Many of her patients clean buildings and houses or work in nail salons, and struggle with staying away from harmful chemicals. She encourages individual solutions such as cooking at home and avoiding processed foods packaged in plastic. She's trying to push baking soda and vinegar instead of toxic cleaning products.
Even though Stotland's patients are low income and probably at higher risk, she said she wasn't talking to them about environmental health until recently. Many doctors in the response comments of the survey said they were concerned about making patients feel overly anxious.
“The social circumstances are so burdensome. Some colleagues think the patients are already worried about paying rent, getting deported or their partner being incarcerated,” Stotland said.
Some doctors urge stronger role
There are many scientific uncertainties about the dangers to fetuses, so clinicians can only proceed with caution.
For example, Conry said there is a lot of research on the effects of BPA, particularly in lab animals, but doctors don’t know how to interpret the results. “So, it hasn't resulted in a change in practice patterns.” Research on environmental chemicals is difficult for clinicians to understand because it differs from what they are used to with pharmaceuticals, she said.
Almost every obstetrician and gynecologist has a desk reference for pharmaceuticals, she said, but “it doesn't have any sections on environmental toxicants. There isn't an easy resource for physicians to use.”
“In the case of pharmaceuticals, the onus is on the pharmaceutical company to do the research with toxicity testing, randomized control trials and post-exposure observational studies," Conry said. "With environmental chemicals, the manufacturer puts out a product, and the onus is on the regulatory bodies, environmental groups and lay public to find problems and study the effects.”
Conry, who will become president of the American Congress of Obstetrics and Gynecologists in May, urges a stronger role for physicians. She is co-author of a paper with Stotland, Sutton and four others concluding that physicians should intervene as early as possible to help women prevent harmful exposures.
For the first time a year ago, the ob/gyn society stepped into a policy-influencing role in environmental health issues. Its president, James N. Martin, wrote a letter to the EPA urging the agency to consider links between prenatal exposure to the insecticide chlorpyrifos and birth defects before deciding whether to ban agricultural uses.
In the new survey, 89 percent of the doctors said guidelines from the American Congress of Obstetricians and Gynecologists would be the most helpful in gaining information on environmental health.
“As a society, we have a lot of work to do both in terms of informing women of dangers and helping them find alternative jobs when they're pregnant,” Stotland said. “This is society's job. Clinicians can't fix the problems in their offices.”
This article originally ran at Environmental Health News, a news source published by Environmental Health Sciences, a nonprofit media company.