Every Woman, Every Time – In Chicago and Beyond

ACOG’s Annual Clinical Meeting in Chicago is just over a week away. I’d like to tell you about the three fabulous speakers that I selected for my President’s Program. I know that each of them will bring alive the spirit of my presidential theme, “Every Woman, Every Time.”

First up will be Dr. Lesley Regan who leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London. She also chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics. In “Human Rights and Women’s Health in the 21st Century,” Dr. Regan will address every woman’s basic rights to health care, as well as the challenges that different cultures around the globe face in providing this care.

Our second lecturer is Dr. Mark Hanson, director of the Academic Unit of Human Development and Health at the University of Southhampton in the United Kingdom. Dr. Hanson has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood. In his lecture, “The Developmental Origins of Health and Disease (DOHaD) Challenge,” he’ll provide his insight into why investing in the health of our current generation is the best way to invest in the health of future generations.

The final speaker will be the distinguished Dr. Tyrone Hayes, professor of biology at the University of California–Berkeley. In “From Silent Spring to Silent Night: The Impact of the Environment on Reproductive Health,” Dr. Hayes will illustrate why we must study the impact of environmental chemicals on our health. As I have said many times, and as Dr. Hayes will demonstrate, ob-gyns need to lead efforts to shift the burden of proof away from physicians and the public back to the chemical industry. Companies must prove that chemicals are safe before they are released into the environment and the marketplace.

This year’s annual meeting promises to have something for everyone—great lectures, wonderful camaraderie with colleagues, and an opportunity for all of us to celebrate our wonderful careers in obstetrics-gynecology. See you in Chicago.

ADMs, CME, and You: Just What the Doctor Ordered

I have almost completed the “sweep” of our fall Annual District Meetings. Once again, I’m impressed with the dedication of my ob–gyn colleagues across the United States. These meetings are proving to be educational, collegial, and administrative. I say ”administrative” because we discuss the “goings on” of each region, including the political factors impacting each of our states, the public health dilemmas we face, and the effect of changing practice patterns. I look forward to these information exchanges and to sharing insights with my colleagues about the forces influencing our practices and our patients.

For me, the educational component of the ADMs has been most exciting. In a time when physicians are increasingly getting their CME online, the ADM courses provide more than just the course information. They provide perspective and insight from the experts in the field in real time. At the District I, III, and IV ADM in Puerto Rico, Jeffrey F. Peipert, MD, PhD, argued for a paradigm shift in our approach to contraception in his presentation about the St. Louis CHOICE Project. With wider use of LARC (long-acting reversible contraception), we can significantly reduce our nation’s high rate of unplanned pregnancies and abortions and start to see healthier pregnancies. Dr. Peipert provided abundant pearls about how easy LARC is to provide to our patients and how it can improve reproductive health outcomes. We can all use this valuable information in our practices.

At the same ADM, Louis J. Guillette, PhD, gave a rousing talk about the impact of the environment on reproductive health. As it turns out, we both did research at the University of Colorado at almost the same time and even shared members of our thesis teams. Who would guess that our paths would cross 35 years later around shared interests? Dr. Guillette’s message: Increase awareness among our patients—without alarming them—about the vast amount of research implicating environmental factors on our health. And, Deborah A. Driscoll, MD, helped to simplify for us the complex world of genetic testing and familial cancers. Thanks to her, genomic microarray-based technologies are now part of our vocabulary.

Increasingly, physicians are earning more of their CME online. The reality is we are all crunched for time and online CME opportunities are valuable options. But online courses don’t allow for that in-person learning that is so often accompanied by practice pearls. Nor do they provide an opportunity for us to have personal, individual conversations with our colleagues which are so important. I hope that you’ll make plans to attend your next ADM…it’s definitely worth your time.

Remember, registration for the 2014 Annual Clinical Meeting in Chicago opens November 5, just a few weeks away!

