Introduction

Many women thinking of becoming pregnant are not aware of the impact environmental toxicants can have on their pregnancy and the health of their child. Toxicants from food, water, air and products can be passed in-utero and during lactation affecting the health of the newborn child. Exposure to chemicals during these critical windows of development can affect the unborn child in various ways. Prenatal exposures can also affect the health of the pregnancy and pregnancy outcomes. It is imperative that physicians take an in-depth environmental history, offer testing for metals and other toxicants, educate woman on how to avoid exposures to chemicals, and guide them through a detoxification plan to remove chemicals from the body prior to conceiving.

Prenatal Exposure and Health Effects

Every day we eat, breath, drink, and put on our body, chemicals that can disrupt the hormonal, neurological and immune system. Many of these chemicals are lipophilic and easily cross the placental barrier. These chemicals not only affect the health of the child but also the health of the pregnancy. One example is the metal lead. There is a significant link between maternal blood lead levels and preeclampsia.^{1, 2} It is also known that maternal blood lead, at even low levels, can cause pre-term birth.³ Health care providers and patients need to be aware that adverse pregnancy outcomes may occur at blood lead concentrations well below the current acceptable levels. Lead isn’t the only chemical affecting pregnancy and the health of the newborn. Mercury from fish; PCBs from food, solvents from air pollution, and products used in the home; phthalates from plastics, food, and cosmetics; pesticides from food and air pollution; bisphenols from canned food, water bottles, and paper receipts; polyaromatic hydrocarbons from food and air pollution; and perfluorinated compounds from food and products, all play a role in prenatal health and outcomes.

In 2015, the International Federation of Gynecology and Obstetrics released an opinion documenting the links between prenatal exposure to environmental chemicals and adverse health outcomes on fertility and pregnancy, and neurodevelopment. The highlights include a link between the following chemicals and health conditions.⁴

• Decreased semen quality with PCBs;
• Miscarriage with solvents;
• Impaired fetal growth with pesticides;
• Miscarriage, low birth weight, and preterm delivery with air pollutants;
• Decreased birth weight, and congenital malformations with toluene;
• Shortened gestational age with phthalates;
• Low birth weight with PCBs;
• Reduced birth weight and fetal growth with perfluorinated compounds (PFCs);
• Impaired cognitive and neurodevelopment; increase in attention problems and ADHD, and reduction in working memory capabilities with pesticides and lead;
• Impaired neurodevelopment and reduction in executive function with phthalates and lead;
• Reduced cognitive performance, impaired neurodevelopment, and reduced psychomotor outcomes with methyl mercury;
• Reduced IQ, attention and executive function deficits with PCBs;
• Impaired neurodevelopment and reduction in attention with polybrominated diphenol ethers (PBDEs);
• Attention problems with polycyclic aromatic hydrocarbons (PAHs);
• Aggression and hyperactivity and reduction in executive functioning skills with BPA.

It is clear that exposure to toxic chemicals in food, water, air, and consumer products affects maternal and child health. Health care providers need to be on the front lines of educating women about avoiding exposure to chemicals before they get pregnant. It starts with in-depth environmental history to identify possible sources of exposure and offering toxicant testing to look for elevated levels in the blood and urine. Since almost every person is exposed in some degree to low doses of toxicants every day, some of which are difficult to detect with testing, providers may consider treatments to help remove the chemicals from the body prior to conceiving. This is often referred to as preconceptive detoxification or cleansing.

Detoxification or Cleansing

There are various methods to help the body process exposure to environmental toxicants. These methods are often referred to as detoxification or a cleanse. In general, the four steps in detoxification treatment plans include mobilizing stored toxins, supporting liver metabolism, enhancing elimination from the body, and avoiding re-exposure to chemicals in the environment.^5-9

Methods used to mobilize pesticides, solvents, and other fat-loving chemicals include

caloric restriction, sauna therapy, and chelation for metals.

