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Controversial advice on chemicals in pregnancy

Friday 14 June 2013

 

From the UK's NHS Choices:

 

PregnancyControversial advice on chemicals in pregnancy

The Daily Mail reports on the warning for pregnant women that household chemicals could pose a threat to their babies. ‘Don’t paint the nursery and avoid non-stick frying pans’ the Mail continues.

The news is based on advice to pregnant or breastfeeding women in a report from the Royal College of Obstetricians and Gynaecologists (RCOG).

The report, titled ‘Chemical exposure during pregnancy: dealing with potential, but unproven, risks to child health’ warns that pregnant and breastfeeding women could be exposed to harmful chemicals through:

  • food packaging
  • ordinary household products
  • medicines
  • personal care items such as moisturisers

It is important to stress that the advice is framed in a safety-first approach. There is no credible evidence that any of the items listed above pose a threat to birth outcomes.

A large amount of uncertainty exists because carrying out studies to assess these risks is difficult. This is because virtually all pregnant women are exposed to certain chemicals as they are found in everyday products.

The report provides a list of recommendations and examples of how women can avoid these potentially harmful chemicals (such as to minimise purchasing household furniture, frying pans or cars – see below for more details).

However, these recommendations are based on little evidence of any risk to the child. It recommends women put ‘safety first’ and assume a risk is present even when it may be small or proven not to be harmful.

Reassuringly, the report does say that one option is for mothers to do nothing and acknowledges that it may be difficult to avoid certain exposures.

The advice has prompted criticism by some, arguing that causing stress during pregnancy could do more damage than a theoretical, and as yet unproven, risk of chemical exposure.

Who are RCOG?

The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional membership organisation based in the UK. According to their website, they encourage the study and advancement of the science and practice of obstetrics and gynaecology (women’s reproductive health). They do this through education and training for their members as well as publication of clinical guidelines and reports for patients and practitioners working in this area.

According to the RCOG press release, the report has been produced by an RCOG Scientific Advisory Committee. It says these papers are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology and that the papers are intended to raise awareness of such issues.

Why has this report been produced?

According to the report, no official advice or guidelines exist that inform women who are pregnant or breastfeeding of the potential risks that some chemical exposures could pose for their babies.

Co-author of the paper, Dr Michelle Bellingham from the University of Glasgow, says, ‘there is much conflicting anecdotal [single observations] evidence about environmental chemicals and their potentially adverse effects on developing babies.’

She adds, ‘The information in this report is aimed at addressing this problem and should be conveyed routinely in infertility and antenatal clinics so women are made aware of key facts that will allow them to make informed choices regarding lifestyle changes.’

What evidence did the report look at?

The report states there is some evidence linking exposure to some chemicals during pregnancy with negative birth outcomes. Encouragingly, it emphasizes that this evidence is only of an association and there is no evidence that one causes the other (causality). It also says that some studies show no association between chemical exposure and disease. This evidence is not provided in detail but links to the primary research are included in the report.

The report mentions that other studies looking at this issue have investigated the effects of chemicals on pregnant animals. However, as the report points out, it is often difficult to interpret animal research and caution should be exercised when trying to generalise these findings to humans. In part, because in some of these studies the animals are exposed to levels of chemicals that would never occur in a real world human setting.

The focus of the report, it says, was to provide examples of where chemical exposures can be avoided.

What recommendations did the report make?

The report recommends the best approach for pregnant women is ‘safety-first’. It says this is ‘to assume there is a risk present even when it may be minimal or eventually unfounded.’

Other recommendations provided in the report include:

  • use fresh food rather than processed food wherever possible
  • reduce use of food and drink in cans or plastic containers
  • minimise the use of personal care products such as moisturisers, cosmetics, shower gels and fragrances
  • minimise the purchase of newly produced household furniture such as fabrics, non-stick frying pans, and cars while pregnant or breastfeeding
  • avoid paint fumes and all pesticides, such as fly spray
  • only take over-the-counter medicines when necessary
  • do not assume safety of all ‘natural’ named products

Despite this list of recommendations, the report acknowledges that it may be difficult for mothers to deal with the uncertainty of chemical exposure risks and that one option is do nothing.

How has the report been received?

It is fair to say that the report has not been universally well received. Many commentators have criticised the findings as being needlessly alarmist without providing any credible evidence of a threat posed by everyday chemical exposure. Ultimately the report, in the words of the critics, provides little in the way of useful advice.

Tracey Brown, of the Sense About Science charitable trust was quoted by BBC News as saying “Pregnancy is a time when people spend a lot of time and money trying to work out which advice to follow, and which products to buy or avoid. The simple question parents want answered during pregnancy is: 'Should we be worried?'

"What we need is help in navigating these debates about chemicals and pregnancy. Disappointingly, the RCOG report has ducked this."

