ACOG updates opinion to reduce prenatal exposure to toxic chemicals

I still clearly remember the day 15 years ago when a reporter called me to ask if women needed to worry about lead in lipstick. Lead in lipstick? Why would there be lead in lipstick? I was Chair of the American College of Obstetricians and Gynecologists (ACOG), California District, at a time when we as a professional organization were just starting to recognize the impact of the environment on the health of pregnant women and babies. Women had questions, whether about chemicals in personal products, which fish was safe to eat during pregnancy, or if they had to worry about BPA in water bottles. It was important for their OB-GYNs to understand how those issues could affect pregnancy, reproduction, the health of their babies – and to provide answers.

While I was President of ACOG in 2013, we issued the first committee opinion on chemicals and reproductive health. It was a landmark moment, as a major medical organization stated: “Robust scientific evidence has emerged over the past 15 years, demonstrating that preconception and prenatal exposure to toxic environmental agents can have a profound and lasting effect on reproductive health across the life course.”[1]

Now ACOG has updated that committee opinion to recognize more detailed evidence on how chemicals undermine women’s health, including how climate change affects the health of women and children. As the opinion states:

Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birthweight, neurodevelopmental delay such as autism and attention deficit hyperactivity disorder (ADHD), and adult and childhood cancers…Obstetric care providers do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists once a hazardous exposure is identified.

The new opinion also expands its clinical recommendations for OB-GYNs to counsel patients. These recommendations include to:

• Ask questions about environmental exposures at work, home, and during recreational activities as part of the patient history.
• Explore workplace and occupational exposures, which can include pesticides, solvents, and radiation.
• Counsel about environmental exposures.
• Discuss food-related exposures, such as which large fish contain high levels of methylmercury that can affect fetal brain development, how to prepare and store food safely (such as to stop using non-stick pans, store food in glass rather than plastic, and never heat foods in plastic containers), and avoid fast food which is often packaged in materials that contain phthalates, a well-known endocrine disrupter.
• Advise patients to check for chemicals in personal care products, especially products marketed to people of color that have been found to contain parabens and phthalates, and to be aware these products often fail to include certain chemicals in their ingredients list, so to be wary of added “fragrances” and select products labeled “fragrance-free.”
• Be aware of regional exposures, such as contaminated water, air pollution advisories, or proximity to power or fracking sites that can affect patient health.

Finally, the new opinion offers four main recommendations for OB-GYNs:

• It is important for obstetric health care clinicians to become knowledgeable about toxic environmental agents in terms of environmental health risk assessment, exposure reduction, and clinical counseling.
• Obstetrician-gynecologists and other obstetric care clinicians should consider including questions about environmental exposures in the patient history during pre-pregnancy visits and during prenatal care.
• Typical elements of an environmental health history include assessment for exposures from the workplace, home, or recreational activities.
• It may be beneficial to integrate environmental health into obstetrics and gynecology training and practice. Implementation is encouraged to include advocating for policies that will reduce harmful exposures and protect the health of pregnant individuals and their children.

The 2021 ACOG Committee Opinion was developed by the Committee on Obstetric Practice in collaboration with Nathaniel DeNicola, MD, MSc and Ann E. Borders, MD, MSc, MPH, with assistance from Veena Singla, PhD and Tracey Woodruff, PhD, MPH. I applaud their efforts and look forward to seeing how this great work will help to improve the health of women and children.

[1] American College of Obstetricians and Gynecologists. (2013). ACOG committee opinion: Exposure to Toxic Environmental Agents. Washington, DC: American College of Obstetricians and Gynecologists

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About the author

Jeanne Conry, MD, PhD is the former president of American College of Obstetricians and Gynecologists and the incoming president of the International Federation of Gynecologists and Obstetricians.