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Environmental toxins affect reproductive health, but are we screening for them?

Exposure to environmental toxins can negatively impact reproductive health. Researchers recently studied how healthcare providers screen for environmental exposure to toxins during the prenatal period.

Exposure to various environmental elements during the prenatal period can affect both the mother and the baby. It is estimated that virtually all pregnant women in the United States are exposed to at least 43 different environmental chemicals, and endocrine-disrupting chemicals are of particular concern.

Endocrine disruptors affect birth weight, pregnancy loss, increased risk of childhood cancer

Endocrine-disrupting chemicals (EDCs) are chemicals that may interfere with the body’s endocrine system. The body’s endocrine system includes the glands that produce hormones that regulate metabolism, development, reproduction, sleep, mood, etc. EDCs can be found in pesticides, food additives and contaminants, and personal care products, among other man-made materials.

Exposure to EDCs can occur through inhalation, ingestion, and contact with food, soil, and other consumer products. Researchers have investigated the impact of environmental exposures on reproductive health and have found that particular EDCs are associated with low birth weight, pregnancy loss, an increased risk of childhood cancer and neurodevelopmental abnormalities.

Routine screening by obstetricians and gynecologists (OBGYNs) is recommended, and the American College of Obstetrics and Gynecologists encourages their members to advocate for policies that support the reduction of exposure to environmental toxins.

How often do OBGYNs screen for exposure to environmental toxins?

In a study recently published in PLOS One, researchers in the United States assessed the frequency of screening for exposure to environmental toxins at the first patient visit. Using a cross-sectional survey of 312 OBGYNs currently practicing medicine, researchers recruited OBGYNs from a social media group and from the Department of Obstetrics and Gynecology at the University of Colorado, USA.

To assess reproductive health related to environmental toxin exposure, the OBGYNs completed a survey that assessed their level of comfort in obtaining adequate environmental history in patients during their first prenatal visit.

Less than 30% of providers screened for environmental exposures

The results of the study showed that less than 30% of providers screened for environmental and occupational exposures. 85% of the providers were not comfortable in obtaining an environmental history, and 58% indicated that they did not regularly screen for environmental exposures.

Among the participants, 73% of providers acknowledged that they did not know they could refer a patient for further information about environmental exposures that could negatively impact their reproductive health. The researchers reported that providers who were in practice for more than four years and those who were not affiliated with a residency program were more likely to screen for environmental exposures.

This study may have included an element of bias because of the low number of participants, which may skew the results to falsely reflect a greater concern for screening of environmental exposure by OBGYNs than compared to the general population. One limitation of the study was the female-dominant participants. Another limitation was the use of a generated survey instead of a validated instrument to assess reproductive health.

Physicians report low comfort levels discussing environmental toxins impact on reproductive health

In conclusion, there is a low rate of obtaining an environmental history and a low frequency of comfort with counselling patients about environmental exposures that may impact reproductive health. Improving physician comfort through training and continuing medical education can potentially increase screening, and as such, improve reproductive health by minimizing exposure to environmental toxins.

Written by Kimberly Spencer B.Sc. (Hons)

Reference: Grindler, N., Allshouse, A., Jungheim, E., Powell, T., Jansson, T., & Polotsky, A. (2018). OBGYN screening for environmental exposures: A call for action. PLOS ONE13(5), e0195375. doi: 10.1371/journal.pone.0195375.



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