Washington, DC -- Toxic chemicals in the environment harm our ability to reproduce, negatively affect pregnancies, and are associated with numerous other long-term health problems, according to The American College of Obstetricians and Gynecologists (The College) and the American Society for Reproductive Medicine (ASRM). In a joint Committee Opinion, The College and ASRM urge ob-gyns to advocate for government policy changes to identify and reduce exposure to toxic environmental agents.
“Lawmakers should require the US Environmental Protection Agency and industry to define and estimate the dangers that aggregate exposure to harmful chemicals pose to pregnant women, infants, and children and act to protect these vulnerable populations,” said Jeanne A. Conry, MD, PhD, president of The College.
“Every pregnant woman in America is exposed to many different chemicals in the environment,” said Dr. Conry. “Prenatal exposure to certain chemicals is linked to miscarriages, stillbirths, and birth defects.” Many chemicals that pregnant women absorb or ingest from the environment can cross the placenta to the fetus. Exposure to mercury during pregnancy, for instance, is known to harm cognitive development in children.
The scientific evidence over the last 15 years shows that exposure to toxic environmental agents before conception and during pregnancy can have significant and long-lasting effects on reproductive health. “For example, pesticide exposure in men is associated with poor semen quality, sterility, and prostate cancer,” said Linda C. Giudice, MD, PhD, president of ASRM. “We also know that exposure to pesticides may interfere with puberty, menstruation and ovulation, fertility, and menopause in women.”
Other reproductive and health problems associated with exposure to toxic environmental agents:
- Miscarriage and stillbirth
- Impaired fetal growth and low birth weight
- Preterm birth
- Childhood cancers
- Birth defects
- Cognitive/intellectual impairment
- Thyroid problems
Approximately 700 new chemicals are introduced into the US market each year, and more than 84,000 chemical substances are being used in manufacturing and processing or are being imported. “The scary fact is that we don’t have safety data on most of these chemicals even though they are everywhere—in the air, water, soil, our food supply, and everyday products,” Dr. Conry said. “Bisphenol A (BPA), a hormone disruptor, is a common toxic chemical contained in our food, packaging, and many consumer products.”
“To successfully study the impact of these chemical exposures, we must shift the burden of proof from the individual health care provider and the consumer to the manufacturers before any chemicals are even released into the environment,” said Dr. Conry.
Certain groups of people and communities have higher exposures to harmful environmental chemicals than others. “For example, women exposed to toxic chemicals at work are at higher risk of reproductive health problems than other women,” Dr. Conry said. “Low-wage immigrants who work on farms have higher exposures to chemicals used on the crops that they harvest.”
“As reproductive health care physicians, we are in a unique position to help prevent prenatal exposure to toxic environmental agents by educating our patients about how to avoid them at home, in their community, and at work,” Dr. Giudice said.
What can physicians do?
- Learn about toxic environmental agents common in their community
- Educate patients on how to avoid toxic environmental agents
- Take environmental exposure histories during preconception and first prenatal visits
- Report identified environmental hazards to appropriate agencies
- Encourage pregnant and breastfeeding women and women in the preconception period to eat carefully washed fresh fruits and vegetables and avoid fish containing high levels of methyl-mercury (shark, swordfish, king mackerel, tilefish)
- Advance policies and practices that support a healthy food system
- Advocate for government policy changes to identify and reduce exposure to toxic environmental agents
Check out ACOG’s Environmental Chemicals—Stay Safe During Pregnancy infographic that explains what steps pregnant women can take to lower their risk of exposure.
Committee Opinion #575 “Exposure to Toxic Environmental Agents” is published in the October issue of Obstetrics & Gynecology.
Go to http://prhe.ucsf.edu/prhe/clinical_resources.html for examples of toxic environmental exposure patient history forms.
See http://www.breastcancerfund.org/ for the Breast Cancer Fund’s recent report on prenatal BPA exposure and breast cancer risk.
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Other recommendations issued in October’s Obstetrics & Gynecology:
Committee Opinion #576 “Health Care for Homeless Women” (Revised)
ABSTRACT: Homelessness continues to be a significant problem in the United States. Women and families represent the fastest growing segment of the homeless population. Health care for these women is a challenge but an important issue that needs to be addressed. Homeless women are at higher risk of injury and illness and are less likely to obtain needed health care than women who are not homeless. It is essential to undertake efforts to prevent homelessness, to expand community-based services for the homeless, and to provide adequate health care for this underserved population. Health care providers can help address the needs of homeless individuals by identifying their own patients who may be homeless or at risk of becoming homeless, educating these patients about available resources in the community, treating their health problems, and offering preventive care.
Practice Bulletin #139 “Premature Rupture of Membranes” (Revised)
ABSTRACT: Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org
The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 7,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons and the Society of Reproductive Biologists and Technologists. www.asrm.org