Doctors Lack Tools to Discuss Toxic Exposures with Pregnant Patients: Survey
July 09, 2014
By Dr. Mercola
If you're a pregnant woman, avoiding exposure to environmental toxins is one of the most important steps you can take to protect your developing baby. In fact, avoiding toxic exposures while pregnant is equally as important to your baby's health as your healthy diet, stress management, safe exercise, and sound sleep.
Unfortunately, few obstetricians routinely warn expectant mothers about the risks of environmental toxins, often because they feel they lack the medical training to do so.
Many Doctors Are Unprepared to Discuss Toxic Exposures with Pregnant Women
In a survey of more than 2,500 US obstetricians on the topic of prenatal environmental exposures, the majority (78 percent) agreed that they could reduce women's exposure to environmental health hazards by counseling their patients.1
However, 50 percent said they rarely take an environmental health history and less than 20 percent said they routinely ask about environmental exposures common to pregnant women.
Worse still, only one in 15 obstetricians reported receiving any training on the topic. In short, while most obstetricians acknowledge the importance of talking to pregnant women about exposure to environmental toxins, few actually do in practice because they feel unprepared to do so. The surveyed obstetricians reported the following barriers to environmental counseling:
- A lack of knowledge of and uncertainty about the evidence
- Concerns that patients lack the capacity to reduce harmful exposures
- Fear of causing anxiety among patients
The study's lead author, Naomi Stotland, a professor of obstetrics at the University of California, San Francisco, explained:2
"Providers were saying, 'If I bring this up with patients... it's going to raise anxiety and questions that I don't know how to deal with… There's a sense that, yes, these things may be harmful, but I don't know how to tell her how to reduce her risk.'"
Developing Babies Are Especially Vulnerable to Environmental Toxins
Obstetricians' reluctance to discuss environmental toxins with pregnant women is unfortunate – and that is a profound understatement. The nine months of development that take place in the womb are the most rapid and most vulnerable period of your baby's life.
And while no one knows exactly what happens when a developing fetus is exposed to hundreds of chemicals in utero, we'll likely be finding out whether we like it or not, as this is occurring daily.
What is known, however, is that children experience greater exposure to chemicals pound-for-pound than adults, and though the blood-brain barrier is fully formed at birth,3 its function may be immature, which may allow greater chemical exposures to reach their developing brains.
Children also have lower levels of some chemical-binding proteins, according to the Environmental Working Group (EWG), which allows more of a chemical to reach their organs, while systems that detoxify and excrete chemicals in adults are not fully developed.4
These factors, coupled with the fact that a child will be around for 80 years or more, allowing more than enough time for chemicals to do their damage, signals a major challenge for kids born today. Experts believe rising rates of birth defects, asthma, neurodevelopmental disorders, and other serious diseases in US children are a result of these early chemical exposures.
Environmental Chemicals Induce Multiple Harms with Effects Seen in Childhood and Adulthood
There are approximately 75,000 chemicals regularly manufactured and imported by US industries, and, disturbingly, most of them have never been adequately tested for safety for adults, let alone their impacts on the most vulnerable among us, our children.
It's becoming hard to deny that early life exposure to a slew of chemicals is changing the health of humankind and is likely instrumental in the rising rates of chronic diseases we're seeing among developed countries. How might these toxins be harming your unborn child? A landmark 2005 study by EWG found that blood samples from newborns contained an average of 287 toxins.
Of these, 180 are known to cause cancer in humans or animals, 217 are toxic to your brain and nervous system, and 208 have been found to cause birth defects or abnormal development in animal tests.5 Taken together, the chemical cocktail that bathes most babies in the womb can exert harm in multiple ways. EWG explained:6
"Some chemicals are directly toxic to an exposed child — lead and mercury, for example, which harm a developing brain — while other chemicals induce a chain of events that may culminate in a diagnosed health problem later in life.
Hormone-mimicking chemicals like dioxins and furans, for example, could induce delayed cancers in hormone-sensitive tissues like the breast, testicle, or prostate gland. Chemicals like PCBs or DDT can reduce growth rates in the womb, initiating in low birth weight babies lasting, internal survival mechanisms that cascade into cardiovascular disease or diabetes later in life.
The fact is, a child can bear a lifelong imprint of risks from the countless molecules of industrial pollutants that find their way through the placenta, down the umbilical cord, and into the baby's body.
