North Coast Journal Editor Carrie Peyton Dahlberg asked Dr. Cherrie Andersen, an obstetrician and gynecologist who practices in Eureka, to give us some of her thoughts on environmental risks during pregnancy.
North Coast Journal: What are some of the most common environmental health threats to pregnant women in Humboldt?
Dr. Cherrie Andersen: Humboldt's traditional industries are logging and fishing. Both industries have concerns. Deep sea fish are exposed to all the chemicals dumped in our oceans. These fish can come from as far away as China, where environmental regulations are lax. Long-lived game fish, like sword fish and tuna, are carnivores. Since they eat small fish and live a long time, they accumulate toxins like pesticides and mercury. Fishermen tend to eat more fish and also concentrate these toxins.
With logging in decline here, pesticide use in the logging industry is probably less of a concern. But it is still a possible source of water contamination, along with pesticides from growing food or marijuana.
We also have a robust agricultural sector, much of it organic. But some of our food and marijuana production is reliant on pesticides and herbicides. Many farm animals receive regular doses of antibiotics. A lot of chemicals are poorly broken down and accumulate in us if we eat this food. Worse, all these chemicals can run off the lands where they are used, contaminating water and aquatic life in the area, including the ocean.
NCJ: What are the two or three environmental health hazards that you think are MOST important for a pregnant woman to avoid in her daily life?
Andersen: First, the dangers behind smoking, obesity and unsafe living environments such as domestic violence or drug use far outweigh all these environmental risks. I just want to get that in, to make sure you know what level of risk we are talking about.
If I had to pick a few to know about, I would pick mercury because the evidence that it harms the fetus is overwhelming and because we don't know if there is a safe level. In Minamura, Japan, children born after industrial spill of mercury in the water had severe developmental delay, limb deformity and blindness. A study done at Harvard in 2008 found that 3-year-olds whose mothers had the most mercury in their systems scored lowest on intelligence exams. A study in 2004 concluded that as many as one in six pregnant women had enough mercury in their bodies to affect their unborn fetus. (Levels of mercury are difficult to check because mercury does not stay in the blood; it is sequestered in the tissues. Also, once it is there, it may be more dangerous to try to get rid of it than to leave it.)
You can't completely get away from mercury. It is in the water in many places, and in car emissions, computers, some light bulbs and some dental work. You can minimize your exposure by eating less predatory fish. Fish that live a long time and eat other fish (shark, swordfish, king mackerel, and tile fish especially, salmon, trout and tuna to some degree) concentrate mercury and pesticides in their fat. That is unfortunate because humans need large quantities of the type of fat that is in fish, especially for brain and eye development. Low levels of those fats decreases the visual acuity and intelligence of the baby at birth. We get around that problem by recommending supplements to women with the fatty acids made by algae, krill or filtered fish oil to remove the impurities.
2.) Teflon and other perfluorinated compounds: Used to create nonstick surfaces, these compounds accumulate in the body and are connected to cancer, birth defects, infertility, immune disorders and liver problems. They off gas when the surface is heated and they mix with the food. They are easily avoided by going back a few decades to the cast iron pan or stainless steel. Also, watch out for these in packaging, such as the nonstick areas in microwave popcorn bags and hot pockets.
3.) BPA: Used to harden plastic, this chemical can soak into water in water bottles or into food if a plastic container is heated or put in a detergent and reused. It is also in heat-treated cash register receipts and in some canned goods. It is suspected of affecting fetal brain tissue, behavior and the fetal prostate gland. It acts as an estrogen in the body and is connected to endocrine disruption, including early puberty, diabetes, obesity, infertility, breast and prostate cancer. It is also connected to heart disease and nerve disorders. Most companies are now making water bottles without BPA, so look for those. Do not wash BPA-laden containers in the dishwasher or microwave food in them.
4.) Triclosan: An antibiotic found in hand soap and hand sanitizers, the chemical now contaminates almost all the water in the United States and is found in the blood of most people. Another endocrine disruptor, triclosan especially affects the thyroid, which produces hormones critical for fetal brain development. To make it worse, studies show it does not improve the bacteria count over normal soap. And most of us don't need anything that clean. A little bit of dirt and bacteria keeps our immune system focused on the contaminants that are out there in the world and not on our own bodies. Wash with regular soap so this chemical does not end up in your water supply.
NCJ: How does class play into environmental awareness in pregnancy?
Andersen: This is a great question. There are so many layers here. First, as I am sure you know, there are the environmental inequities related to poverty. The poor get saddled with homes closer to probable sources of contamination and with the riskiest jobs, like harvesting food sprayed with toxins. Then they have limited access to health care. They get a late start at obstetric care waiting to get on Medi-Cal. They have difficulty getting to the appointments because of transportation issues and long work hours with little protection from being laid off. Medi-Cal pays less than regular insurance pays for OB care. That does not mean the doctor spends half as much time with Medi-Cal patients, but it does mean if you practice in a poorer area, then you have to see more patients to make ends meet. So a patient in a relatively poor area, like Humboldt, might get less consultation, overall, than one in Beverly Hills.
