For example, lifetime and uterine exposure to bisphenol A (BPA), a compound frequently used in plastics and food packaging, has the potential to affect female organs and fetal brain development, said Zlatnik, who is from the University of California, San Francisco (UCSF).
Occupational exposure to BPA has also been shown to cause sexual dysfunction in men, she added, and the endocrine-disrupting chemical could play a role in the obesity epidemic, as reported by Medscape Medical News.
Zlatnik called on physicians to advocate for better regulation to protect patients and their families at the American College of Obstetricians and Gynecologists 2019 Annual Meeting in Nashville, Tennessee.
BPA is just one of the problematic compounds in our products and environment, she told Medscape Medical News. Others include flame retardants, phthalates, and bisphenol S, the BPA replacement commonly found in products labeled BPA-free.
Zlatnik said she was surprised to discover how high her own levels of bisphenol S were when she had her urine analyzed.
“It’s not something you can buy your way out of,” she said. “Personal actions are not enough.”
Individuals can make small changes to decrease their exposure, such as not microwaving food in plastic containers and eating freshly prepared food and a lot of fruits and vegetables, said Zlatnik. But not all patients can make those changes, and they are not the biggest problem, she continued.
“The biggest need is regulatory change” to deal with the ubiquity of the chemicals, Zlatnik said. Still, “OBs should be able to answer their patients’ questions and know where to refer people if they have questions.”
There are resources that can help.
It’s not something you can buy your way out of. Personal actions are not enough.
The website of the UCSF Program on Reproductive Health and the Environment, which promotes research on prenatal exposure to environmental chemicals and develops policies to reflect the findings, provides patient brochures and resources for clinicians.
The Pediatric Environmental Health Specialty Units network, housed at university medical centers throughout Canada and the United States, provides information and guidance on environmental health effects in children. The units are partnered with Agency for Toxic Substances & Disease Registry at the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA), and each has a reproductive expert available to answer questions.
It is the responsibility of obstetricians to translate this information to help guide patients, said Jeanne Conry, MD, PhD, past president of ACOG and president-elect of the International Federation of Gynecology and Obstetrics.
Although healthcare providers do not need to be experts in environmental and occupational risks associated with chemicals, “we do need to be able to educate patients,” she said.
Regulation Is Vital
Even with these resources, however, much more information on these chemicals and their potential effects is needed, Zlatnik said.
Exposures to environmental chemicals can be chronic or acute, overlapping and interacting, and dose, region, and circumstances of exposure can vary, which can complicate research. For example, residents of California have a higher exposure to flame-retardant chemicals because of legislation that mandated their use for years.
And because randomized controlled trials cannot be conducted, scientists have to rely on epidemiologic research; animal studies can only reveal so much.
But incomplete information is not an excuse to maintain the status quo. When research from well-done animal studies is combined with research from well-done epidemiologic studies, it becomes evident that there is “reason for concern,” Zlatnik said.
The magnitude of the problem is what makes government regulation so vital. “People have a right to believe that something they buy at Walgreens is as safe to use as they say,” she explained. “Education certainly can do something, but really we need help from the government.”
We walk a very fine line, trying to create awareness and not be alarmists.
It is a challenge to “get the attention of healthcare providers, who are faced with competing priorities around maternal mortality, cancer, contraception access, STIs,” and the endless list of other concerns, Conry acknowledged.
“But we need to make sure we can address well-woman healthcare and optimize the health of women across their lifespans. One important aspect of that is exposure to toxic chemicals,” she told Medscape Medical News.
“We all are aware that pregnancy is a time when healthcare providers are cautioning about healthy diets, weight gain, and choices against alcohol and tobacco, so adding concerns about pesticides, personal-care products, and food additives can seem overwhelming,” Conry said.
“We walk a very fine line, trying to create awareness and not be alarmists, but I have found women very receptive as they have a developing fetus.” These women want information and guidance from their clinicians, and it is the clinician’s responsibility to fill that need.
“Rather than environmental impacts being a niche discussion,” Conry said, “it can be the backdrop to health.”
Zlatnik has disclosed no relevant financial relationships. Conry reports consulting for the nonprofit Forum Institute and participating in the US Department of Health and Human Services Advisory Council on Infant Mortality.
American College of Obstetricians and Gynecologists (ACOG) 2019 Annual Meeting. Presented May 5, 2019.