The consequences — health disorders, subtle or serious — can surface not only in childhood but also in adulthood. Studies now support origins in early life exposures for a startling array of adult diseases, including Alzheimer's, mental disorders, heart disease, and diabetes."
High Blood Pressure and Autism Are Risks of Chemical Exposure During Pregnancy
It's difficult to quantify the damage potential of environmental chemicals, especially in utero. However, the studies that have tried have yielded some disturbing results. For instance, earlier this year a study published in the journal PLOS Computational Biology7 found that every 1-percent increase in genital malformations in newborn males within a particular county was associated with a 283 percent increased rate in autism.
According to the researchers, genital malformations such as micropenis, undescended testicles, and hypospadias (when the urethra forms on the underside of the penis) are signs of exposure to harmful toxins.
And the correlation between genital malformation and autism in turn offer strong support for the notion that autism may be at least partially the result of parental overexposure to environmental toxins. According to one of the authors, Andrey Rzhetsky, Ph.D., professor of genetic medicine and human genetics at the University of Chicago:8
"Autism appears to be strongly correlated with rate of congenital malformations of the genitals in males across the country. This gives an indicator of environmental load and the effect is surprisingly strong... We interpret the results of this study as a strong environmental signal."
Other recent research has revealed that exposure while in the womb to DDT, a pesticide banned in 1972 after close to 30 years of use, increases women's risk of high blood pressure decades later. Like many environmental toxins, DDT passes freely through the placenta during pregnancy, where it gains direct access to the developing fetus. Past studies have linked DDT to high blood pressure, decreased fertility, premature delivery, and diabetes in adults, but this is the first study to reveal its health risks when exposure occurs prenatally.
The research revealed that women exposed to the most DDT before birth were 2.5 to 3.6 times more likely to develop high blood pressure before the age of 50 than those with the lowest prenatal exposure.9 This means health problems you're experiencing now could potentially be the result of chemical exposures before you were even born.
Damage from Chemical Exposure in Utero May Persist for Many Generations
What is perhaps even more shocking is that toxins you're exposed to while in your mother's womb can end up impacting the health of your great-grandchildren through inherited epigenetic changes. So not only are environmental chemicals potentially jeopardizing the health of your children, they're jeopardizing the health of multiple future generations. EWG noted:10
"…Early life [chemical] exposures can lead to health problems not only in adulthood, but also down through subsequent generations. For instance, adult diseases linked to newborns' low birth weight… cause adverse effects not only in those babies born small, but also in their children of any birth size, through heritable changes in gene expression that result in a phenomenon known as 'epigenetic inheritance.' Very different from genetic mutations, which are physical changes in gene structure, epigenetic inheritance is instead characterized by certain genes being turned on or off, but near permanently in ways that can be inherited.
If a genetic mutation is like changing a light fixture, the comparable epigenetic change would involve taping the light switch on or off. Since genes are responsible for making the chemicals that build and repair the body, this unnatural forcing to a permanent on or off position can have far-reaching consequences. In humans, both kinds of genetic changes, mutations as well as epigenetic changes in gene expression, can be passed down to a baby in the womb."
Even 'Safe' OTC Meds Like Tylenol May Be Harmful
It may be obvious to avoid exposures to toxins like lead, mercury, and pesticides. But if you're pregnant, it is generally best to avoid taking any medications as well, including over-the-counter (OTC) varieties, unless absolutely necessary. This includes while you're trying to conceive, as you could become pregnant and not know it. Most medications have never been tested on pregnant women and their effects on a developing baby are completely unknown. Even the US Centers for Disease Control and Prevention (CDC) acknowledges that very little is known about the impacts of most medications on unborn babies:11
"We do not have enough information about the effects of many medications when they are taken by pregnant women… All prescription and over-the-counter medications are tested to see if they are safe and effective before they become available to the public. Pregnant women usually are not included in these tests because of the possible risks to the unborn baby. As a result, little information is available about the safety of most medications during pregnancy—including those available over the counter—when they first become available."