Methods used to support liver phase one and two metabolic pathways, often called biotransformation, include nutrients that provide cofactors for liver phase one and phase two enzyme pathways: vitamin A (from mixed carotenes), vitamin C, vitamins D and E, all of the B-vitamins, calcium and magnesium, zinc and copper, molybdenum, kelp and iodine, selenium, choline, green tea, turmeric. Also beneficial are herbs that support the liver such as burdock, taraxacum root, silymarin, beet root, and artichoke. For women a treatment plan may include addition nutrients to support hormone metabolism, such as DIM, calcium-d-glucarate, NAC, ALA, methyl B12, methyl folate.

Lastly the plan should include methods to enhance elimination of toxicant bi-products such as; castor oil packs and sauna therapy and bowel support with fiber, coffee enema, or colonics.^5-9 Of course, avoidance education is key to reducing exposure to toxicants. Next follows an example of how to take a patient through this process.

Case

A few years ago, a 33-year-old woman came for a preconception detoxification plan and help with uterine fibroids. She had moderate dysmenorrhea her entire life and recently discovered she had small fibroids. She was ready to start a family with her husband and get healthy. Six years prior to the appointment she had an umbilical endometrioma removed, it was 1.5 cm. It was assumed by the OB/GYN she had endometriosis due to the endometrioma and dysmenorrhea, but the patient did not want to undergo laparoscopy at that time because the dysmenorrhea was mild.

Her family history was significant for the fact she was on only child and her mother had difficulty with fertility, had two miscarriages, uterine fibroids, and dysmenorrhea. Her paternal grandmother had ovarian cancer and her maternal aunt had breast cancer. She was on no medication and took 1,500 mg a day of omega-3 fatty acid, 5,000 iu a day of vitamin-D, and a B-complex. She ate very well—all organic, fish low in mercury—and had already removed cleaning and cosmetic products from her home deemed to contain toxicants. Her current labs were all normal and included CBC, CMP, Lipid, TSH, FT4, FT3, TPO AB, estradiol, testosterone, vitamin D, B12, iron, ESR, DHEA, cortisol and day 21 progesterone. A pelvic ultrasound showed two fibroids about 2 cm each.

An in-depth environmental history revealed she grew up in a major metropolitan city in Pennsylvania where there used to be a lot of industrial plants. She went to college in an area with numerous factories. Scorecard.org revealed that in the zip code where she grew up 3% of the homes had high lead and lots of industry polluting the air with solvents, sulfuric acid, nitrates, and propylene. There was one superfund site in her area, which from 1947 to 1963 disposed of waste contaminated with pentachlorophenol (PCP) in a well that drained into the ground water. In 2002, her county ranked among the dirtiest/worst 10% of all counties in the US in terms of cancer risk score (air and water releases) and the dirtiest/worst 10% of all counties in the US in terms of particulate matter (2.5). She had no toxic hobbies and as an adult did not live near industry or golf courses. She started filtering her water about 10 years prior with reverse osmosis and use a HEPA air filter eight years prior.

We decided to run a blood and first morning urine metal test and interpreted the results based on the NHANES data; her levels were below the 70%. She declined testing for other toxicants but did a test for liver phase one and two single nucleotide polymorphisms. The results showed a SNPs of phase one CYP 1A1 and CYP1B1 and heterozygous for phase two COMT, NAT2, and SOD2 pathways. It isn’t clear if she was born with these alterations or they were induced later in life by exposure to toxicants. It is clear however that these changes make it difficult for the liver to bio-transform toxicants and hormones.

