(Beyond Pesticides, July 2, 2014) According to a new study, few obstetricians offer their pregnantÂ patients advice on how to avoid environmental toxins that might harm their babies, even though doctors recognize that exposure to chemicals like pesticides, bisphenol-A (BPA), and metals can affectÂ a pregnancy. The study recommends that the medical community improve medical education and training, develop recommendations for prevention and less toxic alternatives, as well as lend support to policy change.
The first of its kind study of prenatal counselling, published in the journalÂ PLOS ONE, Counseling Patients on Preventing Prenatal Environmental Exposures – A Mixed-Methods Study of Obstetricians, found that U.S. obstetricians and gynaecologists feel they lack the medical education and training, and evidence-based guidelines and tools for communicating potential environmental risks to patients. Exposure to environmental toxins, the researchers from the University of California, San Francisco (UCSF) found, is rarely discussed with pregnant patients, even though a national survey shows that 80 percent of physicians agree they should play a part in reducing patientsâ€™ exposure to toxins. But, of the 2,500 respondents, only one in five routinely askedÂ theirÂ patients about these exposures, and just one in 15 said they received training on the harmful reproductive effects of toxic chemicals.
Survey participants believe that environmental exposures are important and that reproductive health professionals had a role in prevention. However, this concern did not translate into clinical practice. Few respondents reported routine counseling about exposure to environmental chemicals known to be harmful to reproductive health, and most felt ill-prepared to deal routinely with the issue. Many doctors felt they have a limited amount of time to talk, and more immediate concerns like vitamin intake and sexual health are often at the top of patientsâ€™ priority lists.
Pregnant women, studies have found, carry a toxic soup of hazardous chemicalsÂ in their bodies including high levels of organophosphate pesticides, endocrine disrupting compounds including triclosan, BPA and phthalates. A CDC study,Â Environmental Chemicals in Pregnant Women in the US: NHANES 2003-2004, found almost all â€“99 to 100 percentâ€“ of the pregnant women sampled carry in their polychlorinated biphenyls (PCBs), organochlorine pesticides, perfluorinated compounds, phenols like triclosan, polybrominated diphenyl ethers (PBDEs), phthalates, polycyclic aromatic hydrocarbons (PAHs) and perchlorate.Recent research has shown that environmental toxins can have profound effects on fetal development. Numerous studies have reportedÂ birth defectsÂ andÂ developmental problemsÂ when fetuses and infants are exposed to pesticides, especially exposures that adversely affect mental and motor development during infancy and childhood.Â For instance, pesticides like chlorpyrifosÂ have been shown to pose risks to babies exposed in the womb toÂ brain abnormalitiesÂ after birth.
A study published recently inÂ Environmental Health PerspectivesÂ shows that pesticide exposure can increase a woman’s risk of giving birth to a child with autism.Â Another studyÂ found that maternal exposure to air pollution is associated with low birth weight in infants. Other areas of concern include exposure to bisphenol A (BPA) in household plastics and flame retardant chemicals in fabrics.
Doctors in this new study reported in focus groups that they felt pregnant women were already stressed about reproductive and developmental health issues, and that doctors did not want to burden them further with conversations about toxins.Â Similarly, providers who care for lower-income women feel that they have limited time and more pressing issues to cover, such as poor diet, poverty and psycho-social stressors. However, according to the authors of the study, this fear may be unwarranted, as biomonitoring studies have shown that women want to know and can react in a productive way to information about potentially harmful exposures
The authors put forward several recommendations to pregnant women to reduce their exposures, including switching to organic food, and choosing less toxic alternatives for pest control and household cleansers. They also acknowledged that women with occupational exposures have limited legal protections, as regulations do not always recognize well-documented chronic health impacts. However, doctors can help reduce harmful exposures for pregnant women by lending their support for policy change. See commentary on the proposed revisions to the Worker Protection Standards.
In 2012, the American Academy of Pediatrics (AAP) released a landmark policy statement,Â Pesticide Exposure in Children, and an accompanying technical reportÂ on the effects of pesticide exposure in children. The AAP highlighted current shortfalls in medical training, public health tracking, and regulatory action on pesticides. This report provided recommendations to both pediatricians and government health agencies. Similarly, AAP made a previous policy statement citing the benefits of eating organic food in order to reduce pesticide exposure, especially in children.
In 2008, Beyond Pesticides, Maryland Pesticide Network, and leading Maryland health and elder care facilities released Taking Toxics out of Marylandâ€™s Health Care Sector: Transition to Green Pest Management Practices to Protect Health and the Environment,Â a report that documented practices and policies to eliminate toxic pesticide use. Since this report, Beyond Pesticides and Maryland Pesticide Network have worked withÂ hospital and administrative officials to move away from using toxic pesticides and implement a defined Integrated Pest ManagementÂ strategy (IPM) in their facilities, as well as educate new mothers on the importance of reducing pesticide use and exposures.
For more information on Beyond Pesticides Healthy Hospital program, please visit ourÂ Healthy Hospitals page, and for how pesticides affect children, visit the Pesticide-Induced Disease Database.
All unattributed positions and opinions in this piece are those of Beyond Pesticides.