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Chemicals and Pregnancy Don’t Mix

In our society, exposure to chemicals is unavoidable. As a physician with a PhD in environmental biology, I have a longstanding interest in the many chemicals we come in contact with every day and their impact on our health. These answers do not come quickly. It can take many years and millions of exposures to fully assess the potential impact that chemicals have on humans.

Unlike the pharmaceutical industry—where the burden is on drug makers to prove a new medication is safe—there is no requirement that any chemical be registered or proven safe before release. Of the more than 84,000 chemicals produced, fewer than 200 have been studied, only 12 have been restricted, and FIVE banned in 35 years. With such lack of regulation, we can’t assume these chemicals are safe, especially as a growing field of research suggests that some lead to reproductive health problems and can negatively affect developing fetuses.

This week, ACOG and the American Society for Reproductive Medicine (ASRM) released a new statement warning of the reproductive health effects of exposure to certain environmental chemicals. The goal of this document is not to scare pregnant women or those considering having a baby, but to increase awareness in the health care community and with our patients about chemical exposures and to promote efforts to reduce these exposures where possible. (Find more resources on environmental chemicals and reproductive health here.)

Ob-gyns must be attuned to the risks of environmental exposures and understand how our patients might be affected. For example, minorities are more likely than whites to live in the counties with the highest levels of outdoor air pollution and to be exposed to a variety of indoor pollutants, including lead, allergens, and pesticides. Farm workers are also at higher risk for health problems because they repeatedly come in contact with toxic chemicals in pesticides. Knowing about our patients’ potential exposures will help us anticipate related health outcomes and properly educate them about their risks.

ACOG and ASRM recommend that health care professionals:

• Learn about toxic environmental agents common in their community
• Educate patients on how to avoid toxic environmental agents
• Take environmental exposure histories during preconception and first prenatal visits
• Report identified environmental hazards to appropriate agencies
• Encourage pregnant and breastfeeding women and women in the preconception period to eat carefully washed fresh fruits and vegetables and avoid fish containing high levels of methyl-mercury (shark, swordfish, king mackerel, tilefish)
• Advance policies and practices that support a healthy food system
• Advocate for government policy changes to identify and reduce exposure to toxic environmental agents

By advocating for a cleaner environment now, we can stand up for the health of our patients and of many generations to come.

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Aiming for A BPA-Free Pregnancy

This week, the Breast Cancer Fund released a new and important report drawing attention to prenatal exposure to Bisphenol A (BPA). BPA is a synthetic estrogen and known endocrine disruptor. It is a relative of diethylstilbestrol (DES), a drug that caused genetic mutations and increased reproductive health problems and certain cancers among women whose mothers had taken the drug during pregnancy in the 1940s–1970s. Used widely as a can lining in canned foods and for plastic production, BPA has become ubiquitous in the US food supply. According to the new report, more than 92% of Americans have BPA in their bodies. Unfortunately, most research on BPA is based on animal models, which leaves us to infer risks to humans rather than to study them in a controlled fashion.

Based on animal models, support is building that BPA exposure in utero and shortly after birth is linked to future health problems including breast cancer, prostate cancer, metabolic changes, decreased fertility, early puberty, neurological problems, and immunological changes. To reduce BPA exposure among infants, the substance was banned from use in baby bottles in 2012. However, by the time a child is delivered, some level of exposure has already happened. Pregnant women who consume BPA expose their developing fetus to the compound, often during the first weeks of pregnancy, a crucial time for fetal development.

At this point, potential toxins are released freely into the environment and used broadly without any research assuring their safety before their use. ACOG’s most important role will be in supporting legislation that prevents exposure to chemical sources until those chemicals are studied and deemed safe for us. In the meantime, this new report encourages reproductive health providers to make women aware of the potential risks of BPA. It provides guidance on simple ways to reduce BPA-exposure, such as using glass, ceramic, or stainless steel for food storage, avoiding cooking or reheating in plastic containers, and choosing fresh or frozen foods instead of canned. Anything we can do to increase BPA awareness among physicians and patients will help us to collectively move in the right direction so we can all be BPA-free.

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