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Prenatal Environmental Health Assessment Tool. Katie Huffling, RN, MS, CNM Dimensions OB/GYN Associates. Nurse-Midwifery & Environmental Health. Core competencies Environmental influences on pregnancy planning Environmental influences on pregnancy outcomes.

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Prenatal environmental health assessment tool

Prenatal Environmental Health Assessment Tool

Katie Huffling, RN, MS, CNM

Dimensions OB/GYN Associates

Nurse midwifery environmental health
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?

Carbon monoxide
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

Carbon monoxide1
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

Exposure prevention
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


Drinking water
Drinking Water

The first question to ask:

  • Are you on a private well or public drinking water supply?

Public drinking water
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.

Bisphenol a1
Bisphenol A

  • 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

Myriad of consumer uses
Myriad of Consumer Uses

  • Baby bottles

  • Metal can liners

  • Water bottles

  • Food containers

  • Dental products

  • Compact discs


  • Ubiquitous in humans

  • Federal safety assessment based on two studies

  • Health effects occur at very low dose exposure

Fda bisphenol a
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

Does the dose make the poison
Does the dose make the poison?

Adapted from Wetherill et al.

Effects of bpa exposure
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

Decreasing bpa exposure
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!

Smoking pregnancy
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)

Smoking pregnancy1
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.

Smoking pregnancy2
Smoking & Pregnancy

Personal care products
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

Personal care products1
Personal Care Products

  • Phthalates – Used as plasticizer in PVC, fragrances, solvents

  • Found in hairspray, shampoo, nail polish

  • Impacts fetal development – boys especially susceptible

Personal care products2
Personal Care Products

  • Read Labels!

  • Don’t buy products listing “Fragrance” or “Phthalate” in the ingredients

  • If you’re not sure go to:

Skin deep
Skin Deep

Personal care products3
Personal Care Products

Some cosmetics manufacturers are beginning to listen…


  • Are chemicals designed to kill or repel pests

  • They include:

    • Herbicides

    • Insecticides

    • Fungicides


  • Lawns

  • Home indoor use

  • Workplace - Hospitals

  • Residues on foods

  • Farm application

Health effects
Health Effects

  • Neurological Effects

    • Many pesticides are neurotoxins

    • Cognitive effects

    • Memory deficits

    • Seizures

    • Personality changes

    • Possible link to Parkinson’s disease

Health effects1
Health Effects

  • Reproductive

    • Decreased sperm production

    • Increased risk of stillbirth and miscarriages

    • Increased risk of congenital anomalies

    • Hormone production

What can be done to minimize exposure
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

Worst non organic foods


Bell Peppers








Red Raspberries



Winter Squash

Worst Non-Organic Foods

Best non organic foods












Peas (Sweet)

Best Non-Organic Foods

Sources of mercury in the home
Sources of Mercury in the Home

  • Thermometers

  • Some traditional remedies

  • Compact fluorescent lights (CFLs)

Steps to reduce risks
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

Fish consumption guidelines
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.

Home renovations
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

Reducing exposure
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


  • 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)

Pbde in breastmilk
PBDE in Breastmilk

Schecter et al 2003, Mazdai et al 2003, Kalantzi et al 2004, compiled by NRDC

Pbde in breast milk
PBDE in Breast Milk

Darnerud et al. 2003

Reducing exposure1
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