Even acetaminophen (Tylenol), which has long been considered the "safest" pain reliever for pregnant women, was recently found to be risky as it may raise the risk of behavior problems in your child later on. The study, published in the journal JAMA Pediatrics, noted that "research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development."12 The study included data from more than 64,000 mothers and children in the Danish National Birth Cohort. Over 50 percent of the women reported taking acetaminophen while pregnant, which was found to be linked to:
- A 30 percent increased risk for ADHD in the child during the first seven years of life
- 37 percent increased risk of being diagnosed with hyperkinetic disorder (HKD), a severe form of ADHD
Behavioral effects appeared to be dose dependent. The more frequent the use of acetaminophen during pregnancy, the higher the offspring's chances of being diagnosed with ADHD-related problems. Children of women who used the drug for 20 or more weeks during pregnancy had nearly double the risk of getting an HKD diagnosis. They also had a 50 percent greater chance of being prescribed an ADHD medication. As reported by Forbes:13
"Acetaminophen can cross the placenta, making its way to the fetus and its delicate developing nervous system. The drug is a known endocrine (hormone) disrupter, and has previously been linked to undescended testes in male infants. Since the maternal hormone environment plays a critical role in the development of the fetus, the authors say that it's 'possible that acetaminophen may interrupt brain development by interfering with maternal hormones or via neurotoxicity such as the induction of oxidative stress that can cause neuronal death.'"
Infographic: Top Toxins to Avoid if You're Pregnant
If you're pregnant or trying to conceive, trying to wade through the information pertaining to toxicant exposures can be overwhelming. The infographic below can help to take some of your anxiety away, as it offers a concise list of some of the most damaging toxins that pregnant women should avoid. Ideally, it's important to reduce your chemical exposures and encourage detoxification before you become pregnant in order to protect your future children from your body's toxic load. With that in mind, here are the top toxins to avoid if you're pregnant or planning to become pregnant, including where you're most likely to find them.
Leading a Healthy Lifestyle Will Minimize Your Chemical Exposures Naturally
Since it's unlikely that your obstetrician will advise you on how to reduce your exposure to environmental toxins, you'll need to take matters into your own hands. As an aside, you may want to consider switching to a pregnancy health care provider that will be more in tune with such risks, including how to avoid them, such as a midwife. You'll want to begin with what are likely your largest avenues of chemical exposures: your diet and your home, starting by paying careful attention to what you eat.
Eating organically grown, biodynamic whole foods are a primary strategy and, as an added bonus, when you eat properly, you're also optimizing your body's natural detoxification system, which can help eliminate toxins your body encounters from other sources. From there, simply leading a healthy lifestyle will help you to have as minimal a chemical exposure as possible. This includes the following:
- As much as possible, purchase organic produce and free-range, organic foods to reduce your exposure to pesticides, growth hormones, GMOs, and synthetic fertilizers.
- Rather than using conventional or farm-raised fish, which are often heavily contaminated with PCBs and mercury, supplement with a high-quality purified krill oil, or eat fish that is wild-caught and lab tested for purity.
- Eat mostly raw, fresh foods, steering clear of processed, prepackaged foods of all kinds. This way you automatically avoid artificial food additives, including dangerous artificial sweeteners, food coloring, and MSG. Freshly grown sprouts are particularly nutritious, especially watercress, sunflower, and pea sprouts.
- Store your food and beverages in glass rather than plastic, and avoid using plastic wrap and canned foods (which are often lined with BPA- and BPS-containing liners).
- Have your tap water tested and, if contaminants are found, install an appropriate water filter on all your faucets (even those in your shower or bath).
- Only use natural cleaning products in your home.
- Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants, and cosmetics. The Environmental Working Group has a useful database to help you find personal care products that are free of phthalates and other potentially dangerous chemicals.14 I also offer one of the highest quality organic skin care lines, shampoo, and conditioner, and body butter that are completely natural and safe.
- Avoid using artificial air fresheners, dryer sheets, fabric softeners, or other synthetic fragrances.
- Replace your non-stick pots and pans with ceramic or glass cookware.
- When redoing your home, look for "green," chemical-free alternatives in lieu of regular paint and vinyl floor coverings.
- Replace your vinyl shower curtain with one made of fabric, or install a glass shower door. Most flexible plastics, like shower curtains, contain dangerous plasticizers like phthalates.
- Limit your use of drugs (prescription and over-the-counter) as much as possible. Drugs are chemicals too, and they will leave residues and accumulate in your body over time.
- Avoid spraying pesticides around your home or insect repellants that contain DEET on your body. There are safe, effective, and natural alternatives out there.