Perinatal Environmental Health Education Intervention to Reduce Exposure to Endocrine Disruptors: The PREVED Project

Abstract

Environmental health promotion interventions may reduce endocrine disruptor (ED) exposure. The PREVED (PREgnancy, preVention, Endocrine Disruptors) project was developed to improve knowledge, to enhance risk perception, and to change exposure behavior. Our objective was to present the phases of the PREVED project using the RE-AIM method. PREVED intervention consisted of three workshops during pregnancy. Reach, adoption, and implementation phases were assessed with qualitative studies. Efficacy study consisted of a three-arm randomized controlled trial (RCT) on 268 pregnant women: (i) control group (leaflet), (ii) intervention group in neutral location, (iii) intervention group in contextualized location. The main outcome was the percentage evolution of participants who reported consuming canned food. Secondary outcomes were evolution of psycho-social scores, evolution of ED presence in urine, and ED presence in colostrum. The intervention adoption was centered on upper-privileged women, but implementation assessment showed that key features (highly practical intervention) seemed to be carried out and had initiated some behavior changes. A total of 268 pregnant women participated in the intervention and 230 in a randomized controlled trial (control group: 86 and intervention groups: 172). We found no significant differences in consumption of canned food and in percentage of women having a decrease of bisphenol A or parabens in urine, but we found a significant increase in the evolution of risk perception score and overall psychosocial score in intervention groups (respectively: +15.73 control versus +21.03 intervention, p = 0.003 and +12.39 versus +16.20, p = 0.02). We found a significant difference in percentage of women with butylparaben detection between control group and intervention groups (13% versus 3%, p = 0.03). PREVED intervention is the first intervention research dedicated to perinatal environmental health education in France. By sharing know-how/experience in a positive non-alarmist approach, it improved risk perception, which is key to behavior change, aiming to reduce perinatal ED exposure. Including women in precarious situations remains a major issue.

Lifestyle interventions to reduce endocrine-disrupting phthalate and phenol exposures among reproductive age men and women: A review and future steps

“…Spot urine was collected pre-, mid-, and post-intervention and colostrum was collected at childbirth. Researchers did not observe a significant difference in dietary behavior or change in the percentage of participants with decreased BPA and paraben concentrations; however, there was a significant change in percentage of control (13 %) and intervention group (3 %) participants with BuP (p = 0.03) in their colostrum samples ( El Ouazzani et al, 2021 ). There was also a significant increase in risk perception score (calculated using the perceived risk of and vulnerability to EDCs reported by participants) among intervention group participants (+15.73 control, +21.03 intervention, p = 0.02)—while the workshops/educational interventions did not significantly decrease dietary behaviors alone, they appeared to increase risk perception among participants ( El Ouazzani et al, 2021 ).…”

“…We identified 14 dietary intervention studies; most only focused on phenols (n = 9) ( Table 3 ) ( Sathyanarayana et al, 2013 ; El Ouazzani et al, 2021 ; Park and Chung, 2021 ; Galloway et al, 2018 ; Szybiak et al, 2017 ; Barrett et al, 2015 ; Carwile et al, 2011 ; Rudel et al, 2011 ; Peng et al, 2019 ; Kim et al, 2020 ; van der Meer et al, 2021 ; Jo et al, 2020 ; Chen et al, 2015 ; Christensen et al, 2012 ) Only two interventions exclusively investigated phthalate exposure ( Barrett et al, 2015 ) and ( Chen et al, 2015 ) and three focused on both phthalates and phenols ( Sathyanarayana et al, 2013 ; Rudel et al, 2011 ; van der Meer et al, 2021 ; Barrett et al, 2015 ; Sathyanarayana et al, 2013 ; Rudel et al, 2011 ). Study populations included pregnant women, college students, families, teenagers, and women (not pregnant); five interventions had exclusively female populations ( El Ouazzani et al, 2021 ; Park and Chung, 2021 ; Szybiak et al, 2017 ; Barrett et al, 2015 ; Chen et al, 2015 ). Most dietary interventions used spot urine samples to measure phthalate or phenol concentrations (n = 13), three of which pooled urine samples.…”

“…Among the nine interventions that exclusively evaluated phenols, one study by Ouazzani et al, (2021) enrolled 268 women (~33 years old) for an intervention study, 230 of which participated in an additional three-arm randomized control trial (control group, n = 78; intervention group, n = 152) ( El Ouazzani et al, 2021 ). After random assignment during the first trimester, intervention groups attended three workshops during the second and third trimesters on indoor air quality, nutrition, and personal care products.…”

“…Out of the 21 primary interventions, 11 interventions had a large educational component that often included online or paper materials and or meetings and interviews with professionals or research staff. ( Barrett et al, 2015 ; Sathyanarayana et al, 2013 ; El Ouazzani et al, 2021 ; Park and Chung, 2021 ; Galloway et al, 2018 ; Kim et al, 2020 ; Kim et al, 2021 ; Ley et al, 2017 ; Hagobian et al, 2017 ; Harley et al, 2016 ; Hagobian et al, 2021 ) Among these 11 interventions, six observed a significant reduction in at least some EDCs. The interventions that observed significant decreases in EDCs commonly had weekly meetings, support groups, and or interviews to provide encouragement and feedback to participants in a personalized and accessible setting.…”

“…Selected interventions were further categorized into dietary interventions, behavioral interventions, and residential interventions. Dietary interventions included any intervention that focused on dietary exposures (water, food, plastic food containers, canned food); 14 interventions fit this criterion ( Sathyanarayana et al, 2013 ; El Ouazzani et al, 2021 ; Park and Chung, 2021 ; Galloway et al, 2018 ; Szybiak et al, 2017 ; Barrett et al, 2015 ; Carwile et al, 2011 ; Rudel et al, 2011 ; Peng et al, 2019 ; Kim et al, 2020 ; van der Meer et al, 2021 ; Jo et al, 2020 ; Chen et al, 2015 ; Christensen et al, 2012 ). Behavioral interventions were defined as those that concentrated efforts towards personal care products or other exposures to phthalates and phenols through product use; six interventions fit this category ( Ley et al, 2017 ; Hagobian et al, 2017 ; Harley et al, 2016 ; Hagobian et al, 2021 ).…”