Conclusion

Nervous mothers-to-be may want to take on board RCOG’s recommendations, though as previously mentioned, the evidence to back up these recommendations is lacking. It is important not to lose sight of established harms that are known to cause damage to a pregnancy:

  • smoking
  • drinking alcohol
  • using drugs
  • certain types of medication, such as medications used to treat epilepsy
  • eating certain foods, such as pate or liver

Read more about health and wellbeing in pregnancy in the NHS Choices Pregnancy and baby guide.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

 

The above originally appeared here.

 

Here is the press release from the Royal College of Obstetricians and Gynaecologists:

 

Royal College of Obstetricians and GynaecologistsRCOG release: Mothers-to-be should be aware of unintentional chemical exposures, say experts pain

Published by: Naomi Weston
Date published: 05/06/2013

Pregnant women should be made aware of the sources and routes of chemical exposure in order to minimise harm to their unborn child despite current uncertainty surrounding their effects, say experts from the Royal College of Obstetricians and Gynaecologists (RCOG) in a new Scientific Impact Paper launched today.

While there is much guidance on healthy lifestyle choices that women can incorporate during pregnancy, there is currently no official antenatal advice that informs women who are pregnant or breastfeeding of the potential risks that some chemical exposures could pose to their babies.

Exposure to considerable amounts of environmental chemicals has been linked to adverse health effects in women and children, including pre-term birth, low birthweight, congenital defects, pregnancy loss, impaired immune development, as well as impairment of fertility and reproduction in both the mother and child in later life.

This new paper, "Chemical exposures during pregnancy: Dealing with potential, but unproven, risks to child health", raises awareness of the current issues surrounding chemical exposure during pregnancy and offers advice for women to make informed decisions that will predispose their baby to have the best possible health.

The authors explain that under normal lifestyle and dietary conditions, pregnant women are exposed to a complex mixture of hundreds of chemicals at low levels and exposure to such chemicals can occur through many avenues, including consumption of food, use of household products, over-the-counter medicines, as well as personal care products and cosmetics.

While the consumption of herbal remedies or medicines, such as paracetamol, and use of household cleaning products, such as pesticides, are well-documented sources of chemical exposure, this paper points out the lesser recognised sources that could accumulate with the mixture effect posing potential harm.

The authors, for example, point out that it is not just the type of food that pregnant women consume posing a risk, but the handling equipment and packaging materials used to contain it. The same caution is suggested for personal care products such as moisturisers, sunscreens and shower gels, as current legislation does not require manufacturers to name all potentially harmful chemicals, when used in low dose, on the product label.

The paper recommends that the best approach for pregnant women is a ‘safety first’ approach, which is to assume there is risk present even when it may be minimal or eventually unfounded.

Recommendations made in the paper include: using fresh food whenever possible by reducing foods in cans/plastic containers, minimising the use of personal care products, avoiding paint fumes and use of all pesticides, and only taking over-the-counter medicines when necessary.

Dr Michelle Bellingham, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, and co-author of the paper, said:

“While there is no official advice on this topic available to pregnant women, there is much conflicting anecdotal evidence about environmental chemicals and their potentially adverse effects on developing babies.

“The information in this report is aimed at addressing this problem and should be conveyed routinely in infertility and antenatal clinics so women are made aware of key facts that will allow them to make informed choices regarding lifestyle changes.”

Professor Richard Sharpe, Medical Research Council (MRC) Centre for Reproductive Health, the University of Edinburgh and co-author of the paper, said:

“For most environmental chemicals we do not know whether or not they really affect a baby’s development, and obtaining definitive guidance will take many years.

“This paper outlines a practical approach that pregnant women can take, if they are concerned about this issue and wish to ‘play safe’ in order to minimise their baby’s exposure. However, we emphasise that most women are exposed to low doses of chemicals over their lifetime, which in pregnancy may pose minimal risk to the developing baby.”

Professor Scott Nelson, Chair of the RCOG Scientific Advisory Committee, added:

“There are growing concerns over everyday chemical exposure effects because many chemicals have the potential to interfere with the hormone systems in the body, which play key roles in normal fetal development.

“Realistically, pregnant women are exposed to a complex mixture of hundreds of chemicals at low levels, but methods for assessing the full risk of exposure are not yet developed.

“While pregnant women should be aware of potential risks, there is still considerable uncertainty about the extent of the exposure effects and any women with concerns about certain chemical exposures should consult their obstetrician or midwife.” 
 
Ends

The full SIP paper can be found here.

For media enquiries please contact Caitlin Walsh, Media Officer, Royal College of Obstetricians and Gynaecologists: 020 7772 6300 or cwalsh@rcog.org.uk

About New RCOG Scientific Impact Papers

RCOG Scientific Impact Papers (formerly SAC Opinion papers) are produced by the Scientific Advisory Committee. They are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These documents have been rebranded to raise awareness of the issues in obstetrics and gynaecology discussed in the documents and to more accurately reflect their content and remit of the Committee.

 

The above originally appeared here.

 


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