Environmental effects on reproductive health are not adequately addressed in medical education signifying potential problems on a public health scale.

An environmental exposure history should explore potential exposures via:

• The community
• The home
• Hobbies
• Occupation
• Personal habits

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 health scale.

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 a Physician 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:

The Community

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)?

The Home

• 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 results
• Personal habits around work, hobbies, i.e., use of protective clothing, gloves, mask, respirator, hand-washing, showering, laundering of clothes
• 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.)

Personal Habits

• Other high risk activities, e.g., sport fish consumption.

PREVIOUS | NEXT