The patient’s goal was to try and shrink the fibroids, and support her body to mobilize, metabolize, and eliminate toxicants from past and current exposures. Her plan included sauna therapy, which she managed to complete one session a week for eight weeks. She ate a healthy organic and toxicant-free diet, had four treatments of frequency specific microcurrent for uterine fibroids, and took three supplements. The supplements included one that provided cofactor support (ingredients listed above), an herbal product that had milk thistle, burdock root, dandelion root, beet root, and artichoke, and a third product with hormone metabolism support that contained methyl B12 and methylfolate, ALA, DIM, calcium-d-glucarate, and NAC. She was already using good water and air filtration at home and work and already taking vitamin D and fish oil. After eight weeks her dysmenorrhea resolved and never returned. The repeat pelvic ultrasound showed both uterine fibroids shrunk 1 cm each. She got pregnant easily eight months after completing the 8-week plan and she has three kids now. The dysmenorrhea never returned and 3 years after the initial plan she had a pelvic MRI that showed the same two fibroids where still 1cm each, there was no growth during the pregnancies.

Although this seems like a general plan, it can be applied to both women and men to help them prepare for a healthy pregnancy and pregnancy outcomes. Educating couple on avoiding exposures from food, products, air, and water is the first and very important step. An in-depth exposure history can guide the health care provider towards possible high dose exposure versus low dose daily exposure or exposure during critical windows of development such as in-utero and puberty. Toxicant testing can help determine best treatment options. If metals are present in the blood or urine, then chelation would be part of the treatment plan versus a general detoxification and cleanse to support liver biotransformation and elimination.

Summary

The endocrine, immune, and neurological effects of low dose chemical exposure from food, air, water, and products is well known and documented. It is also evident that prenatal exposure can affect the health of a pregnancy contributing to preeclampsia, low birth weight babies, and pre-term birth. Prenatal exposures can cross the placental barrier during this critical window of development affecting the health of offspring. Children’s asthma, allergies, ADD, ADHD, hormonal and developmental problems can be linked to prenatal exposure to toxicants. ^10,11 It is imperative that health care providers educate men and women on avoiding toxicants not only for their health but for the health of their offspring. An in-depth environmental history and toxicant testing can guide the practitioner towards possible exposures and help individualize a treatment plan. A treatment plan may include methods of mobilizing chemicals and supporting the liver’s biotransformation process and eliminating chemicals from the body. Early intervention prior to a couple conceiving is the best form of preventative medicine. All health care providers should consider making environmental health part of health care.

References

1. Bayat F, et al. The Relationship Between Blood Lead Level and Preeclampsia. Electron Physician. 2016 Dec 25;8(12):3450-3455.
2. Agency for Toxic Substances and Disease Registry (ATSDR). 2007. ToxGuide for Lead. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service https://www.atsdr.cdc.gov/csem/csem.asp?csem=34&po=10

3. Yadav G, et al. Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes. J Family Med Prim Care. 2020 Jun 30;9(6):3106-3111.
4. Di Renzo GC, et al. International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. Int J Gynaecol Obstet. 2015 Dec;131(3):219-25.
5. Marchese, M. Detoxication Strategies for Women. Townsend Letter. 2011. April:89-92
6. Crinnion W. Components of practical clinical detox programs–sauna as a therapeutic tool. Altern Ther Health Med. 2007 Mar-Apr;13(2):S154-6.
7. Cline JC. Nutritional aspects of detoxification in clinical practice. Altern Ther Health Med. 2015 May-Jun;21(3):54-62.
8. Hodges RE, Minich DM. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. J Nutr Metab. 2015;2015:760689. doi:10.1155/2015/760689
9. Peterson S, et al. CYP1A2, GSTM1, and GSTT1 polymorphisms and diet effects on CYP1A2 activity in a crossover feeding trial. Cancer Epidemiol Biomarkers Prev. 2009;18(11):3118-3125.
10. Nilsen FM, Frank J, Tulve NS. A Systematic Review and Meta-Analysis Investigating the Relationship between Exposures to Chemical and Non-Chemical Stressors during Prenatal Development and Childhood Externalizing Behaviors. Int J Environ Res Public Health. 2020;17(7):2361.
11. Nilsen FM, Ruiz JDC, Tulve NS. A Meta-Analysis of Stressors from the Total Environment Associated with Children’s General Cognitive Ability. Int J Environ Res Public Health. 2020;17(15):5451.