(Published January 2010)
In the morning, a patient asks you during an annual well-woman visit how long before conceiving she should stop eating tuna fish. That afternoon, a woman in her third month of pregnancy asks you whether her headaches could be caused by exposure to chemicals in her workplace. On the drive home, you hear a report on the radio saying that the majority of infants are born with detectable blood levels of a chemical that leaches from plastics. When you arrive home, your teenage daughter asks whether she needs to rinse the bell peppers for your family’s salad. By the end of the day, are you wondering if you need a better understanding of environmental health issues?
The purpose of this monograph is to provide front-line clinicians with practical guidance on environmental reproductive health issues, based on the best available evidence. Because of ethical concerns about human studies with toxicants, the best available evidence in many cases is derived from animal data. In addition, because of the multifactorial nature of many adverse health effects, it is often impossible to establish direct cause-and-effect relationships with certainty. In many instances, this means that one cannot definitively determine that a particular substance will result in a particular reproductive health effect. However, often there is sufficient evidence from animal and population-based studies to warrant the recommendation that patients reduce their exposure to specific toxicants.
This document provides clinicians at the front lines of care with the information they need in everyday practice to counsel patients on environmental issues that affect reproductive health. This monograph defines key terms, discusses environmental exposures and how they may affect reproductive health, and highlights a few key examples of chemical exposures. Through the use of case studies and vignettes, the document illustrates how clinicians can help patients assess potential environmental exposures and take steps to reduce the impact on their reproductive health. These case studies and vignettes focus on environmental exposures that primary health care providers are likely to encounter in their everyday practice and through questions generated by an increase in media attention. The monograph concludes with a collection of tools and resources that clinicians can use to address environmental health concerns in their daily practices.
Environmental reproductive health is an emerging field that includes terminology and basic concepts that may be unfamiliar to many clinicians. An important concept to understand is the distinction among the terms hazard, risk, and exposure. Although the terms hazard, risk, and exposure are sometimes mistakenly used interchangeably, in environmental reproductive health, the words have distinct meanings.
- Hazard is the potential for radiation, a chemical, or another pollutant to cause human illness or injury.1,2
- Exposure is the process by which a substance becomes available for absorption by the target population, organism, organ, tissue, or cell, by any route.3
- Risk is a measure of the probability that damage to life, health, property, and/or the environment can occur as a result of exposure to a given hazard.1
The next chapter covers guidance on environmental reproductive health issues for providers.
- Environmental Protection Agency. Terms of environment. 2009. Available at: http://www.epa.gov/OCEPAterms/. Accessed November 29, 2009.
- Schwartz JM, Woodruff TJ. Shaping Our Legacy: Reproductive Health and the Environment. San Francisco: University of California-San Francisco, Program on Reproductive Health and the Environment. 2008.
- International Union of Pure and Applied Chemistry. Glossary of terms used in toxicology. 2007. Available at: http://sis.nlm.nih.gov/enviro/iupacglossary/frontmatter.html. Accessed November 29, 2009.