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Environmental Factor, April 2012

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Researchers call for changes in policy and reproductive healthcare

By Eddy Ball

Program on Reproductive Health and the Environment logo
Patrice Sutton

First author Patrice Sutton (Photo courtesy of UCSF)

Linda Giudice

Lead researcher Linda Giudice was one of several clinician researchers involved in the study. (Photo courtesy of UCSF)

In a new clinical opinion paper, NIEHS- and U.S. Environmental Protection Agency (EPA)-funded children’s health specialists advocate for a proactive approach for preventing harmful environmental exposures, by engaging reproductive health professionals in prevention efforts within and beyond the clinics.

Published online in March by the American Journal of Obstetrics and Gynecology, the article surveys trends in recent reproductive environmental health science research. The review considers the developmental origins of human disease, low-dose and coexposure toxicology, and epigenetic modification of gene expression triggered by exposures during windows of susceptibility.

The authors combined findings from what they describe as “this new science,” to build a compelling argument for concerted action by reproductive health practitioners, institutions, and professional groups to improve individual health and drive policy change.

Considering the rise in reproductive adversity linked to environment

The team set the stage for their analysis, by referencing findings of increases in reproductive and developmental adversity, ranging from declines in fertility and fecundity to increases in such childhood diseases as autism and certain types of cancer. The scientists also point to the alarming rise in the number of obese children and adolescents who will be at higher risk for developing diabetes and cardiovascular disease as they age.

“Because these and other barometers of reproductive health and capacity have changed at a relatively rapid pace,” the authors contend, “they are unlikely to be explained by changes in genetic makeup.” An important contributor to reproductive adversity, according to the researchers, is widespread human exposure to environmental chemicals. Over the past 70 years, there has been a 16-fold increase in U.S. production and use of chemicals that are largely unregulated and untested.

The research team cited data from the National Health and Nutrition Examination Survey indicating virtually all pregnant women have measured levels of a wide range of trace metals and chemicals in their bodies that have been documented to be harmful to human reproduction and development. These exposures range from lead and mercury to pesticides and endocrine-disrupting compounds, and many of them may act synergistically to impair health and cause disease.

According to the authors, studies have repeatedly linked exposures to these chemicals and compounds during critical windows of human development to adverse outcomes in human and animal studies. The associations are strong enough, they argue, to justify immediate precautionary measures to reduce or prevent exposures among vulnerable populations, such as pregnant women and children.

The researchers also point to statements and recommendations by professional organizations, such as the National Academy of Sciences, Endocrine Society, and American Academy of Pediatrics, on the links between environmental exposures and disease, as support for the need for timely action to prevent harm.

Translating environmental health science into prevention

“Obstetricians, gynecologists, and other reproductive health professionals can play a groundbreaking role, by intervening in critical stages of human development,” the authors conclude, “to translate the new science into healthier pregnancies, healthier children, and healthier future generations.”

The authors call for changes in patient evaluation and education practices, increased advocacy by professional organizations, and better-informed institutional purchasing practices, especially with regard to food , with the goal of reducing exposures among pregnant women and children to harmful chemicals in the environment.

Led by senior author Linda Giudice, M.D., Ph.D., distinguished professor and chair of the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco (UCSF), the team included researchers in her department, as well as ones affiliated with the UCSF Program on Reproductive Health and the Environment (PRHE). PRHE members included Research Scientist Patrice Sutton, first author; second author Tracey Woodruff, Ph.D., PRHE director; and third author Joanne Perron, M.D., a postdoctoral fellow in the program.

Also participating in the study were scientists and clinicians from the UCSF Pediatric Environmental Health Specialty Unit and Kaiser Permanente North Valley network, and the American Congress of Obstetricians and Gynecologists. In addition to major funding from NIEHS and EPA, the research team also received support from the New York Community Trust.


Sutton P, Woodruff TJ, Perron J, Stotland N, Conry JA, Miller MD, Giudice LC. 2012. Toxic environmental chemicals: the role of reproductive health professionals in preventing harmful exposures. Am J Obstet Gynecol; doi: 10.1016/j.ajog.2012.01.034 [Online 8 March 2012].

Joanne Perron, M.D.

Perron, who has 20 years of experience treating women with reproductive disorders, has written about the effects of pesticides and air pollution on reproductive health and child development. (Photo courtesy of UCSF)

Tracey Woodruff, Ph.D.

PRHE Director Woodruff is the lead on NIEHS grants to support research on the effects of environmental exposures during pregnancy. (Photo courtesy of UCSF)

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