Controversial advice on chemicals in pregnancy

Controversial advice on chemicals in pregnancy: The Daily Mail reports on the warning for pregnant women that household chemicals could pose a threat to their babies. ‘Don’t paint the nursery and avoid non-stick frying pans’ the Mail continues.

The news is based on advice to pregnant or breastfeeding women in a report from the Royal College of Obstetricians and Gynaecologists (RCOG).

The report, titled ‘Chemical exposure during pregnancy: dealing with potential, but unproven, risks to child health’ warns that pregnant and breastfeeding women could be exposed to harmful chemicals through:

• food packaging
• ordinary household products
• medicines
• personal care items such as moisturisers

It is important to stress that the advice is framed in a safety-first approach. There is no credible evidence that any of the items listed above pose a threat to birth outcomes.
A large amount of uncertainty exists because carrying out studies to assess these risks is difficult. This is because virtually all pregnant women are exposed to certain chemicals as they are found in everyday products.
The report provides a list of recommendations and examples of how women can avoid these potentially harmful chemicals (such as to minimise purchasing household furniture, frying pans or cars – see below for more details).
However, these recommendations are based on little evidence of any risk to the child. It recommends women put ‘safety first’ and assume a risk is present even when it may be small or proven not to be harmful.
Reassuringly, the report does say that one option is for mothers to do nothing and acknowledges that it may be difficult to avoid certain exposures.
The advice has prompted criticism by some, arguing that causing stress during pregnancy could do more damage than a theoretical, and as yet unproven, risk of chemical exposure.

Who are RCOG?

The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional membership organisation based in the UK. According to their website, they encourage the study and advancement of the science and practice of obstetrics and gynaecology (women’s reproductive health). They do this through education and training for their members as well as publication of clinical guidelines and reports for patients and practitioners working in this area.
According to the RCOG press release, the report has been produced by an RCOG Scientific Advisory Committee. It says these papers are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology and that the papers are intended to raise awareness of such issues.

Why has this report been produced?

According to the report, no official advice or guidelines exist that inform women who are pregnant or breastfeeding of the potential risks that some chemical exposures could pose for their babies.
Co-author of the paper, Dr Michelle Bellingham from the University of Glasgow, says, ‘there is much conflicting anecdotal [single observations] evidence about environmental chemicals and their potentially adverse effects on developing babies.’
She adds, ‘The information in this report is aimed at addressing this problem and should be conveyed routinely in infertility and antenatal clinics so women are made aware of key facts that will allow them to make informed choices regarding lifestyle changes.’

What evidence did the report look at?

The report states there is some evidence linking exposure to some chemicals during pregnancy with negative birth outcomes. Encouragingly, it emphasizes that this evidence is only of an association and there is no evidence that one causes the other (causality). It also says that some studies show no association between chemical exposure and disease. This evidence is not provided in detail but links to the primary research are included in the report.
The report mentions that other studies looking at this issue have investigated the effects of chemicals on pregnant animals. However, as the report points out, it is often difficult to interpret animal research and caution should be exercised when trying to generalise these findings to humans. In part, because in some of these studies the animals are exposed to levels of chemicals that would never occur in a real world human setting.
The focus of the report, it says, was to provide examples of where chemical exposures can be avoided.

What recommendations did the report make?

The report recommends the best approach for pregnant women is ‘safety-first’. It says this is ‘to assume there is a risk present even when it may be minimal or eventually unfounded.’
Other recommendations provided in the report include:

• use fresh food rather than processed food wherever possible
• reduce use of food and drink in cans or plastic containers
• minimise the use of personal care products such as moisturisers, cosmetics, shower gels and fragrances
• minimise the purchase of newly produced household furniture such as fabrics, non-stick frying pans, and cars while pregnant or breastfeeding
• avoid paint fumes and all pesticides, such as fly spray
• only take over-the-counter medicines when necessary
• do not assume safety of all ‘natural’ named products

Despite this list of recommendations, the report acknowledges that it may be difficult for mothers to deal with the uncertainty of chemical exposure risks and that one option is do nothing.

How has the report been received?

It is fair to say that the report has not been universally well received. Many commentators have criticised the findings as being needlessly alarmist without providing any credible evidence of a threat posed by everyday chemical exposure. Ultimately the report, in the words of the critics, provides little in the way of useful advice.
Tracey Brown, of the Sense About Science charitable trust was quoted by BBC News as saying “Pregnancy is a time when people spend a lot of time and money trying to work out which advice to follow, and which products to buy or avoid. The simple question parents want answered during pregnancy is: 'Should we be worried?'
"What we need is help in navigating these debates about chemicals and pregnancy. Disappointingly, the RCOG report has ducked this."

Conclusion

Nervous mothers-to-be may want to take on board RCOG’s recommendations, though as previously mentioned, the evidence to back up these recommendations is lacking. It is important not to lose sight of established harms that are known to cause damage to a pregnancy:

• smoking
• drinking alcohol
• using drugs
• certain types of medication, such as medications used to treat epilepsy
• eating certain foods, such as pate or liver

Read more about health and wellbeing in pregnancy in the NHS Choices Pregnancy and baby guide.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Food packaging and furniture: What to avoid when you're pregnant. The Independent, June 5 2013
A mum-to-be? Don't paint the nursery and avoid non-stick frying pans: Pregnant women warned over risk to baby from exposure to chemicals. Daily Mail, June 5 2013
Expectant mothers told not to paint the nursery or use non-stick frying pans in case of chemical exposure. The Daily Telegraph, June 5 2013
Chemicals: a worry for pregnant women? BBC News, June 5 2013
Pregnancy safety advice prompts criticism. BBC News, June 5 2013
Pregnant Women Warned Of Chemical Exposure. Sky News, June 5 2013
Pregnant women warned over household products. ITV News, June 5 2013