Environmental Toxins Are a Scary Subject for Most OBs

US obstetricians agree that they should have a role in reducing pregnant women’s exposure to environmental toxins, but most fail to discuss the subject with patients.

In continuing to call attention to the need to educate patients about the dangers that chemical exposures pose to women's health, researchers from the University of California, San Francisco conducted a survey of 2,500 obstetricians.

Pertinent Points

- Most physicians fail to talk to pregnant women about environmental exposure to toxins that could be harmful to both mother and child.

- Many obstetricians are uncomfortable discussing the current scientific evidence on the issue because they did not feel knowledgeable enough about the subject.

The results, published in PLOS One, showed that nearly 80% of obstetricians acknowledged they should help patients reduce exposure to environmental health hazards. Yet, only 1 in 15 obstetricians surveyed said they had been trained in the harmful reproductive effects of toxic chemicals that are most prevalent among pregnant women.

Better training and evidence-based guidelines would help physicians be more proactive, without fear of unduly alarming their patients, the authors noted.

"We have good scientific evidence demonstrating that pregnant women are exposed to toxic chemicals, and there's a link between these exposures and adverse health outcomes in children," said Tracey Woodruff, PhD, MPH, who directs the UCSF Program on Reproductive Health and the Environment at UCSF and is the study's senior author. "But physicians are not offering this information to their patients."

Among the survey results, the doctors indicated they didn’t know enough about the subject or that they were uncertain about the existing evidence, making them uncomfortable with providing concrete advice to pregnant women. In addition, the survey revealed that many physicians were often busy addressing more immediate health concerns, including poor diet, obesity, and chronic illness.

Focus groups conducted in conjunction with the survey indicated physicians were afraid of scaring their patients about the ubiquitousness of environmental chemicals, since it's almost impossible to avoid being exposed to them.

The authors suggested physicians focus on substances that are most likely to cause harm and provide easy ways to reduce exposure. Some examples of toxins are mercury levels in fish and potential chemical exposures at workplaces and homes. They pointed to the Committee Opinion on Exposure to Toxic Environmental Agents issued jointly last year by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine for more insight into the issue and what physicians can do to counsel patients.