For instance, even though the dangers of mercury are well established, only four out of every 10 doctors said they discuss the contamination with pregnant women.
Since 2004, the U.S. Environmental Protection Agency and the Food and Drug Administration have warned pregnant women to avoid eating high-mercury fish such as swordfish and shark and to limit consumption of albacore tuna. In addition, the American Congress of Obstetricians and Gynecologists issues statements to its members on the importance of patients avoiding mercury in fish.
Yet an estimated 300,000 newborns each year – one out of every 14 – are exposed to levels of methylmercury that exceed the guidelines that the EPA set to avoid neurological effects in fetuses. Mercury in the womb has been tied to reduced IQs and other effects on developing brains.
Dr. Naomi Stotland said warnings over mercury could result in women eating less fish, which is a low-calorie protein rich in omega-3 fatty acids critical for a baby’s brain development.
“Mercury in fish is a tricky one,” said Stotland, who practices at San Francisco General Hospital and was lead investigator on the survey. “Fish is such a good protein source for women, and they're probably not eating enough of it. I give out printed materials that direct them to fish with lower levels of mercury,” such as sardines, herring, pollock, shrimp and scallops.
“Most of my patients don't even read food labels. Are they carrying around the fish list? I worry, and I know other colleagues worry, that women will replace fish with processed hamburger. I don't think it's such a simple message.”
Dr. Jane Hightower, who practices internal medicine in San Francisco, agreed that the warnings are confusing but said ob/gyns should take more time to learn about food and contaminants.
“To make ends meet, there are too many patients crammed into the schedule. Food science literature and environmental toxicant literature are difficult to sort out, and the doctors are not being taught about nutrition or contaminants in school,” said Hightower, who has authored a book and several scientific journals reports about unhealthful levels of mercury in fish.
Despite evidence that environmental factors contribute to many health problems, medical students report fewer than six hours of environmental health training, according to University of Texas School of Medicine researchers.
“The whole medical establishment needs to look at themselves and start evaluating old practices that might not be so safe for the patient in the long run," Hightower said.
Flynn holds pre-pregnancy counseling sessions with her patients, who are mostly middle-to-upper class women living in San Francisco. She gets a lot of questions about environmental chemicals, sometimes from prospective mothers and sometimes from the mothers of young patients. She said the role of the ob/gyn is changing as environmental chemicals are gaining more attention as agents of defects and disease.
Twenty-five years ago, “people were not quite as cognizant. Now they ask for the resource, or a reputable web site. Before the internet that was not an option,” she said.
Flynn goes further than most by telling women they can reduce BPA exposure by not buying canned foods and beverages with resin liners, and that they can avoid cosmetics and plastics containing chemicals called phthalates.
In contrast, at San Francisco General Hospital, Stotland sees low-income patients on California's Medicaid program. Stotland doesn't get the questions that Flynn often encounters.
“Most of my patients don't ask me about environmental exposures. They don't ask about cosmetic products, bisphenol A or organic foods. Most don't have high-speed Internet access, and don't read articles and get alerts.”