Laura Vandenberg worries whenever she hears a pregnant friend talk about painting a nursery. She gets even more concerned when she learns of a childbearing woman spraying chemical pesticides on her lawn. "It sounds like a no-brainer, but you see it," said Vandenberg, a postdoctoral fellow in biology at Tufts University.
"If there is a group of people that could inform these women about the dangers to an expected child," she added, "it is absolutely their OB/GYNs."
Many reproductive health doctors remain largely unaware of both the lengthening list of toxic chemicals their patients are exposed to every day and the widening range of risks the chemicals might pose to a vulnerable, developing baby -- from cancer to obesity to lower IQ.
A pair of papers published this month highlight this dilemma, as well as the public health benefits that could come with solving it. More babies would grow up healthy, researchers say, if more obstetricians and gynecologists use their unique positions to counsel women and inform policies that eliminate toxic chemicals from a woman's environment in the first place.
It took a patient asking if growing up in Love Canal, N.Y. -- home of the infamous toxic waste site -- could have anything to do with her recurrent miscarriages for Dr. Linda Giudice to connect environmental exposures and human health.
"I didn't know what to say," recalled Giudice, chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, and a researcher on one of the new papers.
Now, after educating themselves, Giudice and a growing number of reproductive health physicians are cautioning patients to avoid things like spraying pesticides while trying to get pregnant or during pregnancy.
"Every mom wants to do the right thing for their baby," said Dr. Tanya Dailey, an OB/GYN in Providence, R.I., and a researcher on the other paper.
"We don't want to scare women, but we also want to limit exposures," added Dailey, who said she received little-to-no training on environmental exposures during medical school, yet faces more and more questions on the issue from patients. Now, Dailey might advise a pregnant woman to eat only small fish, for example, explaining that marine life lower on the food chain will accumulate less mercury and other toxic chemicals.
Taking your shoes off before going inside the house is one of Dr. Sheela Sathyanarayana's recommendations. That, and keeping carpets and windowsills clean, can cut down on the array of toxic chemicals carried by dust. Eating fresh foods, she added, avoids bisphenol A (BPA) and other chemicals commonly consumed via processed foods and leaching cans and plastic packaging.
"There are simple things you can do to reduce all of your exposures at once," said Sathyanarayana, a pediatric environmental health expert at Seattle Children's Hospital and lead researcher on the paper with Dailey. "But you can never get to zero exposure -- that's just not realistic."
Dr. Tracey Woodruff has found that virtually all pregnant women in the U.S. carry multiple chemicals in their body, including BPA, dichlorodiphenyltrichloroethane (DDT) and polychlorinated biphenyls (PCBs). Of the 163 chemicals analyzed in a study published last year, 43 were found in nearly all of the women tested.
"The burden is not just one or two chemicals -- it's actually many," said Woodruff, also a co-author on Giudice's paper. "And we know that these chemicals can act together," with combined effects that may be even greater than the sum of each acting alone.
A recent study led by Tuft's Vandenberg also shows that exposures to even small doses of a toxic chemical can prove hazardouss -- in some cases, the smaller dose actually poses the higher risk.
What's more, scientists are learning that the consequences can last a lifetime, even multiple generations. The groundbreaking evidence of this latter phenomenon -- now an emerging science called epigenetics -- is based on the popular use of a hormone drug by pregnant women in the 1950s and 1960s. Touted at the time for preventing miscarriages, diethylstillbestrol (DES) has now been associated with cancers and reproductive defects in the exposed women's children, as well as their children's children.
"Genetics alone can't explain all the things we observe in terms of familial disease patterns," said Woodruff.
Largely under Woodruff's lead, obstetrics and gynecologists in California have weighed in on public policy matters including bans on BPA in baby bottles and flame retardants in furniture.
"As new legislation moves forward, we want the issue of pregnant women to be adequately incorporated," said Woodruff, noting that laws have not kept up with the deluge of chemicals in the marketplace or the pace of science.
"While there are things they can do to minimize chemical exposures, the burden should not all be on mothers," she added. "It should be on industry and government agencies to make sure chemicals have been tested and don't pose undue risks to children."
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