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Review

Reproductive health and the environment: Counseling patients about risks

Bella Haruty, MPH, REHS, Julie Friedman, MPH, CHES, Stephanie Hopp, MHS, MS, Ryane Daniels, MPHC and Janet Pregler, MD
Cleveland Clinic Journal of Medicine May 2016, 83 (5) 367-372; DOI: https://doi.org/10.3949/ccjm.83a.14070
Bella Haruty
Los Angeles County Department of Public Health, Environmental Health Division South Los Angeles District, Los Angeles, CA
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Julie Friedman
Director, Iris Cantor-UCLA Women’s Health Education and Research Center, Los Angeles, CA
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  • For correspondence: [email protected]
Stephanie Hopp
Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine
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Ryane Daniels
Tulane University, New Orleans, LA
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Janet Pregler
Director, Iris Cantor-UCLA Women’s Health Center, Los Angeles, CA
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    TABLE 1

    Information for patients: Tips for avoiding endocrine-disrupting chemicals

    Endocrine-disrupting chemicals may affect how hormones work in our bodies. They are found throughout the environment, and cannot be completely avoided.
    To reduce bisphenol A (BPA) exposure for infants
    Breastfeed infants for at least 12 months when possible for overall health. If breastfeeding is not an option, it is important to use the formula recommended by your healthcare provider.
    But be aware of the following:
    Liquid formula in cans contains BPA. A government study showed that powdered formula mix did not contain measurable amounts of BPA.
    Use BPA-free containers to prepare infant formula.
    As of 2009, the six major makers of infant bottles and feeding cups have not used BPA when manufacturing for the US market. Avoid older bottles and cups if possible.
    BPA is found in many items made of plastic, including baby toys. Look for “BPA-free,” although this is not a guarantee, since in some cases BPA has been replaced by similar chemicals. Some but not all plastics marked with recycle code 7 may be made with BPA.
    Do not heat foods in containers made with BPA. Hot or boiling liquids can transfer traces of BPA. When possible, avoid micro-waving foods in plastic containers.
    Liners of canned food containers are made with BPA. Rinse canned food well, and substitute fresh foods or food in other types of containers when possible.
    Do not use cracked or scratched plastics to prepare or contain liquids or solid food. Cracked or scratched plastics that contain BPA are more likely to transfer BPA to liquids and foods.
    To minimize pesticide exposure at home
    Reduce or eliminate pests through cleaning, home repair, and trapping. Avoid chemical pesticides.
    Eating fruits and vegetables is important for health
    It is more important for health to eat fruits and vegetables than to avoid pesticides by not eating any. To minimize pesticide exposure:
    Buy organic for foods with the highest levels of pesticides when grown nonorganically. These include apples, celery, bell peppers, peaches, strawberries, imported nectarines, grapes, spinach, lettuce, cucumbers, domestic blueberries, and potatoes.
    Eat foods that are low in pesticides when conventionally grown, including onions, sweet corn, pineapples, avocado, cabbage, sweet peas, asparagus, mangoes, eggplant, kiwi, domestic cantaloupe, sweet potatoes, grapefruit, watermelon, and mushrooms.
    Avoid phthalates
    Phthalates are found in many personal-care products. Diethyl phthalate, dimethyl phthalate, and dibutyl phthalate are commonly used in deodorants, fragrances, hair sprays, hand and body lotions, and nail polish. Unfortunately, not all products that contain them may list them as an ingredient on the label. Read the label and avoid products containing phthalates. Look for “phthalate-free.”
    Plastics with recycle code 3 may contain phthalates.
    Avoid flame-retardant chemicals
    Fire retardants are often used in polyurethane foam found in items such as couches, upholstered chairs, futons, car seats, crib mattresses, and nap pads.
    Endocrine disruption is linked to compounds such as tris (1,3-dichloro-2-propyl) phosphate (TDCPP, also known as chlorinated tris and Firemaster) found in household products, including furniture, appliances, electronics, and baby products.
    Reproductive difficulties and developmental delays are linked to some flame retardants.
    Older foam products (ie, made before 2005) may be more hazardous.
    Buy products without flame retardants.
    • Based on information in references 24–26.

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    TABLE 2

    Resources on reproductive health and the environment

    Information from professional associations, academic institutions, community organizations, and government agencies
    Academic Pediatric Association
    Research articles
    American Society for Reproductive Medicine
    Environment and reproduction special interest group membership information
    Research articles
    Smoking and infertility
    Asian Communities for Reproductive Justice
    Safer products and working conditions, specifically in nail salons
    Association of Reproductive Health Professionals
    Clinical publications
    Continuing medical education
    Research
    California Healthy Nail Salon Collaborative
    Improving the health and safety of workers and customers in nail salons
    California Teratogen Information Service
    Pregnancy risk information
    Environmental exposures and reproductive health
    Center for Science in the Public Interest
    Steps to protect pregnant women from harmful bacteria and parasites in food
    Collaborative on Health and the Environment
    Chemicals, endocrine disruptors, and reproductive health concerns
    Environmental Working Group
    Index of chemicals with associated routes of exposure and health effects
    March of Dimes
    Environmental risks and pregnancy
    Mercury and reproductive health
    Moms Rising
    Pesticides and pregnancy
    National Institute of Environmental Health Science
    How endocrine disruptors work and their effects
    US Centers for Disease Control and Prevention
    Effects of tobacco, pesticides, and lead on reproductive health and infertility
    Diethylstilbestrol update
    US Food and Drug Administration
    dvice for parents on bisphenol A
    University of California San Francisco Program on Reproductive Health and the Environment
    Publications on reproductive health related to exposures at work, food and chemical exposure, and toxins in everyday living
    Women for a Healthy Environment
    dvice on eating habits, exercising, and avoiding certain chemicals for healthier, environmentally safe pregnancies
    Women’s Health and the Environment
    Information on avoiding polyvinyl chloride, styrene, and polycarbonate to maintain hormonal health
    Women’s Voices for the Earth
    Chemicals and reproductive health
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Cleveland Clinic Journal of Medicine: 83 (5)
Cleveland Clinic Journal of Medicine
Vol. 83, Issue 5
1 May 2016
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Reproductive health and the environment: Counseling patients about risks
Bella Haruty, Julie Friedman, Stephanie Hopp, Ryane Daniels, Janet Pregler
Cleveland Clinic Journal of Medicine May 2016, 83 (5) 367-372; DOI: 10.3949/ccjm.83a.14070

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Reproductive health and the environment: Counseling patients about risks
Bella Haruty, Julie Friedman, Stephanie Hopp, Ryane Daniels, Janet Pregler
Cleveland Clinic Journal of Medicine May 2016, 83 (5) 367-372; DOI: 10.3949/ccjm.83a.14070
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    • ABSTRACT
    • ENDOCRINE-DISRUPTING CHEMICALS ARE UBIQUITOUS
    • EDCs AFFECT MULTIPLE PATHWAYS
    • EVIDENCE OF HARM, LIMITATIONS OF EVIDENCE
    • THE PRECAUTIONARY PRINCIPLE
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