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Pregnancy and the environment.

The effect of the environment on reproduction has been described for centuries, as men in medieval Europe avoided lettuce to prevent sterility and women increased their water intake to promote "clean" amniotic fluid (www.whattoexpect. com). Through the ages, old wives tales have advised women about behaviors they should follow to either guarantee a healthy baby or avoid adverse outcomes such as miscarriages or birth defects. In the past century, modern science has allowed us to investigate the truth behind many of the ancient claims about the effects of the mother's environment--what she eats, breathes, and puts on her skin--on her pregnancy. The advancement of modern science has also included the development and production of thousands of chemicals --over 80,000 have been produced since the beginning of the industrial age. Chemicals have allowed for the improvement of health and quality of life for millions of people on our planet, but we are now coming to realize that many of these chemicals, even in low doses, can result in unexpected health outcomes. Pregnant and nursing women exposed to hazardous chemicals in their environment pass on the toxins through the placenta and their breast milk. The preconception period is also a window of vulnerability as many toxins have slow elimination rates (months) and may still be circulating in maternal blood during the pregnancy.

Recent publications in the scientific literature (Sathyanarayana Focareta, Dailey, & Buchanan, 2012; Sutton et al., 2013), have highlighted the increasing evidence of adverse pregnancy outcomes due to environmental chemical exposures during pregnancy and the preconception period. Studies of exposure to toxicants including lead, mercury, pesticides, and endocrine disrupting chemicals (EDCs) have definitively shown that the fetus is susceptible to exposure

--sometimes at many times the concentration in the mother

--with sometimes tragic results to childhood physical and cognitive development, future reproductive capacity, and the development of cancer. Publications in the lay press such as Living Downstream by Sandra Steingraber and Origins by Annie Murphy Paul have raised the awareness of patients who are looking to their healthcare providers to advise them about how to prevent exposures and maximize the health of their offspring. Childbirth educators can play an important role in informing pregnant patients of the effects of environmental exposures and advising them of behaviors that will decrease their risk of adverse birth outcomes.

Methyl mercury, present in most fish but more concentrated in large species, has been shown to concentrate in fetal brain and has been associated with poorer scores on the Denver Developmental tests, poor performance on attention, language, memory testing, and risk of preterm delivery (Food and Nutrition Board, 2007; Stokes-Riner et al., 2011; Xue, Holzman, Rahbar, Trosko, & Fischer, 2007). Mothers who eat fish frequently or who consume fish high in mercury are at risk for these adverse health outcomes. On the other hand, fish is an excellent source of omega-3 fatty acids which promote vision and neurodevelopment (Genuis, 2008; Mozaffarian & Rimm, 2006; Williams, Birch, Emmett, Northstone, 2001) There are many resources for fish advisories that address commercial fish and fish in local waterways. Most advisories recommend that pregnant women consume at least two fish meals per week of fish low in mercury and avoid altogether fish with the highest mercury levels. Childbirth educators should become familiar with the fish advisories in their area so that they can inform their pregnant patients to "eat fish, but choose wisely."

Exposure to lead during pregnancy, even at low concentrations, can cause fetal lead exposure and impair fetal growth and child neurodevelopment (Gardella, 2001). Pregnant women should be counseled to avoid the ingestion of non-food items and the use of traditional remedies or imported pottery, and should be referred for blood lead screening if they have any potential exposures to lead or if anyone at home has elevated blood lead. The US Centers for Disease Control screening guidelines for lead in pregnancy should be followed (Centers for Disease Control and Prevention, 2010).

Pesticide use is extremely common for killing bugs, weeds, mice and rats, and mold. Exposure to pesticides during pregnancy has been linked to intrauterine growth restriction and low birth weight (Stillerman, Mattison, Giudice, & Woodruff, 2008), lower IQ and poorer performance on other neurodevelopmental tests (Bouchard et al., 2011) and leukemia among offspring (Turner, Wigle, & Krewski, 2010). Explaining to pregnant women that the use of pesticides is sometimes unnecessary and that there are safer alternatives for most chemicals used for pests in the home will help decrease their risk of these health effects.

Endocrine disrupting chemicals (EDCs) like Bisphenol A (BPA) and phthalates, both used in plastics, and polybrominated diethyl ethers (PBDEs), components of flame retardants, can mimic or antagonize the effects of endogenous hormones. Exposure to these chemicals can come from food can linings, food storage items, toys, furniture, mattresses, and clothing. In animal studies, prenatal exposures to phthalates, BPA, and PBDEs have been shown to cause a variety of impacts in offspring including reproductive tract abnormalities and poorer performance on neuro-developmental testing (Stapleton, Eagle, Anthopolos, Wolkin, & Miranda, 2011). Advice on avoidance of endocrine disruptors is complex, since products containing EDCs are ubiquitous in our everyday lives. Studies on the health effects of endocrine disruptors are on-going and their findings hopefully will be used to spur regulatory action to reduce our exposure.

