Pregnancy and Environmental Health

by Judith Balk, MD, MPH, Magee-Womens Hospital of UPMC and Assistant Professor, University of Pittsburgh and
Michele Ondeck, RN, Med, LCCE childbirth educator, Magee-Womens Hospital of UPMC

All parents want to have healthy children. In our industrialized world, women and men of childbearing age need to not only address issues of how to eat healthy and maintain fitness but also are confronted with environmental and workplace exposures that may impact their health and the health of their unborn child.

A woman's health before her pregnancy is the most significant determinant of a healthy pregnancy and baby. A preconception visit (a visit to a primary care doctor by a woman who could conceive before her next visit) may include counseling related to her workplace exposures and the need to achieve normal weight and establish an active lifestyle, as well as a recommendation that she take prenatal vitamins (this is good advice for all women of childbearing age). Questions about fathers' workplace exposures and good and bad habits are also relevant. It is important for a woman who is obese to lose weight before conceiving in order to reduce pregnancy complications and to reduce her body burden of environmental toxins that are stored in fat tissues.

In this article, Magee-Womens Hospital of UPMC physician Dr. Judy Balk and childbirth educator Michele Ondeck answer some frequently asked questions from pregnant women around environmental health issues.

I love to eat fish, but the guidelines of what fish are safe to eat during pregnancy confuse me.

Eating a diet high in omega 3 fatty acids, found in salmon for instance, is good for your cardiovascular health and is important for the fetus' brain growth. Women of childbearing age should avoid eating fish high in methylmercury (organic mercury). Methylmercury can permanently damage the brain of the developing fetus and can increase the chance that birth defects will occur. Organic mercury was used as a fungicide in agriculture in the 1960's, and also released into water as a byproduct of the metals industry. The larger, older and fattier the fish, the more methylmercury and other contaminants it can contain. Methylmercury can especially accumulate in high levels in large or predatory fish, such as tuna, shark, king mackerel, swordfish, and tilefish. Children and pregnant women should not eat these fish. If a pregnant woman eats mercury-contaminated fish, the mercury travels from her bloodstream and across the placenta to the fetus.

Experts recommend that when a woman is preparing for pregnancy she should avoid fish high in mercury for 3 to 6 months. When pregnant, a woman should eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury (such as salmon, canned light tuna, shrimp, pollock, and catfish). Consumers also need to be aware of the source of their fish, as only a small percentage of fish are inspected. Check advisories about fish caught locally. The safest fish are wild caught or farmed in the United States by environmentally responsible operations. Next time you are shopping, consider buying a can of salmon that is not only low in mercury but also inexpensive and a good source of protein and omega 3 fatty acids.

A friend told me that I should not use make-up when am pregnant. But, I look so much better in make-up. What can I use and still be safe?

A teratogen is something that causes harm to a fetus, and there is no known way to predict if an individual fetus will be sensitive or not to a substance. It depends on the substance itself, how much exposure the pregnant woman/fetus had to it, and for how long and when during the pregnancy a woman is exposed. It is thought that the most vulnerable period for the fetus is within the first 57 days of pregnancy.

There are many concerns about personal care products and cosmetics. An average woman uses about 12 products a day. That could mean she is applying well over 100 different chemicals to her skin, hair and nails in a single day. The Federal Drug Administration (FDA) does not regulate or require personal care product manufacturers to test products, so little or no data exists on most of the chemicals of concern. In the Unites States, we are guided by the principle of "prove harm" before regulating chemicals. In contrast, the European Union is guided by the "precautionary principle" and has banned most of these chemicals of concern. The best approach is prevention.

Thankfully, now there is an on-line guide with safety ratings of more than 23,000 products at www.comesticsdatabase.com. Skin, hair and nail care products are rated for safety, depending on the chemicals they contain as well as other criteria. All women, pregnant or otherwise, should learn to always read product labels with the idea that fewer ingredients usually means a lower risk. It is also a good idea to avoid products with words like "fragrance," "parabens," or " phthalates" on the label and to avoid nail polish with formaldehyde in it. Organic cosmetics and personal care products are a safer alternative, but there are still, as yet, no national standards established for using the words "natural" or "organic" in personal care products.

Magee-Womens Hospital is hosting a book reading and discussion related to safe cosmetics about the new book by Stacy Malkan, entitled Not Just a Pretty Face: The Ugly Side of the Beauty Industry (New Society, 2007) on Wednesday, February 13, 2008 from 6:00--8:00 pm. Dr. Maryann Donovan of the Center for Environmental Oncology will also discuss these issues along with Mia Davis from the Campaign For Safe Cosmetics. To register, call the education department at 412-802-8299 or register at www.magee.upmc.com.

I was so happy that I stopped smoking before I was pregnant. I asked my family to stop smoking, too, but they say it doesn't matter. Is that true?

First of all, congratulations that you have stopped smoking! You have decreased the chances that your baby will be born prematurely or with a low birth weight.

Your family is mistaken. Second-hand smoke does matter! Second-hand smoke or environmental tobacco smoke is a combination of smoke exhaled from the smoker and smoke from the burning cigarette. Cigarette smoke contains some 4000 chemicals, including carbon monoxide, ammonia, lead, and nicotine, which are known reproductive toxins that cross the placenta. If you and your unborn child are regularly exposed to second-hand smoke, you increase your and your child's chances of eventually developing lung cancer, heart disease, emphysema, allergies and asthma. Also, babies exposed to tobacco smoke have an increased risk of Sudden Infant Death Syndrome (SIDS) and are hospitalized more frequently with other health problems.

So, keep your home and car smoke-free. At Magee-Womens Hospital, women are tested at the prenatal clinics for carbon monoxide. Carbon monoxide levels are higher in women who live with smokers compared to those who live in a smoke-free environment. Share this information and encourage smokers in your family to consider a smoking cessation program. Knowing that this will protect your health and the health of your unborn child may be just the motivation they need to quit.

I am working hard to eat a healthy diet now that I am pregnant. At work, I was heating my lunch in a plastic container, and someone said I was poisoning my baby. What should I do?

Do not microwave in plastic, as this can release toxic contaminants from the plastic into foods. It is also important to pay attention to how you prepare and store your food. When food is stored in plastic containers, some of the chemicals in the plastic may leach into the food. Some of those chemicals are hormone-mimicking chemicals called endocrine disruptors which can have negative impacts on a fetus' reproductive organs. For safety, it is recommended to store food in glass or ceramic containers, and only in plastic containers after foods have cooled. Never microwave in plastic containers or wrap, even those marked "microwave safe." Again, a glass or ceramic bowl is recommended for use in the microwave. Discard any plastic containers that have started to break down.

If you look on the bottom of plastic cups, bottles and containers, there is a triangle with a number in it. Plastics marked 1, 2, 4, and 5 are "safer" plastics. Avoid plastics marked 3, 6, and 7 as they can leach harmful chemicals into your food or drink. Check children's plastic sippy cups and their plastic baby bottles for unsafe numbers on them. This is also applicable to baby's plastic toys. For instance, the bathtub rubber ducky toy can be made from an unsafe plastic called PVC.

Magee-Womens Hospital's intensive care unit for babies has eliminated the use of one of these plastics in medical equipment called DEHP. They have replaced intravenous tubes bringing baby's blood, medicine or nutrition with a safer plastic. In addition, Magee's nurses have been trained to be knowledgeable about some of these issues, and all new parents are given information about environmental health before they are discharged from the hospital.