Environmental Exposures

1. Environmental Exposures Presented by: Cecilia Escorbore Walden University Environmental Health – PUBH 6165-4 Professor: Dr.Thron July 31, 2014

2. Environmental ExposuresDuring the Prenatal Months

3. Objectives At the end of this presentation: Participants will have gained an understanding of environmental exposure risks associated with the unborn fetus. Participants will learn about different chemicals and toxins in the environment Participants will learn about different personal products that contain several chemicals that can be a health hazard Participants will have the knowledge needed to embrace the importance of educating pregnant women about the risk of environmental exposures during pregnancy. Participants will have an idea of resources to utilize to give to their clients as a reading guide about environmental exposures.

4. Environmental Exposures What are Environmental Exposures As human beings we are exposed to the different chemicals and toxins in the environment. Our health in many cases is affected by the same environment we live in and are exposed to on a daily basis. Many diseases can be initiated, promoted, sustained, or stimulated by environmental factors. In an effort to provide the unborn fetus with a healthy beginning in life pregnant women must be made aware of the risk of certain factors during pregnancy. Source: Moeller D., 2011 Environmental Health (p 5-6)

5. Factors to Consider • Chemical • Biological • Physical • Socioeconomic Source: Moeller D., 2011 Environmental Health (p 5-6)

6. Prenatal Period Prenatal women and the different exposures: Women are concerned with a healthy pregnancy and a positive outcome. Because of this reason they are seeking prenatal care and are interested in all of the information available for a healthy 10 months. This is also a time of heightened concern about the decisions they are making. Hence the perfect opportunity. Source: Acog, 2013

7. Reproductive Health Problems with Exposure Some health problems to consider associated with environmental exposure include: • Miscarriage and Stillbirth • Impaired Fetal Growth and Low Birth Weight • Preterm Birth • Childhood Cancers • Birth Defects • Cognitive/intellectual Impairments • Thyroid Problems Source: Acog, 2013

8. Long Lasting Health Effects The exposure during pregnancy can lead to other long lasting effects for children and adulthood. Fetus that were exposed to environmental chemicals\pesticides can develop certain cancers as children, they can also interfere with the development of the fetus in all stages. As teens females develop early into puberty and even their reproductive functions can be affected. Males that have been exposed have been found to experience altered semen quality, sterility, and even prostate cancer. Source: National Institute of Environmental Health Science, 2014

9. Products & Chemicals Chemicals are use in the following Products • Bisphenol-A – is used in large amounts to produce polycarbonate plastics and epoxy resins. • Polycarbonate is used in some containers of food, drink packaging for example drinking bottles, infant bottles, CD’s, safety equipment, and medical devises. • Epoxy resins are used as a coating for metal products like food cans, bottle tops, and water pipes. Source: Acog, 2013

10. Reported Adverse Outcomes Several reports have revealed a number of adverse prenatal outcomes associated with the exposures of pregnant women to several environmental contaminants. • Tobacco smoke – associated with reduced birth weight and preterm delivery. • Pesticides & Polychlorinated Biphenyls – associated with decreased fetal growth and the length of gestation. • Organic solvents & Chlorophenoxy Herbicides – associated with birth defects. • Dichlorodiphenyltrichloroethane & Bisphenol-A – associated with pregnancy loss. • Polyacrylamide – associated with adverse fetal development. • Fumes – these can be emitted from gasoline, associated with reduced birth weight and preterm delivery. Source: Environmental Health News, 2012

11. Adverse Outcomes Continued In utero exposure can also increase the risk of developmental delays (impaired neurological function) Adult chronic illnesses (heart disease, diabetes, cancer) Next generation effects (reduced reproductive capacity) Source: National Institute of Environmental Health Science, 2014

12. Way of Exposure People come in contact with these chemicals mainly by ingesting them. Also there could be exposures from air, dust, and water consumption. According to the National Institute of Environmental Health the majority of the time we are consuming these chemicals by drinking from containers that were made utilizing these chemicals. The temperature of these containers may be a factor for the leach of the chemical. For example if the container is placed in the microwave the risk of exposure increases. Source: National Institute of Environmental Health Science, 2014

13. Prevention Strategies The National Institute of Environmental Health Sciences recommends that: People should not microwave (heat) polycarbonate plastic. People should reduce the use of canned foods. People should utilize more glass, porcelain, or stainless steel containers ( especially for hot foods or for liquids). Source: US Department of Health and Human Services, 2005

14. Cosmetic Products and Other Personal Use Products Polyacrylamide is used in water treatment, pulp and paper production. It is also used in the synthesis of dyes, adhesives, contact lenses, cosmetics, and skin creams. The population is exposed to this chemical by dermal contact and again by food\liquids Source: CDC, 2013

15. Exposure to Gasoline & Cigarette Smoke The Centers for Disease Control and Prevention report that benzene is a chemical found in crude oil, gasoline, and cigarette smoke. They also report that some industries use benzene to make other chemicals that are used for plastics, resins, and synthetic fibers. Source: Environmental Health News, 2012

