Environmental Toxins Associated With Recurrent Pregnancy Loss

Jennifer R. Gardella, R.N.C., M.S.N. and Joseph A. Hill III, M.D.

Disclosures

Semin Reprod Med. 2000;18(4) 

In This Article

Abstract and Introduction

Couples experiencing recurrent pregnancy loss are often concerned that toxins within the environment have contributed to their reproductive difficulty. Questions posed by these couples to their health care providers are difficult to answer because scientifically accurate information regarding the reproductive impact of potential environmental toxins and other teratogens is not readily available. Heavy metals such as lead and mercury, organic solvents, alcohol, and ionizing radiation are confirmed environmental teratogens, and exposure could contribute to pregnancy loss. Caffeine, cigarette smoking, and hyperthermia are suspected teratogens, and the teratogenic impact of pesticides remains unknown. The teratogenic potential of multiple other environmental factors has been studied and is reviewed. Before definitive conclusions can be drawn regarding the teratogenicity of environmental exposures, several clinical factors need to be addressed, including gestational age at the time of exposure, the amount of toxin reaching the conceptus, the duration of exposure, the impact of other factors or agents to which the mother or her conceptus is simultaneously exposed, and the physiological status of the mother and conceptus. In addition, in a given population, the interrelationship between frequency of exposures, frequency of effects, and recognizability of adverse outcomes, such as spontaneous abortion, should be considered.

Since the publication of Rachel Carson's Silent Spring in 1962,[1] society has become more aware of and concerned about environmental toxins. Many couples who have experienced recurrent pregnancy loss are concerned that toxins within the environment may have contributed to their reproductive difficulty. Scientifically accurate information concerning the reproductive impact of potential environmental toxins is not readily available to the public. In addition, popular media coverage often leads to exaggerated or inappropriate conclusions from research findings. Thus, it is important that health care providers, counseling patients about exposures to substances in the environment, have current and accurate information in order to respond to these concerns.

This article is designed to assist physicians and other health care providers in counseling patients who have concerns about possible effects of environmental agents on reproduction, specifically early pregnancy loss. Counseling should be tailored to each patient's individual intellectual, educational, psychosocial, and cultural background. Difficult or complex cases should be referred to appropriate specialists. The interested practitioner is encouraged to read additional texts and reviews, which provide more comprehensive information.[2,3,4,5,6]

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