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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A Healthy Weight for Pregnancy

It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.

Prenatal Screenings: Spot Health Risks Before Birth

During pregnancy, ob-gyns use routine lab and diagnostic tests to help monitor the health of women and their babies, identify problems, and develop treatment plans. Most women will receive these common screenings as part of their prenatal care:

  • Blood glucose tests screen for the amount of sugar (glucose) in the bloodstream. High levels can signal diabetes. Unchecked diabetes can lead to liver damage, birth defects, stillbirth, and other complications for mother and baby.
  • Blood type and antibody testing determines a woman’s blood group (A, B, AB, or O) and Rh type (positive or negative). Fetal problems may occur when an Rh negative woman carries a fetus that is Rh positive.
  • Screening for birth defects (such as Down Syndrome) may be performed in the first and/or second trimester.
  • Late in pregnancy, women are tested for group B streptococcus (GBS) bacteria, which can cause infections of the blood, lungs, brain, or spinal cord in infants. GBS can be transmitted from an infected mother to the baby during delivery.
  • Hemacrit and hemoglobin tests check the blood for low iron levels (anemia).
  • HBV testing screens for Hepatitis B, a virus that affects the liver and can cause severe complications in newborns if passed from mother to baby.
  • All pregnant women should be screened for HIV infection—a disease that attacks the body’s immune system. Treatment of HIV-positive mothers during pregnancy can drastically reduce the risk that the infants will become infected and help improve the mother’s health.
  • A blood test is used to check for signs of past rubella (German measles) infection. Pregnant women who have not had or not been vaccinated against rubella should avoid any infected individuals and be vaccinated after delivery.
  • Screening for sexually transmitted diseases, such as chlamydia, gonorrhea, and syphilis, may be recommended. They can cause preterm birth, miscarriage, eye infections, birth defects, or other problems.
  • At each prenatal visit, urine analysis checks for elevated blood sugar and protein levels and signs of bladder and kidney infections.

Depending on a woman’s age, health history, or ethnic background, additional screenings may be offered for genetic disorders and birth defects, such as cystic fibrosis or spina bifida. Learn more about prenatal screenings on ACOG’s website.

A Vitamin for Healthy Moms and Babies

Pop Quiz: What vitamin is associated with a 50–70% reduction in birth defects? Answer: Folic Acid

I recently wrote about the importance of eating your vitamins through food, but getting enough folic acid from natural sources can be tough. Folic acid is an essential B vitamin necessary for proper cell growth. It’s vital to the development of a baby’s brain, spinal cord, and central nervous system and integral in preventing birth defects such as spina bifida, anencephaly, and cleft lip and palate. Here’s the catch: In order for folic acid to provide the best protection against birth defects, levels of the vitamin need to be high in a woman’s body before she becomes pregnant and through the first three months of pregnancy.

Because nearly half of the pregnancies in the US are unintended, it’s important that reproductive-age women build up their folic acid stores, whether planning a pregnancy or not. ACOG recommends that all childbearing-age women take 400 micrograms of folic acid each day. Women who have had a child with a neural tube defect or certain other birth defects, are pregnant with twins, have particular medical conditions (such as sickle cell disease), or take some forms of medication (such as antiseizure medication) may need more.

Our bodies can’t process folate—the naturally occurring form of folic acid found in leafy green vegetables, citrus fruits, and beans—as easily as the man-made form. Folic acid-enriched breakfast cereals, breads, flours, pastas, rice, and other grains can help, but even women who eat diets high in these sources may not get enough. To make sure you get the recommended amount, take a daily supplement or multivitamin containing 0.4 milligrams or 400 micrograms of folic acid.