Childbirth educators can play a unique role in promoting healthy pregnancy by advising women to lower exposures to environmental toxicants. Several educational resources are available aimed at both healthcare providers and pregnant patients that offer specific detail about the exposures, their health effects, and methods to reduce exposure.

Selected Resources:

Green Parenting--Video Series from the University of Pittsburgh Medical Center at playlist?list=PL03646Di28774A6BB&feature=edit_ok

Promoting Good Prenatal Health: Air Pollution and Pregnancy--Booklet for prenatal providers from the United States Environmental Protection Agency at http://$File/OCHP_Prenatal_FS_7_10.pdf

Toxic Matters: Protecting Our Families from Environmental Hazards--a series of brochures from the Program on Reproductive Health and the Environmental at the University of California, San Francisco at http://


Bouchard, M. F., Chevrier, J., Harley, K. G., Kogut K., Vedar, M., Calderon, N., ...Eskenazi, B. (2011). Prenatal exposure to organophosphate pesticides and IQ in 7-year-old children. Environtmental Health Perspectives, 119(8), 1189-1195.

Centers for Disease Control and Prevention. (2010). Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. In. A. S. Ettinger & A. C. Wengrovitz (Eds.). U.S. Department of Health and Human Services. Retrieved September 15, 2013, from http://

Food and Nutrition Board (2007). Seafood choices: Balancing benefits and risks/Committee on nutrient relationships in seafood: Selections to balance benefits and risks, In. M. Nesheim & A. L. Yaktine (Eds.) Institute of Medicine of the National Academies, Washington, D.C.

Gardella C. (2001). Lead exposure in pregnancy: A review of the literature and argument for routine prenatal screening. Obstetrics and Gynecological Survey, 56(4), 231-238.

Genuis, S. J. (2008). To sea or not to sea: Benefits and risks of gestational fish consumption. Reproductive Toxicology, 26, 81-85.

Mozaffarian, D., & Rimm E. B. (2006). Fish intake, contaminants, and human health: Evaluating the risks and the benefits. JAMA, 296. 1885-1899.

Sathyanarayana, S., Focareta J., Dailey, T., & Buchanan, S., (2012). Environmental exposures: How to counsel preconception and prenatal patients in the clinical setting. American Journal of Obstetrics and Gynecology, 207(6), 463-470.

Stapleton, H. M., Eagle, S., Anthopolos, R., Wolkin, A., & Miranda, M. L. (2011). Associations between polybrominated diphenyl ether (PBDE) flame retardants, phenolic metabolites, and thyroid hormones during pregnancy. Environmental Health Perspectives, 119,1454-1459.

Stillerman, K. P., Mattison, D. R., Giudice, L., C., & Woodruff, T. J. (2008). Environmental exposures and adverse pregnancy outcomes: A review of the science. Reprod Sci, 15, 631-650.

Stokes-Riner, A, Thurston, S. W., Myers, G. J., Duffy, E. M., Wallace, J., Bonham, M., .Davidson, P. W. (2011). A longitudinal analysis of prenatal exposure to methylmercury and fatty acids in the Seychelles. Neurotoxicol Teratol, 33, 325-328.

Sutton, P, Woodruff, T. J., Perron, J., Stotland, N., Conry, J. A., Miller, M., & Giudice, L. C., (2012). Toxic environmental chemicals: The role of reproductive health professionals in preventing harmful exposures. American Journal of Obstetrics and Gynecology, 207(3), 164-173.

Turner, M. C., Wigle, D. T., & Krewski, D.(2010). Residential pesticides and childhood leukemia: a systematic review and meta-analysis. Environ Health Perspectives, 118, 33-41.

Williams, C., Birch, E. E., Emmett, P. M., & Northstone, K. (2001). Stereo-acuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: A report from a population-based cohort study. American Journal of Clinical Nutrition, 73, 316-322.

Xue, F., Holzman, C., Rahbar, M. H., Trosko, K., & Fischer L.(2007). Maternal fish consumption, mercury levels, and risk of preterm delivery. Environmental Health Perspectives, 115, 42-47.

Susan Buchanan is Director of the Great Lakes Center for Children's Environmental Health which is supported by the US Environmental Protection Agency and Agency for Toxic Substance and Disease Registry. She is also a member of the USEPA Children's Health Protection Advisory Committee which provides oversight to the EPA's children's environmental health activities. She is Associate Professor of Environmental and Occupational Health Sciences at the University of Illinois at Chicago School of Public Health.
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Author:Buchanan, Susan
Publication:International Journal of Childbirth Education
Article Type:Guest editorial
Geographic Code:1USA
Date:Oct 1, 2013
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