Is Your Doctor Looking Out For You?

Expansion of Environmental Exposure Care in ACOG Guidelines

Your practicing Obstetrician-Gynecologist (OBGYN) and other maternal and child health (MCH) professionals turn to established guidelines and protocols when cultivating the most relevant and quality care they can provide. For the care of mothers and children, The American College of Obstetricians and Gynecologists (ACOG) provides published guidelines for perinatal care. From prepregnancy care to postnatal care, the piece builds a well grounded foundation for OBGYN care and counseling sessions for patients; it includes topics like family planning, immunizations, medications, genetic history, screenings for newborns, and even teratogen exposure (1). Despite this, there is zero mention of EDCs and little to no guidance on what screening for teratogens or environmental/occupational exposures might look like. 

In July 2021, the ACOG released a Committee Opinion piece supporting the expansion of perinatal care guidelines to include screening for environmental toxins both before and after pregnancy (2). Although they acknowledged that OBGYNS do not have to be experts in this field, it is still important that environmental health is given space at appointments to be screened for and discussed. Reducing exposure to toxins can also reduce the prevalence of adverse health outcomes it’s linked to – including, but not limited to, infertility, developmental differences, miscarriage, and preterm birth. The document highlights key information regarding new research and emerging information that links environmental exposures and adverse reproductive and developmental health outcomes (2). The paper also acknowledges that environmental exposure can range from water contaminants and air pollution to personal care products and disparities in exposures do exist. Communities of color are at risk of being more heavily exposed, making it even more important for their first line of maternal and child health (MCH) providers to provide support in combating environmental exposures. The opinion piece clearly states the recommendations and conclusions of the ACOG, found here. However, the question remains: Why hasn’t the ACOG expanded their prenatal care guidelines to include screening for environmental toxins? 

ACOG guidelines and protocols are extremely important for care. Every 24 to 26 months, the ACOG clinical guidelines are reviewed by the committee reviewers to assess for its relevance and accuracy on OBGYN care (3). It has become clear that endocrine-disrupting chemicals are impacting this community and something needs to be done to address it. When care becomes standardized not only does patient care become more cost effective, but quality of practice and the delivery of support also improves (3). If OBGYNs are encouraged to conduct assessments and counseling for patients to discuss typical exposures – at the workplace, at home, etc – and realistic plans of actions in reducing toxic agents, we can work towards a healthier future. 

As the ACOG mentioned, “scientific uncertainty should not be used to postpone preventative measures” (2). With that, we ask that our community members from Pregnancy, Baby, and You help us and many other environmental health advocates in encouraging the ACOG to take the next step and formally include counseling and education of prenatal exposure to toxic agents in their “Guidelines for Perinatal Care.” Help us by sending this email to the Advisory Committee urging for environmental health action!