By: Heather Cook, MD
In the United States there are over 80,000 registered chemicals that can cause environmental contamination through soil, drinking water, food, and consumer products. In pregnant women studied, 99 – 100% of women had detectable levels of these chemical toxins known to contribute to specific medical diseases. Aside from smoking and alcohol use (which are generally well-known toxins already discussed by most providers) there are certain chemical compounds commonly found in most Americans that should be of concern to women specifically in the preconception and prenatal periods.
Mercury, the most common of these chemicals, is released as a byproduct of coal burning, and is mainly found in fish. Mercury is a neurotoxin and can increase risk of cerebral palsy and other neurologic conditions as well as decreasing IQ scores in children. Patients should be screened for mercury exposure by asking about fish consumption, specifically with avoidance of: King Mackerel, Shark, Swordfish, Marlon, Orange Roughy, Tile Fish and Tuna.
Patients should also be screened for lead toxicity as increased levels of lead in maternal serum have been associated with many pregnancy complications. Women should be questioned regarding lead exposure at their workplace, pica use, and asked if they live in a house built before 1987 (specifically if they are undergoing renovation). Lead levels greater than 20 mcg/dL are concerning and require additional evaluation.
Endocrine-disrupting chemicals such as bisphenol A (BPA), phalates, and ploybrominated diethyl ethers (PBDEs) are found in food processing, personal care products, and cosmetics, and are difficult to avoid. BPA and phalates are used for plastics, canned food liners, cash register receipts, cosmetics and lotions and have been associated with both reproductive/ fertility difficulty as well as with pregnancy complications. Women should be screened regarding their use of plastic drinking bottles and plastic food containers and should be encouraged to avoid these if possible. Glass or stainless steel containers would provide a more desirable option.
Finally, women should be screened for exposure to pesticide exposure such as insecticide use at home or on pets. Women should also be encouraged to choose organic fruits and vegetables when grocery shopping and to wash hands if they do work around agriculture. An excellent resource for patients can be found through the University of California, San Francisco- click here to read.