Reducing Prenatal Exposure to Toxic Environmental Agents

Abstract

There is emerging evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes. Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birth weight, neurodevelopmental delay such as autism and attention deficit hyperactivity disorder, and adult and childhood cancer. Although there is substantial overlap in the type of exposure and the associated health outcomes, for the purposes of this document, exposures generally can be grouped into the following categories: toxic chemicals, air pollution, and climate change-related exposures. Obstetric care clinicians do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists, if needed, when a hazardous exposure is identified. It is important for obstetrician–gynecologists and other obstetric care clinicians to become knowledgeable about toxic environmental exposures that are endemic to their specific geographic areas, such as local water safety advisories (eg, lead-contaminated water), local air quality levels, and patients’ proximity to power plants and fracking sites. Although exposure to toxic environmental agents is widespread across populations, many environmental factors that are harmful to reproductive health disproportionately affect underserved populations and are subsumed in issues of environmental justice. Clinical encounters offer an opportunity to screen and counsel patients during the prepregnancy and prenatal periods—particularly individuals most disproportionately affected—about opportunities to reduce toxic environmental health exposures. This Committee Opinion is revised to integrate more recent literature regarding reducing prepregnancy and prenatal toxic environmental exposures.

Nutritional interventions to ameliorate the effect of endocrine disruptors on human reproductive health: A semi‐structured review from FIGO

“…Healthcare providers should be aware that endocrine disruptors propose significant risk to reproductive health and prenatal development. 49 Recommendations from professional bodies may include those such as from the American College of Obstetricians and Gynecologists, 50 centered around the environmental health history with counseling for a reduction in exposure. Education among medical communities on this issue is essential, incorporating the interventions highlighted here as effective strategies for a reduction in exposure, with integration of environmental health into medical training.…”

“…Education among medical communities on this issue is essential, incorporating the interventions highlighted here as effective strategies for a reduction in exposure, with integration of environmental health into medical training. 50 There is also an urgent need for further research into effective interventions to reduce exposure to EDCs or ameliorate its adverse effects. While the present review did find 14 studies, just three of them were of high quality, underling the need for further investigation.…”

Perceptions and experiences of environmental health and risks among Latina mothers in urban Los Angeles, California, USA

“…Given the vulnerability of infants to environmental contaminants [ 7 ], the disproportionate role that mothers play in managing household activities and family health [ 8 ], and the relative frequency with which pregnant people interact with health professionals, pregnant people and new mothers are often the key audience for media and public health campaigns. Further, pregnancy is seen as a key time for interventions designed to reduce environmental health disparities [ 9 ].…”

Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention

“…The WHO and the American Obstetrician Society encourage healthcare professionals to conduct an environmental screening in order to assess exposure and risk to environmental health factors during the prenatal period. 2 , 3 Following this advice, the Pediatric Environmental Health Specialty Unit in the Clinical University Hospital Virgen de la Arrixaca located in Murcia, Spain, developed Green Page, a clinical screening tool on reproductive environmental health. 4 – 8 This questionnaire produces a standard clinical record of each pregnant woman and includes a series of basic questions by healthcare professionals to identify environmental exposures during or when planning a pregnancy.…”