prenatal environmental health assessment tool katie huffling, rn, ms, cnm dimensions ob/gyn...
TRANSCRIPT
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Prenatal Environmental Health Assessment Tool
Katie Huffling, RN, MS, CNMDimensions OB/GYN Associates
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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?
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Assessment Tool
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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
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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
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Carbon Monoxide Sources
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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• http://www.epa.gov/iaq/co.html
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Assessment Tool
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Drinking Water
The first question to ask:• Are you on a private well or
public drinking water supply?
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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.
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Bisphenol A
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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
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Myriad of Consumer Uses
• Baby bottles• Metal can liners• Water bottles• Food containers• Dental products• Compact discs
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Concerns
• Ubiquitous in humans• Federal safety assessment based on two
studies• Health effects occur at very low dose exposure
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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
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Does the dose make the poison?
Adapted from Wetherill et al.
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Does the dose make the poison?
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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
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Infant Formula
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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!
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Assessment Tool
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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)
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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.
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Smoking & Pregnancy
http://www.epa.gov/smokefree/index.html
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http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
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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 http://www.cosmeticsdatabase.com/research
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Personal Care Products
• Phthalates – Used as plasticizer in PVC, fragrances, solvents
• Found in hairspray, shampoo, nail polish• Impacts fetal development – boys especially
susceptible
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Personal Care Products
• Read Labels!• Don’t buy products listing “Fragrance” or
“Phthalate” in the ingredients• If you’re not sure go to:
www.cosmeticsdatabase.org
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Skin Deep
www.cosmeticsdatabase.com
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Personal Care Products
Some cosmetics manufacturers are beginning to listen…
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Household Products
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Pesticides• Are chemicals designed to kill or repel pests• They include:
– Herbicides– Insecticides– Fungicides
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Exposure• Lawns• Home indoor use• Workplace - Hospitals• Residues on foods• Farm application
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Health Effects• Neurological Effects
– Many pesticides are neurotoxins– Cognitive effects– Memory deficits– Seizures– Personality changes– Possible link to Parkinson’s disease
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Health Effects
• Reproductive– Decreased sperm
production– Increased risk of stillbirth
and miscarriages– Increased risk of congenital
anomalies– Hormone production
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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
spcpweb.org www.pesticideinfo.org www.beyondpesticides.org
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Worst Non-Organic Foods
• Apples• Bell Peppers• Celery• Cherries• Grapes• Nectarines• Peaches
• Pears• Potatoes• Red
Raspberries• Spinach• Strawberries• Winter
Squash
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Best Non-Organic Foods
• Asparagus• Avocadoes• Bananas• Broccoli• Cauliflower• Corn
• Kiwis• Mangos• Onions• Papayas• Pineapples• Peas
(Sweet)
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Assessment Tool
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Sources of Mercury in the Home
• Thermometers• Some traditional remedies• Compact fluorescent lights (CFLs)
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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
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Mercury in the Environment
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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.
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Fish Consumption Guidelines
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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
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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
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PBDE
• 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)
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PBDE in Breastmilk
Schecter et al 2003, Mazdai et al 2003, Kalantzi et al 2004, compiled by NRDC
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PBDE in Breast Milk
Darnerud et al. 2003
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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
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