Prenatal Environmental Health Assessment Tool

1. Prenatal Environmental Health Assessment Tool Katie Huffling, RN, MS, CNM Dimensions OB/GYN Associates

2. 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?

3. Assessment Tool

4. 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

5. 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

6. Carbon Monoxide Sources

7. 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

8. Assessment Tool

9. Drinking Water The first question to ask: • Are you on a private well or public drinking water supply?

10. 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.

11. Bisphenol A

12. 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

13. Myriad of Consumer Uses • Baby bottles • Metal can liners • Water bottles • Food containers • Dental products • Compact discs

14. Concerns • Ubiquitous in humans • Federal safety assessment based on two studies • Health effects occur at very low dose exposure

15. 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

16. Does the dose make the poison? Adapted from Wetherill et al.

17. Does the dose make the poison?

18. 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

20. Infant Formula

21. 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!

23. Assessment Tool

24. 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)

25. 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.

26. Smoking & Pregnancy http://www.epa.gov/smokefree/index.html

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

28. 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

29. Personal Care Products • Phthalates – Used as plasticizer in PVC, fragrances, solvents • Found in hairspray, shampoo, nail polish • Impacts fetal development – boys especially susceptible

30. 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

31. Skin Deep www.cosmeticsdatabase.com

32. Personal Care Products Some cosmetics manufacturers are beginning to listen…

33. Household Products

34. Pesticides • Are chemicals designed to kill or repel pests • They include: • Herbicides • Insecticides • Fungicides

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

36. Health Effects • Neurological Effects • Many pesticides are neurotoxins • Cognitive effects • Memory deficits • Seizures • Personality changes • Possible link to Parkinson’s disease

37. Health Effects • Reproductive • Decreased sperm production • Increased risk of stillbirth and miscarriages • Increased risk of congenital anomalies • Hormone production

38. 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

39. Apples Bell Peppers Celery Cherries Grapes Nectarines Peaches Pears Potatoes Red Raspberries Spinach Strawberries Winter Squash Worst Non-Organic Foods

40. Asparagus Avocadoes Bananas Broccoli Cauliflower Corn Kiwis Mangos Onions Papayas Pineapples Peas (Sweet) Best Non-Organic Foods

41. Assessment Tool

42. Sources of Mercury in the Home • Thermometers • Some traditional remedies • Compact fluorescent lights (CFLs)

43. 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

44. Mercury in the Environment

45. 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.

46. Fish Consumption Guidelines

47. 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

48. 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

49. 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)

50. PBDE in Breastmilk Schecter et al 2003, Mazdai et al 2003, Kalantzi et al 2004, compiled by NRDC