Implications for Clinical Practice
It would be inappropriate to suggest that environmental chemicals
represent the most important causes of reproductive and developmental
effects in Canada. We acknowledge that the factors influencing reproductive
health are multiple and diverse and include nutrition and behavioural
factors such as smoking and caffeine, alcohol and drug use. However,
the aim of this resource is to draw attention to the environmental
effects on reproductive health because it is not adequately addressed
in medical education and signifies potential problems on a public
Because of the complex nature of reproductive development, it is
a significant challenge to accurately identify causes of reproductive
disorders. This is particularly true since the effects from preconceptional
or prenatal exposures may not be detected until the individual (or
offspring of the exposed person) reaches sexual maturity and attempts
to conceive a child.
This summary indicates as well that there are still considerable
gaps in our knowledge of the exact effects on human reproductive
development from various environmental exposures.
Exposure to reproductive toxicants, however, can produce adverse
effects in men and women in their childbearing years, pregnant women,
infants and adolescents. The clinician, therefore, is well advised
to be cognizant of the potential for problematic exposures in these
categories of patients from the home, workplace or community.
Questions to Ask
Alongside a general medical history, a thorough environmental exposure
history is one important tool in identifying potential environmental
exposures of concern. Given that there are a number of potential
ways that children or their parents may be exposed to reproductive
toxicants, questions must cover the fundamental areas as outlined
by the CH2OP framework.
Greater Boston Physicians for Social Responsibility (GBPSR) provides
Fact Sheet that summarizes information on chemicals that affect
reproductive and developmental health and provides recommended questions
for taking an environmental history.
An exposure history should focus on exploring:
Are there local sources of exposure to substances such as
pesticides or heavy metals?
- Do people in the neighbourhood routinely apply pesticides
to their lawns?
- Have the neighbours nearby recently sprayed pesticides?
Children who play outdoors in summer may have direct exposure to
the drift from pesticide spraying, or they may be exposed from playing
on pesticide-treated lawns. Pesticides can also be tracked into
the home on shoes, feet and paws.
If the child lives in an agricultural community, or on a
farm, there may be exposure to pesticides used in fields. There
may also be contamination of ground water from agricultural run-off. Drift from pesticide spray may also contaminate household gardens.
If the neighbourhood is near a golf course there may also
be excess exposure to pesticides.
Is there an industrial source of exposure to lead (i.e., secondary
or primary lead smelter)?
- Use of chemicals, solvents, pesticides?
- Potential sources of exposure to lead?
Hobbies and Occupational Exposure
- Specific nature of the patient's past and present work, including
job classification, substances handled or present in the workplace,
duration of exposure
- Conditions in the workplace: levels of ventilation, air monitoring
- Personal habits around work, hobbies, i.e., use of protective
clothing, gloves, mask, respirator, hand-washing, showering, laundering
- Specific nature of patient's hobbies, i.e., what compounds used,
conditions of use, precautions taken
- Occupation and/or hobbies of spouse, partner or children
See also "The Pregnant Worker." (Sami Youakim, Harold
Hoffman and Laura Shanner. The Canadian Journal of CME. 1999;October:175-190.)
- Other high risk activities, e.g., sport fish consumption.