Obstet Gynecol. 2021 Jul 1;138(1):170-171. doi: 10.1097/AOG.0000000000004450.
There is emerging evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes. Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birth weight, neurodevelopmental delay such as autism and attention deficit hyperactivity disorder, and adult and childhood cancer. Although there is substantial overlap in the type of exposure and the associated health outcomes, for the purposes of this document, exposures can be generally grouped into the following categories: toxic chemicals, air pollution, and climate change-related exposures. Obstetric care clinicians do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists, if needed, when a hazardous exposure is identified. It is important for obstetrician-gynecologists and other obstetric care clinicians to become knowledgeable about toxic environmental exposures that are endemic to their specific geographic areas, such as local water safety advisories (eg, lead-contaminated water), local air quality levels, and patients' proximity to power plants and fracking sites. Although exposure to toxic environmental agents is widespread across populations, many environmental factors that are harmful to reproductive health disproportionately affect underserved populations and are subsumed in issues of environmental justice. Clinical encounters offer an opportunity to screen and counsel patients in during the prepregnancy and prenatal periods-particularly individuals most disproportionately affected-about opportunities to reduce toxic environmental health exposures. This Committee Opinion is revised to integrate more recent literature regarding reducing prepregnancy and prenatal toxic environmental exposures.
越来越多的证据表明，接触有毒环境因素与不良生殖和发育健康结果之间存在关联。与生殖和发育健康相关的有毒暴露主要与不孕不育和流产、早产和低出生体重等产科结局、自闭症和注意力缺陷多动障碍等神经发育迟缓以及成人和儿童癌症有关。尽管暴露类型和相关健康结果存在大量重叠，但就本文件而言，暴露通常可分为以下几类：有毒化学品、空气污染以及与气候变化相关的暴露。产科护理临床医生无需成为环境卫生科学专家，就能在识别出有害暴露时向患者提供有用信息，并在必要时将患者转介给合适的专科医生。对于妇产科医生和其他产科护理临床医生来说，了解其特定地理区域特有的有毒环境暴露情况非常重要，例如当地的水安全建议（如铅污染水）、当地空气质量水平以及患者与发电厂和水力压裂场地的距离。尽管接触有毒环境因素在人群中广泛存在，但许多对生殖健康有害的环境因素对服务不足的人群影响尤为严重，并被纳入环境正义问题之中。临床问诊提供了一个机会，可在孕前和孕期对患者进行筛查和咨询，尤其是对受影响最严重的人群，告知他们减少有毒环境健康暴露的机会。本委员会意见经过修订后纳入了更多关于减少孕前和孕期有毒环境暴露的最新文献。
