Doctors Fail To Counsel Pregnant Women On Toxic Chemical Risks

A Missed Opportunity To Protect Unborn Babies From Toxic Chemicals

When Penelope Jagessar Chaffer became pregnant, her obstetrician warned her to avoid alcohol, cigarettes and mercury-laden tuna. Dangers posed to her unborn child by industrial chemicals such as flame retardants, pesticides and plastics, however, never came up.

"No one told me anything about any of this stuff," said Jagessar Chaffer, 44, a documentary filmmaker and children's environmental health advocate. She said it was the same story with all of her pregnancies. "I wasn't being empowered."

As Jagessar Chaffer taught herself while carrying her first child, dozens of environmental chemicals can course through a pregnant woman's body, cross the umbilical cord and wreck havoc on a developing fetus. Birth defects, IQ losses and childhood cancers are just some of the potential risks scientists have now tied to even low levels of exposure.

Despite these high stakes, Jagessar Chaffer's prenatal care experience is more or less the norm, according to a national survey that gauged obstetricians' stances on counseling pregnant patients about environmental health hazards.

"They said they'd rather not go there," noted Dr. Naomi Stotland, an obstetrician at the University of California, San Francisco and lead author of the study published on Wednesday.

Among more than 2,500 doctors consulted for the survey, nearly all of them reported counseling patients on factors such as diet, exercise and cigarette smoking. However, only about 20 percent said they addressed environmental exposures. They pegged their hesitation to a number of factors, from the fear of overwhelming patients with anxiety-inducing worries to limited appointment time to a lack of environmental health education.

Just one in 15 doctors said they had received training on the harmful reproductive effects of toxic chemicals.

"Medical school and residencies tend to frame their curriculum around the boards and required licensing exams," said Stotland. "This material is not yet on those tests."

The result, according to the study authors and other environmental health experts and advocates, is a serious missed opportunity.

The American College of Obstetrics and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) issued a statement in October that underscored mounting evidence of "significant and long-lasting effects" caused by industrial chemicals, and emphasized doctors' role in protecting pregnant women.

ACOG president Dr. John Jennings told The Huffington Post it is "extremely important" to incorporate knowledge of toxic chemicals into the curricula of medical school, residencies and continuing education.

"Reproductive care providers can be effective in preventing prenatal exposure to environmental threats to health because they are uniquely poised to intervene before and during pregnancy, which is a critical window of human development," the groups stated in their opinion.

Sonya Lunder, senior analyst with the nonprofit Environmental Working Group, noted that pregnancy can also be a window of increased exposures. "Being pregnant is a time when people are more likely to be moving or remodeling," said Lunder, citing often overlooked concerns such as volatile organic compounds in the paint that expecting parents might apply inside a new nursery.

"Doctors feel there are not clear messages they can give to patients. But I think there are," said Lunder. "While there is uncertainty in some relationships [between chemicals and health problems], there are a lot of associations that have been borne out."

The heavy metal lead is perhaps the most notorious environmental neurotoxin. Despite being banned from gasoline and residential paint, it still lingers widely -- especially in dust from deteriorating paint. (This can pose a particular hazard during remodeling if lead paint is not removed properly.) More recently, synthetic chemicals that mimic human hormones have come under intense scrutiny. Although still hotly debated, most studies of bisphenol A, for example, find that the chemical, commonly found in plastics, may disrupt natural hormone messengers responsible for critical processes such as metabolism, growth and reproduction.

The chemical industry, however, suggests providers are already doing plenty for their pregnant patients. And they point to the new study as further support of their position.

"These results confirm that OB/GYNs believe it is unnecessary and counter-productive to alarm their patients about everyday environmental exposures to chemicals that expert scientists at government regulatory agencies have approved for daily use," Anne Kolton, a spokeswoman with the American Chemistry Council, told HuffPost in an emailed statement. "Creating confusion and alarm among expectant mothers will distract from the well-established steps doctors recommend to support a healthy pregnancy and a healthy baby."

