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Occupational and environmental risks to reproduction in females

Author
Rose H Goldman, MD, MPH
Section Editor
Louise Wilkins-Haug, MD, PhD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Reproduction is a general term that applies to all aspects of procreation [1]. A reproductive hazard interferes with the ability of a couple to achieve a successful birth. Reproductive hazards affect fertility, conception, pregnancy, and/or delivery. Development refers to the growth and maturation of the embryo, fetus, infant, and child. A congenital defect in an organ system or limb, or an intellectual deficit that becomes manifest after birth, are examples of adverse developmental effects.

Occupational and environmental risks to the reproductive system are a concern to many patients and a high public health priority [2-4]. Well-known examples of devastating outcomes from exposure to teratogens include children born with limb malformations related to maternal use of thalidomide for insomnia or morning sickness, and children with severe neurological problems related to maternal consumption of methyl mercury contaminated fish from Minamata Bay (Japan).

Current concerns have been fueled by reports and studies of problems to common environmental agents, including contaminants from plastics (such as bisphenol A and phthalates), chemicals that act as endocrine disruptors, polychlorinated biphenyls (PCBs), low-level lead and mercury exposures, perchlorate, pesticides, and air pollution. Occupational exposures to these agents and others are also concerning, since a large number of women in the United States are engaged in occupations that have potential exposure to known or suspected reproductive toxicants [5]. Additional concerns have been raised about the toxic (and cumulative) effects of (low level) exposures to the myriad industrial chemicals that are not regulated with the aim of protecting children [6,7].

Exposure to small amounts of potentially toxic chemicals is common. In a study of lead, mercury, and PCB blood levels among women of childbearing age (16 to 49 years) who participated in the National Health and Nutrition Examination Survey (NHANES), 33 percent had levels at or above the median for two of these chemicals and another 23 percent had blood levels at or above the median for three of these chemicals [8]. Although the levels of each individual agent were well below levels usually considered of clinical significance, the authors pointed out the need to study the effects of combinations of low level chemicals.

TYPES OF REPRODUCTIVE HAZARDS

The three general categories of reproductive hazards are (1) physical factors (eg, radiation, exposure to electrical shock, excessive vibration or heat), (2) biological factors (eg, viruses, parasites), and (3) toxic agents (eg, toxicant exposure via ingestion, inhalation, or contact with skin). Some fetal toxicant exposures are concurrent with the pregnancy; however, others are the result of a previous (nonconcurrent) exposure, but with ongoing maternal elimination of the toxicant, or by mobilization of stored toxicants (eg, PCB's from fat stores, lead from bone stores).

                        

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