chemical tick and flea collars or dips for pets.

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: how to counsel preconception and prenatal patients in the clinical setting”: http://www.sciencedirect.com/science/article/pii/S0002937812001512?v=s5(The uncorrected, original manuscript is currently available for reference).
See the Environmental exposures slideshow

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

Mercury
Risk factors: Exposure can come from eating fish, contact with quicksilver, and use of skin-lightening creams. Exposure during pregnancy can lead to adverse neurodevelopmental outcomes that include lower IQ, poor language and motor development.
Reducing exposure: Pregnant, preconception and breastfeeding women should follow U.S. Environmental Protection Agency and state-specific fish consumption guidelines. Avoid shark, swordfish, king mackerel, tile fish and large tuna.
Resources: http://www.doh.wa.gov/ehp/oehas/fish/fishchart.htm, http://www.nrdc.org/health/effects/mercury/guide.asp

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/dnn/AAPCC/FindLocalPoisonCenters.aspx

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, #4 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/

At the forefront of pediatric medical research, Seattle Children’s Research Institute is setting new standards in pediatric care and finding new cures for childhood diseases. Internationally recognized scientists and physicians at the Research Institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention and bioethics. With Seattle Children’s Hospital and Seattle Children’s Hospital Foundation, the Research Institute brings together the best minds in pediatric research to provide patients with the best care possible. Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine, which consistently ranks as one of the best pediatric departments in the country. For more information, visit http://www.seattlechildrens.org/research.