16. Educating Pregnant Women What are some issues that doctors face when they provide prenatal care to a women Preventing: • Pre-term labor • Obesity • Hypertension Source: Environmental Health News, 2012

17. Opportunities This prenatal period grants obstetricians the opportunity to educate women on the possible adverse health outcomes of being exposed to certain chemicals during the months of pregnancy. In addition obstetricians can also educate women on some measures to take to reduce their risks of exposures. Source: Environmental Health News, 2012

18. What Some Obstetricians Report According to a report by Environmental Health News – 4 out of 10 doctors report that they discuss chemical contaminations with pregnant women during their visits. Women see their doctors every month during pregnancy and these visits increase as the trimesters progress. Source: Environmental Health News ,2012

19. Why Should Obstetricians take the Time to Educate Some factors to take into consideration include: • Positive birth outcomes • Possibility of reducing infant mortality • Reduction of long-term health effects • Cost effective Source: CDC, 2014

20. Important Statistics According to the Centers for Disease Control and Prevention in 2004, in the US, birth defects led to more than 139,000 hospital stays. These stays resulted in 2.6 billion dollars in hospital cost. One in every 33 babies is born with a birth defect every year. Every 4.5 minutes a baby is born with a birth defect. Source: CDC, 2014

21. Important Statistics Continued We know that it is almost impossible to prevent all of the birth defects we come across in the medical field each year. We also know that there is more that we could do by lending a helping hand to women.

22. We are not Alone in this Fight It is important to mention some of the organizations and institutions that play a vital role in educating women during her prenatal months. Some partners include: Obstetricians Perinatologist Midwifes Nurse Practitioners Programs like Healthy Start, and Home visiting programs Lactation Consultants Childbirth Educators Nutritionist WIC Office

23. Higher Learning Institutions If we advocate and possibly present this information to colleges we can start a trend for colleges and universities to implement an addition of environmental exposure topics to their students courses. When the student graduates he or she already has the foundation needed to talk to their patients about environmental exposures during the perinatal period.

24. Conclusion As we have seen from the presentation we are all exposed to the adverse health effects of environmental pollutants \chemical, and toxins. The population we discussed today is at a vulnerable time of their lives. We can all work together to help reduce some of the adverse health effects discussed today.

25. Questions If you think of any questions at a later time please feel free to contact me at (954)805-4041 or cescorbore@yahoo.com Thank You!

26. References Centers for Disease Control and Prevention, 2014 – Birth Defects – Retrieved from http://www.cdc.gov/ncbddd/birthdefects/index.html Centers for Disease Control and Prevention, 2013 - Facts About Benzene – Retrieved from http://www.bt.cdc.gov/agent/benzene/basics/facts.asp Kay .J, 2012 - Most doctors don't warn pregnant patients about environmental risks. Environmental Health news – Retrieved from http://www.environmentalhealthnews.org/ehs/news/2012/ob-gyns-and-environmental-health Moeller .D, 2011 – Environmental Health National Institute of Environmental Health Science, 2014 - Bisphenol A (BPA) - Retrieved from http://www.niehs.nih.gov/health/topics/agents/sya-bpa/ National Toxicology Program – US Department of Health and Human Services, 2005 -Center for the evaluation of risks to human reproduction – Retrieved from http://ntp.niehs.nih.gov/ntp/ohat/acrylamide/acrylamide_monograph.pdf#search=cosmetics that include chemicals that have adverse health effects Stillerman .K, Mattison . M,2012 - Environmental Exposures and Adverse Pregnancy Outcomes: A Review of the Science. Sage Journals – Retrieved from http://rsx.sagepub.com/content/15/7/631.short The American College of Obstetricians and Gynecologists - Committee on Health Care for Underserved Women, 2013 American Society for Reproductive Medicine Practice Committee. The University of California, San Francisco Program on Reproductive Health and the Environment – Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Exposure-to-Toxic-Environmental-Agents The American College of Obstetricians and Gynecologists, 2013 Environmental Chemicals Harm Reproductive Health. Ob-Gyns Advocate for Policy Changes to Protect Health – Retrieved from http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Environmental-Chemicals-Harm-Reproductive-Health

27. Sources If you are interested in additional information or resources explore the following cites: The American College of Obstetricians and Gynecologist www.acog.org/about-acog/news-room/news-releases/2013/environmental-chemicals-harm-reproductive-health Poster www.acog.org/~/media/departments/health%20care%20for%20underserved%20women/images/environmentalchemicalsinfographic.jpg Podcast – If you are pregnant don’t smoke www.2c.cdc.gov/podcasts/player.asp?f=7868 Pocket Guide to Chemical Hazards www.cdc.gov/niosh/npg Center for Environmental Research & Children’s Health www.cerch.org/research~programs/chamacos-community-outreach/increasing-awareness-of-childrens-environmental-health/prenatal-kiosk/ Different Links for environmental information www.Coeh.berkeley.edu/ucpehsu/linksg.html#prenatal