Environmental Contributions to Perinatal Outcomes Melissa A. McDiarmid, MD, MPH, DABT University of Maryland School of Medicine Occupational Health Program II.  Definitions     Reproductive and developmental risks will be separated     Reproductive Risks Alter the ability of a couple or a breeding pair to   successfully achieve a clinically recognized pregnancy        Developmental Risks Alter the embryo or fetus producing structural and/or functional malformations        Effects of toxic exposure to the reproductive system Environmental Medicine     refers to…”diagnosing and caring for people exposed to chemical and physical hazards in their homes, communities and workplace…     through such media as contaminated soil, water and air”    IOM, 1988;1992 Community Drinking Water Supply Well water – special case Proximity to hazardous industry or waste site Spontaneous Abortions Possibly Related to Ingestion of Nitrate-contaminated Well Water - - LaGrange County, Indiana, 1991-1994 Home Diet Hobbies Household Exposures Pesticides Paints/solvents EPA/FDA Fish Advisory 2004 Pregnant women Likely to become pregnant Breast feeding women No shark, swordfish, mackerel, tile fish Others up to 2 meals/week 6 oz. Each IOM, 2006 “reasonable intake…” 2 meals/week    3 oz each Bisphenol A Low acute toxicity “endocrine disruptor” Estrogen receptor agonist Mimics estrogen effects Workplace The principal exposure opportunity to environmental reproductive or developmental toxicants is the workplace. In 2002: 67M of the 113M women > age 16 were labor force participants. Nearly 6 of every ten women > age 16 work. 8 of every ten women between the ages of 20 and 54 work. One half of the nations teenaged women ages 16-19 work. Job Modification Consider Temporary Reassignment when potential for exposure cannot be adequately controlled through engineering or work-practices Medical history or risk factors suggest need Temporary Protective Reassignment Reassignment of Duties Within Same Job OR True Position Reassignment Needed Identify specific Duties within a Job as Hazardous Explore Scenarios of Temporary Duty Transfer rather than position re-assignment Discussions with affected Parties and Supervisors Summary Women work in many high hazard occupations with exposures which are key determinants of birth outcomes and child health. This point is under-recognized by care providers and policy markers when addressing outcomes surrounding pregnancy. Begin including environmental/occupational history and potential need for job modification as a standard element of the PC Care visit, Community Home Workplace