Valley Parents: Chemical Concerns During Pregnancy
In an undated photograph, Dr. Dina Levin examines Elizabeth Clarke, of Brookfield. An obstetrician at Gifford Medical Center in Randolph, Levin counsels her patients to use common sense when it comes to their exposure to chemical agents during their pregnancies. With research showing that pregnant women are exposed to more than 230 known toxic substances, Levin said there is no way to know for sure which ones will prove harmful and which ones will not.
Photograph courtesy of Gifford Medical Center
As an obstetrician who oversees the pregnancies and births of high-risk patients at Dartmouth-Hitchcock Medical Center, Dr. Michele Lauria said she is not overly concerned about the possible dangers of the chemical agents lurking in plastic bottles, commercial hair dyes, insecticides or cleaning agents. The real danger areas, she said, are the known risks of infection and substance abuse.
Photograph courtesy of Dartmouth-Hitchcock Medical Center
When Kristina Aldrich opened Vivo Salon and Day Spa on Mechanic Street in Lebanon in the summer of 2008, the danger that toxic chemicals might pose to the fetuses of her female employees — and of her own children yet to be born — was not on her mind. A first-time business owner, Aldrich had a building to renovate, supplies to order, people to hire, appointments to set up. Questions about the effect that hair dyes and permanent wave solutions might have on human cells dividing unseen inside a woman’s body were not an issue.
Fast forward five years, however, and such questions might seem to have come into style, since no fewer than six children have been born to Vivo stylists and receptionists. “Four boys and two girls,” Aldrich said, each of them “born healthy and with no medical problems or complications.”
But even if anecdotal evidence suggests that potentially harmful chemical agents appear not to be causing problems on the development of salon workers’ babies, many young women have questions about how the plethora of chemicals in both their home and work environments could affect their pregnancies. Nicole Brousseau, a stylist at Vivo who hopes to start a family of her own one day, brought the issue up several months ago while she was cutting my hair. Almost immediately, the room was abuzz with questions from customers and workers alike.
What’s safe? What isn’t? Who knows?
My curiosity was piqued, and not only because my hairdresser thought the story was a good idea. I was also getting text messages from my 22-year-old daughter in Austin, Texas. Newly pregnant with her first child, she was restraining herself from changing the cat litter box, fearful that she might contract something called toxoplasmosis, an infection that could, according to numerous websites, cause miscarriage and congenital defects.
I have changed a lot of cat litter in my days, pregnant or not. The idea that a seemingly harmless household task could cause irreparable damage to a fetus was news to me.
Trolling the Internet for information about chemical exposure during pregnancy proved mind-expanding as well. I added the word teratogens to my vocabulary. It’s a Greek word meaning “monster forming,” and it pops up in connection with stories about deformed babies born to women who were prescribed Thalidomide during pregnancy, or women who contracted chickenpox during pregnancy, or treated their acne with Accutane during pregnancy. I started looking askance at the swordfish on my dinner plate, the paint on my walls, the bug spray in my garden shed, the plastic of the water bottle in my hand. When I assumed the point of view of a pregnant woman, the entire world started looking like a chemical mine field.
The Devil We Don’t Know
None of this was surprising to Dr. Dina Levin. An obstetrician at Gifford Medical Center for the last two years, with 13 years previous experience in Portland, Ore., Levin has guided hundreds of women through pregnancy and birth. She has seen a lot. Women who smoked all through their pregnancies and gave birth to thriving babies. Women who ate well, exercised, abstained from drugs and alcohol, and gave birth to premature infants who struggled to gain weight. And seemingly every possible variation in between.
But even Levin, who stays current with the medical literature on the subject, said it’s virtually impossible for doctors to lay the blame for birth defects on specific chemical agents that are present in work and home environments. Some dangers, like tobacco use, are known and absolute, Levin said. No responsible doctor is going to tell a pregnant woman it’s OK to smoke. But pick out one chemical from the miasma of agents with which modern women come into contact and say it absolutely causes problems in pregnancy? No one, Levin said, can do that.
The first thing to understand is that there simply is not a lot of data.
“Think about it,” Levin said, when I mentioned hair care products. “A reputable double-blind study is nearly impossible to conduct. Are you going to give 50,000 women hair products, and 50,000 not, and then follow their offspring for 20 years to see the difference? Nobody is ever going to do that study, because you would consider it unethical and it would cost a huge amount of money and you would have to do that with every chemical available.”
