ACOG Issues Updated Guidance on Reducing Patients’ Exposure to Environmental Toxins Before and During Pregnancy

Washington, D.C. — Obstetrician–gynecologists should consider screening patients for exposure to environmental toxins before and during pregnancy, with counseling on how to minimize the associated reproductive and developmental health risks, according to a Committee Opinion released by the American College of Obstetricians and Gynecologists (ACOG). The organization notes that obstetrician–gynecologists do not need to be experts in environmental health to help patients reduce their exposure to environmental toxins that may contribute to infertility, premature birth, miscarriage, developmental disabilities, and other adverse outcomes. Importantly, underserved communities are disproportionately exposed to these toxins. The Committee Opinion, Reducing Prenatal Exposure to Toxic Environmental Agents, was prepared by ACOG’s Committee on Obstetric Practice and is endorsed by the American College of Nurse–Midwives.

The updated Committee Opinion was published in the July edition of Obstetrics & Gynecology. “We are responding to an emerging body of evidence that further corroborates and extends the boundary of knowledge we had five years ago,” said Nathaniel DeNicola, MD, MSHP, FACOG, environmental health liaison between ACOG and the American Academy of Pediatrics and a lead author of the Committee Opinion.

The guidance acknowledges that the scientific investigation of environmental toxins is incomplete, while emphasizing the potential threat to human health and the importance of precautionary measures. Some toxins, such as lead and mercury, are proven neurodevelopmental hazards. Others, including solvents and phthalates (chemicals used in plastics), are associated with adverse reproductive and developmental health outcomes. The document includes tables summarizing the quality of the relevant research, key components of an environmental history, and counseling points to help reduce exposure when possible.

The guidance emphasizes that many environmental risks to reproductive health, such as air pollution and lead, disproportionately affect patients in underserved communities. These may be compounded by other systemic injustices. The guidance recognizes that some individuals and communities may have limited control over such exposures and may need to balance competing risks. Recommendations are intended to guide counseling on reducing exposure where possible and to advocate for policies that will protect all populations.

The opinion emphasizes that obstetrician–gynecologists are uniquely positioned to screen patients for possible exposures and discuss feasible ways to reduce them. “We talk about nutrition in prenatal visits; for example, avoiding large fish that may be contaminated with mercury. We can expand that to counsel about eating foods that have been wrapped in plastic,” said Dr. DeNicola, a practicing obstetrician–gynecologist at Johns Hopkins Health System in Washington, D.C.

Other actions within individuals’ control may include minimizing the use of cleaning products containing certain solvents associated with miscarriage and low birth weight. Potentially safer options include cleaning with vinegar and baking soda and not dry-cleaning clothes. Personal care products may contain phthalates, linked to neurodevelopmental conditions and to male reproductive problems. Recommended strategies include using fragrance-free rather than scented or unscented products.

The opinion calls for rigorous research into specific environmental health exposures and adverse reproductive and developmental outcomes. It emphasizes that reducing harmful environmental exposures must involve policy change.

This document replaces Committee Opinion 575 and its accompanying white paper, incorporating more recent literature regarding reducing prepregnancy exposure and reducing prenatal toxic exposures.