Even with adequate time, these patients have concerns that far outweigh lessening their environmental toxin exposure. They frequently have difficulty getting food or adequate shelter. And there is a limited amount a poor woman can do to address the issue. Better-off women who are pregnant might shop organic, or replace their pots and pans with cast iron, but a woman on a strictly limited budget will need to continue to get her food at the dollar store and eat foods that are possibly imported from places with lower environmental and consumer protections or grown here but in a pesticide soaked field.
NCJ: What environmental health advice would you give to women of childbearing age in Humboldt who are trying to become pregnant?
Andersen: 1. Quit smoking. That is smoking anything at all. Lighting up exposes you to pesticides used to grow the crop and also introduces high temperatures, which create new chemicals in whatever you're smoking. We know smoking causes birth defects and low birth weight.
2. Drink water filtered through carbon or a reverse osmosis system. Most pollutants are attracted to the filter substance, leaving the water with fewer contaminants.
3. Maintain a normal, healthy weight. Many chemicals don't want to be in water -- they want to be in fat. So they accumulate in body fat. Some can reach blood levels 100 times the amount in the water a person is drinking. Having less fat gives them less area to accumulate.
4. Chose foods lower down on the food chain: Fruits, vegetables, grains and legumes. When eating meat, choose prey animals rather than predators, and lean cuts rather than fatty ones. Consider a Meatless Monday, when you get protein from vegetable sources like beans and other legumes. Fish is a particular problem. Do not eat any of these types while pregnant: Shark, swordfish, king mackerel, tile fish. Limit servings of fatty fish (salmon, trout and tuna) to 6 ounces once a week. Consider eating lower on the food pyramid with herring, shrimp or anchovies. They have important nutrients but less contamination because they don't live as long and are not predators. Walnuts and fortified eggs, from chickens fed a diet high in omega fatty acids, also contain a high level of important fatty acids.
5. Seal pressure-treated wood. Pressure-treated wood is usually treated with arsenic. Don't use it to make raised beds unless the beds are lined, and seal area decks or play areas so your skin is not exposed to this poison.
6. Do not use Teflon or similar non-stick pans. Use cast iron or stainless steel.
7. Beware of packaging. Don't microwave in plastic containers or put containers in detergent and reuse unless you know the container is BPA free.
8. Limit pesticide exposure. Try to go organic. If you can't afford to go all organic, check out a great list assembled every year by the Environmental Working Group, which helps cost-conscious consumers know which produce tends to be least contaminated (the Clean 15) and which most troublesome (the Dirty Dozen).
9. Avoid canned foods. Pick fresh or frozen.
10. Avoid packaged food with "PEG" or "-eth" in the ingredient list.
11. Avoid anything with a Prop 65 warning on the label.
NCJ: How commonly would an obstetrician or pediatrician here in Humboldt see problems in newborns that might be attributable to environmental toxins?
Andersen: This is a tough question for both pediatricians and me, and I will tell you a story to illustrate the difficulty.
In 1944, the Nazis occupied the Netherlands and blockaded food supplies, cutting off 4.5 million Dutch. The famine ended with liberation in May 1945. During that time, some women became pregnant or had babies. The surviving babies were smaller, with lower weight than normal, but otherwise seemed just fine -- until they hit their middle 40s. A research project in epidemiology followed the people born at that time and discovered that they were more susceptible to heart disease, obesity, depression and diabetes in their 40s. Later it was discovered that neurological defects and schizophrenia were more common in these survivors as well. It appears that starvation in the uterus alters the proteins around DNA in a permanent way, turning on some genes and turning off others.
However, not every adult survivor had one of the disorders attributable to the famine. We discovered this effect because it involved a large number of people in a small area over a small amount of time, and because the children born in the famine were tracked for many years. Also, some fairly bright people made the connection and followed up on their suspicions.
It is impossible to say that one person's birth defect is due to a certain drug because those defects occur even without exposure. Similarly, many fetuses exposed don't get the defect. What we can say is that a group exposed to these drugs will have a larger chance of having the defect.
Right now, we are seeing a huge increase in hypospadious in males (the urethra in the wrong place). We don't know why. Autism rates and ADD are on the rise. We don't know why. We are in what can only be called a diabetes and obesity epidemic. Human fertility rates are dropping off rapidly. We don't know why.
Most likely some environmental insult plays a role in all of these, but at the moment, we don't know what the insult is, or how to even go about figuring it out.