Why doctors don’t talk to pregnant women about toxic chemicals
Reducing pregnant women’s exposure to environmental toxins was recently deemed “critical” by the American College of Obstetricians and Gynecologists to prevent birth defects and other fetal health problems. But a survey published last week of more than 2,500 physician members of that group found that fewer than one in five of them ask pregnant patients about any exposure they have had to unsafe levels of toxic chemicals.
Eighty percent of these doctors agreed that they could have an impact on lowering exposure to dangerous substances, but only about 7 percent said they had any training on the topic, according to the study published in the journal PLOS One.
“It’s not surprising that they’re avoiding these discussions,” said Dr. Alan Woolf, director of the pediatric environmental health center at Boston Children’s Hospital, who was not involved with the study. “Very few doctors feel comfortable in their knowledge of this issue to discuss it.”
A 2011 study found that pregnant women are exposed to at least 43 chemicals known to affect fetal development including pesticides, polychlorinated biphenyl (PCBs), and phthalates that interfere with hormones.
For this reason, ACOG recommended last year that its physicians “identify specific types of exposure that may be harmful to a developing fetus” during the first prenatal visit. Doctors should be asking about workplace exposures — such as chemicals used in a lab or factory — and whether a patient lives in an older home, which could contain harmful lead paint, or has undertaken do-it-yourself home renovation that involves toxic agents.
Half of the obstetricians-gynecologists surveyed in the new study said they rarely take this kind of environmental health history.
“Doctors told us they have so many more pressing issues to talk about,” said study leader Naomi Stotland, an associate professor of obstetrics-gynecology at the University of California, San Francisco. “Their patients may be cigarette smokers, drink alcohol, or eat fast food every day, which they need to deal with first.”
But those who serve highly educated populations often find themselves flummoxed by questions from pregnant patients about which cosmetics, cleaners, and sunscreens to use.
Part of the reason doctors avoid addressing environmental exposure concerns, the study found, is that they don’t want to make their patients even more stressed out about protecting their baby’s health than necessary. Many pregnant women have become so diligent about avoiding mercury and other pollutants in fish, for example, that the US Food and Drug Administration recently announced that pregnant women need to eat more fish to improve their baby’s health. (The FDA recommended avoiding only those fish high in mercury like shark, swordfish, and tile fish.)
Woolf also pointed out that providing advice to pregnant women on reducing certain environmental exposures can be difficult for doctors partly because studies have yielded ambiguous results about what risks they pose to fetuses. “The science isn’t precise in terms of casual relationships,” he said. “That’s because there’s so much complexity in terms of the variety of chemicals women are exposed to as well as separating them from other lifestyle factors” like how many fruits and vegetables they eat and how much weight they gain.
Unlike cigarette smoke, illicit drug use, or excessive alcohol consumption, exposures pregnant women typically get to environmental chemicals don’t pose life-threatening risks to babies. Instead, they may cause subtler health effects. “They could lead to lower or higher birth weights,” Stotland said, “or epigenetic changes — in terms of how genes are expressed — that could make babies more susceptible to adult diseases later on.”
While pregnant women won’t be able to avoid exposures to all chemicals that are potentially toxic to their babies, they can take certain measures to reduce their risk like eating organic fruits and vegetables without pesticides. Stotland and her colleagues developed an online brochure www
.prhe.ucsf.edu to help guide pregnant women and parents on products safe to use in their homes.
“Some things are no brainers and easy to do,” Stotland said, “like avoiding spray air fresheners and not using antibacterial soaps, which are unnecessary and have triclosan.” The FDA announced plans last December to remove triclosan — thought to increase antibiotic resistance and disrupt hormonal systems — from its list of safe ingredients.