SAN FRANCISCO – When Dr. Darragh Flynn sits down with her pregnant patients, she preaches healthy habits: Don’t smoke or drink, eat nutritious foods and take vitamins.
She also advises them to avoid gasoline fumes, pesticides, certain types of fish and some household cleaners and cosmetics.
“It's only for nine months,” she tells them. “Let someone else put gas in the car.”
But Flynn is in the minority. A new nationwide survey of 2,600 obstetricians and gynecologists found that most do not warn their pregnant patients about chemicals in food, consumer products or the environment that could endanger their fetuses. More than half said they don’t warn about mercury, and hardly any of them give advice about lead, pesticides, air pollution or chemicals in plastics or cosmetics.
Many doctors say their priority is to protect pregnant women from more immediate dangers, and that warning them about environmental risks may create undue anxiety. Some say they don't feel confident in their ability to discuss the topics.
“We're worrying about pre-term labor, obesity and hypertension,” said Dr. Jeanne A. Conry, an ob/gyn at Kaiser Permanente in Roseville, Calif., and incoming president of a national medical society. “Obesity trumps almost everything. We put our time and energy there, and don't dwell on some of the other things we should be aware of.”
More than 100 chemicals
Virtually all pregnant women have chemicals in their bodies that might harm fetal development.
Monitoring of pregnant women found about 100 different chemicals, with 43 of them in all women tested. Lead, mercury, toluene, perchlorate, bisphenol A, flame retardants, perfluorinated compounds, organochlorine pesticides and phthalates are among the chemicals, according to the U.S. Centers for Disease Control and Prevention's nationwide testing program.
Studies suggest that for many these compounds, low-level exposures in the womb seem to disrupt development of the brain or reproductive systems. Others may raise the risk of birth defects, or lead to cancer, immune problems, asthma, fertility problems or other disorders later in life.
Yet that information is not reaching most women who are pregnant or may become pregnant.
Almost all of the doctors in the new, nationwide survey, conducted by University of California, San Francisco researchers, said they routinely discussed smoking, alcohol, diet and weight gain. Eighty-six percent also said they discuss workplace hazards, and 68 percent warn about second-hand smoke.
But only 19 percent said they talk to their pregnant patients about pesticides and only 12 percent discuss air pollution. Forty-four percent said they routinely discussed mercury with pregnant women. Eleven percent said they mention volatile organic compounds, which are fumes emitted by gasoline, paints and solvents.
Even fewer physicians warned their patients about two chemicals in consumer products that are often in the news: bisphenol A (BPA) at 8 percent and phthalates at 5 percent. Nine percent of the doctors told their patients about polychlorinated biphenyls (PCBs), industrial compounds often found in fish.
The results show a disconnect between environmental health research and what the physicians do – and do not – tell their patients, said Patrice Sutton, a research scientist at University of California, San Francisco's Program on Reproductive Health and the Environment who helped design the survey. The goal of the study, which was discussed at a recent conference but is not yet published, was to try to break down obstacles that keep health messages from pregnant women.