Levin pointed me to a recent study in which umbilical cord blood was drawn from 10 pregnant women and analyzed for the presence of known toxic substances. The total number the researchers came up with was an astonishing 232.
BPA, or Bisphenol A, the organic compound used in the production of plastic bottles, was detected in nine out of the 10 infants. It’s a hot topic these days, Levin said, and if you look up BPA on the Internet you’ll find it being blamed for a host of health problems, everything from miscarriage to prostate cancer. But that doesn’t mean it’s something that needs to be — or even can be — avoided.
One of our biggest exposures to BPA, Levin said, comes through the thin, plastic lining on the inside of food cans.
“It’s there because it enables the manufacturers to heat treat the stuff so that it doesn’t make you sick. If you take that out, what are you going to put in instead? Then it becomes the devil you know versus the devil you don’t know. If they take out BPA and put in BPS or BPG, then maybe BPG is worse, but we just don’t know that yet.” In the meantime, pregnant women, most of whom can’t afford an all-organic diet, need the vitamins, nutrients and protein that can be found in canned peas and carrots, tuna fish, minestrone soup, kidney beans, spinach, corn chowder and all the rest.
“So who knows?” Levin asked rhetorically.
That kind of uncertainty is exactly what makes the issues surrounding potential, or even probable, teratogens so difficult to discuss. The best advice she can give to pregnant women is to limit their exposure to chemicals in general.
“Do what makes sense,” she said. “Do you need to dye your hair? Well, probably not. Do you have to paint the bedroom? Maybe you do. But use a water based paint and keep the room well ventilated or have someone do it for you.”
Levin said it’s also important to remember that not all chemical exposures are created equal. Paper receipts are another common product lined with BPA that virtually all consumers come into contact with. But does a pregnant woman doing the family grocery shopping have to be concerned about her exposure to BPA because the cashier just handed her a computer generated heat-sensitive receipt? Most likely not. But if the cashier is pregnant? “That’s a no brainer to me,” Levin said. “The cashier who’s touching (BPA) all day should be wearing gloves. ”
The Devil We Do Know
Dr. Michele Lauria is a professor of obstetrics and gynecology at the Geisel School of Medicine at Dartmouth. She is also a maternal fetal medicine specialist who oversees many high-risk pregnancies in her practice at Dartmouth-Hitchcock Medical Center, where she has worked for 15 years. When it comes to exposure to dangerous chemicals during pregnancy, Lauria was unfazed by the unknown hazards expectant women face as they go about their daily lives in the chemical stew that has become the norm of contemporary life. It’s the known dangers that occupy Lauria’s mind.
“We’re exposed to a lot of chemicals and most of them probably have no impact on us,” Lauria said.
She always asks new patients what they do for work. In fact, though, Lauria said, “most people do not have workplace exposures that put them at risk. The federal government has done a really good job about chemical exposure. Every chemical that you use in the work place has a fact sheet about it. So if someone has a question about a chemical, they can get that fact sheet.”
Of vastly greater concern are the dangers of smoke, alcohol and drugs.
“Smoke is bad,” Lauria said. “Smoke is so bad for the baby, if I had to choose between having someone smoke half a pack a day or have their hair dyed every month, I’d tell them to get their hair dyed every month. They need to quit smoking. It has a huge impact on how the placenta is formed and how it functions.”
The deleterious effects of marijuana smoke are even worse. Lauria said there appears to be a rumor floating among younger women that marijuana smoke, especially if it comes from plants that they grow themselves, is less harmful than tobacco smoke. Nothing could be further from the truth, she said.
“Smoking marijuana during pregnancy is really bad,” Lauria said. “There are no regulations on how it’s grown, what they cut it with, how it’s processed. There’s no filter on it and people hold it in their lungs for as long as possible.”
Lauria said we can think of the placenta as “a giant lung for the baby. When you smoke, you fill the lung with toxins.” And unlike tobacco, the chemicals in marijuana are more diverse, possibly even laced with methamphetamines.
Still, Lauria said, “I have patients who get high every day.”