Importantly, the majority of doctors surveyed in the study did actually agree that counseling patients on environmental threats could reduce exposures, and could be vital to a healthy pregnancy, even if they felt ill-equipped to do so themselves. Only 14 percent of all OB/GYNs contacted for the survey responded, however, which suggests those participating may have been biased in their concern around the issue.

Stotland, the study author, allowed that for some patients, addressing basic issues such as diet may indeed be most critical. One participant in her survey suggested obstetricians often had "bigger fish to fry," such as women who "eat at Popeye's four times a week."

"I can relate to that struggle," said Stotland, who serves low-income populations. "Many patients are burdened with a lot of challenges. How many things can you throw at her at once?"

Dr. Sheela Sathyanarayana, a pediatric environmental health expert at Seattle Children's Hospital, proposed tailoring information on a patient-by-patient basis. A family's income may determine whether or not replacing furniture filled with flame retardant is a realistic option -- and therefore worth addressing in a doctor's office -- while a family's geographical location might point to local hazards such as agricultural pesticides or highway exhaust.

"Different people have different sources of exposure," said Sathyanarayana, who authored a 2012 paper with suggestions for doctors counseling pre-conception and prenatal patients on environmental exposures.

Still, experts highlight some general steps any woman can take to avoid contaminants, even if she can't afford organic food or change her workplace.

The University of California, San Francisco now offers a free handout, available online in both English and Spanish, that encourages pregnant women to take off their shoes before going inside, use natural cleaners such as vinegar and microwave food in glass rather than plastic, among other strategies.

The Environmental Working Group provides a free pregnancy guide that covers several toxin-avoiding steps, including cutting out nonessential personal care products and making seafood choices that maximize healthy omega-3 fatty acids while minimizing mercury exposure.

On Wednesday, the group also published a critique of a new Food and Drug Administration and Environmental Protection Agency joint advisory concerning fish consumption. The EWG warns that the guidance does not provide enough detail to steer pregnant women toward the safest and most nutritious seafood options, such as salmon. Pregnant women who follow the government's dietary recommendation of two to three servings of fish a week could consume an excess of toxic mercury, for example.

Advocates also suggest a need for stronger federal regulation of chemicals in commerce.

Doctor groups, including ACOG, are joining the push to reform the outdated Toxic Substances Control Act of 1976. While drug companies must perform rigorous tests of their products before marketing them to the public, chemicals in consumer products such as food containers and raincoats need little or no proof of safety before they land on store shelves. The EPA has required toxicity testing of around 200 of the more than 80,000 chemicals permitted for use in the U.S.

"The government should have the power to require manufacturers to test chemicals before they go on the marketplace," said Tracey Woodruff, an author on the new paper and director of the University of California, San Francisco Program on Reproductive Health and the Environment. "Having doctors partner in this is extremely powerful."

Meanwhile, after-the-fact research on many chemicals continues to hint at health hazards. New studies just in the last month warn of potential links between pesticides and autism, as well as flame retardants and IQ deficits.

"Environmental toxins are everywhere. They are released by the thousands," said Jennings. "We're not sure what are toxins and what are benign chemicals ... The best thing we can do right now is to take a precautionary approach."

Since arming herself with information on environmental health, and continuing to raise two healthy children, Jagessar Chaffer now aims to empower others. She said she frequently fields questions from pregnant women and obstetricians, who see her as an expert due to her TED Talk and forthcoming documentary film, "Toxic Baby."

"I meet a lot of women who carry a lot of guilt," said Jagessar Chaffer. "Maybe their child is sick, or has cancer, and they'll ask, 'Why didn't anyone tell me about this when I was pregnant?'"

CORRECTION: A previous version of this story misidentified ACOG as the American Council of Obstetrics and Gynecologists. The group's name is the American College of Obstetrics and Gynecologists.

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