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. 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 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.orgwww.pesticideinfo.orgwww.beyondpesticides.org

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

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

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

51. PBDE in Breast Milk Darnerud et al. 2003

52. Reducing Exposure Vacuum and dust at least once a week – use HEPA filter if possible Replace furniture with crumbling cushions or cover with fabric If possible, do not reupholster foam cushions Be careful if replacing carpet When replacing products find out what kind of fire retardant used – avoid brominated