Alcohol use during pregnancy is another danger that pregnant women need to be aware of. Lauria acknowledge that, in some cultures, modest amounts of alcohol are believed to be of no consequence to fetal development. She disagreed. According to the most up-to-date research, she said, “There’s probably no threshold for any alcohol use in pregnancy that’s safe.”
But if an occasional glass of red wine is a risk, one night of excessive drinking may be a catastrophe.
“It’s binge drinking that has the most impact on the fetus,” Lauria said. “If you get a massive dose of alcohol that your body can’t deal with, it all goes straight across the placenta to the baby. Alcohol is metabolized in your liver and the baby’s liver is not fully functional. So that alcohol goes to the baby’s brain and has a huge impact on how the neurons develop in the brain.”
Abuse of alcohol during pregnancy is the number one known cause of mental retardation in the U.S., Lauria said.
“It is devastating for the development of the fetal brain. Mom gets drunk, her baby’s drunk too. Only the alcohol stays around in the fetus for a really long time and the baby can’t metabolize (the alcohol) to get it out of its system.”
Illicitly obtained prescription drugs —opiates like Percocet, Demerol, Vicodin — are another of Lauria’s major concerns. While they are not known for causing birth defects, Lauria said that about 50 to 80 percent of the time, a woman using opiates during pregnancy will cause her child to be born addicted to the drugs. “That child has to go through withdrawal and may be in the hospital up to three months,” Lauria said.
And it’s not a problem those of us living in rural Vermont and New Hampshire should take lightly. “That’s a huge problem is our area,” Lauria said. “I think 30 percent of my practice is women who use opiates on a daily basis. It’s a lot of untreated depression. People turn to marijuana, alcohol and opiates.”
The best option for such women, Lauria said, is to get into treatment. But Lauria said she remains “amazed by how many people are using street drugs,” and the number of women who forgo methadone treatment because they don’t want go to a center for treatment every day.
Food-related dangers are on Lauria’s list of red flags, too, especially listeria and exposure to mercury. Listeria infection, which pregnant women can contract from eating soft cheeses, unpasteurized dairy products, or luncheon meats, “is a very real risk,” Lauria said. It infects the uterus and can cause pregnancy loss. That doesn’t mean pregnant women can’t eat ham sandwiches for lunch. They just need to heat the luncheon meats up until they steam, and save the brie for after the baby is born.
Lauria would have pregnant women reduce their exposure to mercury by avoiding some of the larger fish options on the market as well. The bigger the fish, such as swordfish, orange roughy and southern blue fin tuna, the more likely it is to contain high concentrations of mercury, which can lead to development delays. Lauria is wary of tuna, so readily available in convenient little cans. “But tuna is a big fish,” Lauria said. “And there has not been a lot of really good, systematic testing of tuna fish for mercury.”
Working Women’s Concerns
Back at Vivo Salon and Day Spa, Aldrich, a mother of one, said that she followed her midwife’s suggestions when she was pregnant. She avoid coloring her own hair during the first trimester, but continued to apply color and perform permanent waving services on her guests.
All of which is probably fine, according to Lauria.
“Studies have been done on people who work in hair salons and I don’t believe the magnitude of the effect is very big,” Lauria said. The thing that pregnant women want to be aware of is the effect of standing on their feet too long. Studies have shown some causation between “working incredibly long hours on your feet all day with small babies and pre-term births,” Lauria said. “But you have to be looking at 16 to 18 hours a day. Really, really long shifts or continuously lifting really heavy things.”
Neither of those conditions exist at Aldrich’s work place, which is also equipped, Aldrich said, “with an air ventilation/purification system that includes both carbon and HEPA (high-efficiency particulate air) filters.”
Aldrich said she also continues to expand the availability of organic hair care products, as well as products that don’t contain ammonia, sulfate or paraben, even if they haven’t been proven to cause problems in pregnancy.
Such measures would suit both Levin and Lauria. If you’re pregnant and itching to get your hair colored, Lauria said, “Use vegetable-based hair dyes — the ones that don’t smell bad. And make sure you’re getting your hair done in a well ventilated salon.”
Both doctors would also emphatically add: When you step out of the salon with your new hairdo, don’t smoke, drink, or use drugs.
Diane Taylor can be reached at 603-727-3221 or firstname.lastname@example.org.