Prenatal Environmental Health Assessment Tool

Katie Huffling, RN, MS, CNMDimensions OB/GYN Associates

Nurse-Midwifery & Environmental Health

• Core competencies– Environmental influences

on pregnancy planning– Environmental influences

on pregnancy outcomes

But how can a practitioner translate this into practice?

Assessment Tool

Carbon Monoxide

• Odorless, colorless, tasteless• Symptoms of poisoning similar to those of

pregnancy – fatigue, nausea, vomiting• First trimester appears to be time of greatest

fetal sensitivity• First trimester exposure associated with

intrauterine growth restriction, lower birth weight, preterm delivery

Carbon Monoxide

• Prenatal exposure may negatively impact lung function in children with asthma

• Decreased lung function found in:• African American children

• Children diagnosed prior to age 2

Mortimer et al. 2008

Carbon Monoxide Sources

Exposure Prevention

• Do not idle automobiles in the garage• Make sure combustion heating sources are

working properly and are properly vented• Have carbon monoxide detectors on every

level of house with combustion heating• http://www.epa.gov/iaq/co.html

Assessment Tool

Drinking Water

The first question to ask:• Are you on a private well or

public drinking water supply?

Public Drinking Water

• Water companies test the water

• The findings are made public annually

(Consumer Confidence Report)

• In emergency situations, an alert is to be made.

Bisphenol A

Bisphenol A

• Originally produced in 1891• Estrogen-like compound• When DES was found to be more estrogenic,

its use as a pharmaceutical was discontinued• Was rediscovered when chemists found it

could be mixed with a polymer to produce polycarbonate plastic

Myriad of Consumer Uses

• Baby bottles• Metal can liners• Water bottles• Food containers• Dental products• Compact discs

Concerns

• Ubiquitous in humans• Federal safety assessment based on two

studies• Health effects occur at very low dose exposure

FDA & Bisphenol A

• Safety assessment flawed• Based on two studies

– Both studies funded by the chemical industry– One has never been published– Other with questionable scientific methodology

• Approx. 100 peer-reviewed studies came to a different conclusion

Does the dose make the poison?

Adapted from Wetherill et al.

Does the dose make the poison?

Effects of BPA Exposure

• Polycystic ovarian syndrome• Endometrial changes• Miscarriage• Decreased hormonal levels in men needed for

sperm formation• Breast and prostate cancers• Infertility in men and women• Insulin resistance

Infant Formula

Decreasing BPA exposure

• Avoid #7 plastics• Plastics with #1, #2, and #4 are safer• Do not use liquid infant formulas• Avoid canned foods• If using metal water bottle make sure it does

not have an epoxy liner!

Assessment Tool

Smoking & Pregnancy

• Smoking during pregnancy– Doubles the risk of having a low-birthweight baby– May increase risk of congenital heart defects– Increases risk of preterm delivery– Increases risk of placenta previa & abruption– Increases risk of premature rupture of membranes

(PROM)

Smoking & Pregnancy

• If a woman quits smoking even as late as the second trimester, her risk of having a low-birthweight baby is the same as if she had never smoked.

Smoking & Pregnancy

http://www.epa.gov/smokefree/index.html

http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Personal Care Products

• Over 10,000 different chemicals used in personal care products

• Only 11% have been tested for safety

• In a 2004 survey, adults used an average of 9 products a day for a total of 126 different ingredients daily http://www.cosmeticsdatabase.com/research

Personal Care Products

• Phthalates – Used as plasticizer in PVC, fragrances, solvents

• Found in hairspray, shampoo, nail polish• Impacts fetal development – boys especially

susceptible

Personal Care Products

• Read Labels!• Don’t buy products listing “Fragrance” or

“Phthalate” in the ingredients• If you’re not sure go to:

www.cosmeticsdatabase.org

Skin Deep

www.cosmeticsdatabase.com

Personal Care Products

Some cosmetics manufacturers are beginning to listen…

Household Products

Pesticides• Are chemicals designed to kill or repel pests• They include:

– Herbicides– Insecticides– Fungicides

Exposure• Lawns• Home indoor use• Workplace - Hospitals• Residues on foods• Farm application

Health Effects• Neurological Effects

– Many pesticides are neurotoxins– Cognitive effects– Memory deficits– Seizures– Personality changes– Possible link to Parkinson’s disease

Health Effects

• Reproductive– Decreased sperm

production– Increased risk of stillbirth

and miscarriages– Increased risk of congenital

anomalies– Hormone production

What can be done to minimize exposure?

• Minimize pesticide use on your lawns and in your homes– Encourage your patients to do the

same

• Read labels• Encourage use of Integrated

Pest Management where you work

• Buy organic foods

spcpweb.org www.pesticideinfo.org www.beyondpesticides.org

Worst Non-Organic Foods

• Apples• Bell Peppers• Celery• Cherries• Grapes• Nectarines• Peaches

• Pears• Potatoes• Red

Raspberries• Spinach• Strawberries• Winter

Squash

Best Non-Organic Foods

• Asparagus• Avocadoes• Bananas• Broccoli• Cauliflower• Corn

• Kiwis• Mangos• Onions• Papayas• Pineapples• Peas

(Sweet)

Assessment Tool

Sources of Mercury in the Home

• Thermometers• Some traditional remedies• Compact fluorescent lights (CFLs)

Steps to Reduce Risks

• Use only non-mercury thermometers

• Do not use mercury-containing remedies

• Dispose of CFLs and mercury containing items properly

• Do not vacuum up spills• Large spills – contact local health

department

Mercury in the Environment

Fish Consumption Guidelines

FDA/EPA Fish Advisory •NO Shark, Swordfish, King Mackerel, or Tilefish•Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury.

Fish Consumption Guidelines

Home Renovations

• Many home improvement products contain Volatile Organic Compounds (VOCs)

• Can off-gas for months• Have been linked to asthma, earaches in

newborns, developmental delays, and cancer

Reducing Exposure

• Choose low/no VOC paint• Let someone else do the renovations and stay

away until the room is well-ventilated• Allow house to air out frequently• If buying new furniture for nursery - avoid

pressed wood, stain resistant upholstery

PBDE

• Polybrominated diphenyl ethers (PBDEs)• Persistent in the environment• Three types used in furniture, adhesives,

electronics, home building supplies• Very high levels found in breastmilk of U.S.

women• Health effects – reproductive, developmental

(especially neurological)

PBDE in Breastmilk

Schecter et al 2003, Mazdai et al 2003, Kalantzi et al 2004, compiled by NRDC

PBDE in Breast Milk

Darnerud et al. 2003

Reducing Exposure

• Vacuum and dust at least once a week – use HEPA filter if possible

• Replace furniture with crumbling cushions or cover with fabric

• If possible, do not reupholster foam cushions• Be careful if replacing carpet• When replacing products find out what kind of

fire retardant used – avoid brominated