Genuis Stephen J, Genuis Rebecca A
Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada T5H 3V9; University of Calgary, Calgary, AB, Canada.
Millcreek Environmental Health Clinic, Edmonton, AB, Canada T6K 4C1.
Biomed Res Int. 2016;2016:6150976. doi: 10.1155/2016/6150976. Epub 2016 May 29.
Emerging research suggests that much pediatric affliction has origins in the vulnerable phase of fetal development. Prenatal factors including deficiency of various nutrients and exposure to assorted toxicants are major etiological determinants of myriad obstetrical complications, pediatric chronic diseases, and perhaps some genetic mutations. With recent recognition that modifiable environmental determinants, rather than genetic predestination, are the etiological source of most chronic illness, modification of environmental factors prior to conception offers the possibility of precluding various mental and physical health conditions. Environmental and lifestyle modification through informed patient choice is possible but evidence confirms that, with little to no training in clinical nutrition, toxicology, or environmental exposures, most clinicians are ill-equipped to counsel patients about this important area. With the totality of available scientific evidence that now exists on the potential to modify disease-causing gestational determinants, failure to take necessary precautionary action may render members of the medical community collectively and individually culpable for preventable illness in children. We advocate for environmental health education of maternity health professionals and the widespread adoption and implementation of preconception care. This will necessitate the translation of emerging knowledge from recent research literature, to health professionals, to reproductive-aged women, and to society at large.
新出现的研究表明,许多儿科疾病起源于胎儿发育的脆弱阶段。包括各种营养素缺乏和接触各种有毒物质在内的产前因素是众多产科并发症、儿科慢性病以及可能一些基因突变的主要病因决定因素。随着最近认识到可改变的环境决定因素而非遗传宿命是大多数慢性病的病因来源,受孕前改变环境因素提供了预防各种身心健康状况的可能性。通过明智的患者选择来改变环境和生活方式是可行的,但有证据证实,由于大多数临床医生在临床营养、毒理学或环境暴露方面几乎没有接受过培训,他们在为患者提供有关这一重要领域的咨询方面能力不足。鉴于目前存在的关于改变致病妊娠决定因素可能性的全部科学证据,不采取必要的预防措施可能会使医学界成员集体和个人对儿童可预防疾病负有责任。我们主张对孕产妇保健专业人员进行环境卫生教育,并广泛采用和实施孕前保健。这将需要把近期研究文献中的新知识转化给卫生专业人员、育龄妇女以及整个社会。