Environmental screening and toxins to avoid during pregnancy

As directed by the state of New York, we conduct a yearly Prenatal Care Standard audit. This audit evaluates the care and documentation practices of healthcare providers for obstetric members. A critical component of the audit is the risk assessment section, which scores providers based on various factors affecting pregnancy, including genetic, nutritional, environmental, and behavioral elements. Each risk category is weighted, and historically, providers tend to lose points due to insufficient attention to environmental screening and discussion.

Impact of toxic exposures

Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birth weight, neurodevelopmental delays such as autism and attention deficit hyperactivity disorder, and adult and childhood cancer. Exposures can be grouped into the following categories: toxic chemicals, air pollution, and climate change-related exposures.

Role of obstetric care clinicians

Obstetric care clinicians can provide useful information to patients and refer patients to appropriate specialists, if needed when a hazardous exposure is identified. Obstetrician and gynecologists and other obstetric care clinicians need to become knowledgeable about toxic environmental exposures that are endemic to their specific geographic areas, such as local water safety advisories (for example, lead-contaminated water), local air quality levels, and patients’ proximity to power plants.

Many environmental factors that are harmful to reproductive health disproportionately affect underserved populations. Clinical encounters offer an opportunity to screen and counsel pregnant patients about opportunities to reduce toxic environmental health exposures.

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

• It is important for obstetric care clinicians to be knowledgeable about toxic environmental agents in relation to environmental health risk assessment, exposure reduction, and clinical counseling.
• Obstetric care clinicians should consider including questions about environmental exposures in the patient history during pregnancy.
• Typical elements of an environmental health history include assessment for exposures from the workplace, home, or recreational activities.
• It may be beneficial to integrate environmental health into obstetrics and gynecology training and practice. Advocating for policies that will reduce harmful exposures and protect the health of pregnant women and their children is encouraged.

Toxic chemicals

Chemicals can be found in a wide range of consumer products, personal care products, food packaging, and household materials, as well as in air and water. Chemicals can cross the placenta and, in some cases, can accumulate in the fetus, which results in higher fetal concentrations than maternal levels.

Air pollution

Air pollution may be associated with adverse fetal outcomes, including preterm birth and low birth weight.

Climate change

The American College of Obstetricians and Gynecologists recognizes that climate change is an urgent women’s health concern as well as a major public health challenge.

Environmental health history

Obstetric care clinicians should consider including questions about environmental exposures in the patient history. An environmental health history is the key first step in identifying specific types of potentially harmful exposures to the pregnant individual and fetus to tailor appropriate exposure reduction strategies.

Typical elements of an environmental history include assessment for exposures from the workplace, home, or recreational activities. For example, pregnancy counseling can include an assessment of lead exposure.

After an environmental health history and assessment are completed, obstetric care clinicians are encouraged to provide information regarding reducing exposure to toxic agents at home, in the community, and at work, being mindful of the economic and other costs that reduction may entail. If an exposure is identified, patients can be educated regarding avoiding or reducing exposure to toxic agents where possible.

Workplace and occupational exposures

Employment sectors are at risk of hazardous exposures during pregnancy include agriculture (pesticides), manufacturing (organic solvents and heavy metals), dry cleaning (solvents), custodial cleaning services (organic solvents), beauty salons (solvents and phthalates), and healthcare (biologics and radiation).

Food‑related exposures

Patients can be counseled that preparing and storing foods in glass or non‑plastic containers may reduce exposure to plastic.

Personal care products

Personal care and cosmetic products may contain unrecognized toxins.