Why are ObGyns Talking Toxins ?

Let’s make environmental health part of health care

Doctors from 125 countries want policies to prevent exposure to toxic chemicals

Produced for PRHE by Susan Lamontagne, Public Interest Media Group, for the International Federation of Gynecology and Obstetrics (FIGO) XXI World Congress on September 30, 2015.

Why are Doctors Talking Toxins ?

And how to reduce exposure to toxic chemicals worldwide ?

It’s time to shift the burden of proof, from scientists, back to the chemical industry

Video published on 5 June 2019, by UCSF Program on Reproductive Health and the Environment.

Primodos Drug Cover-Up : Marie Lyon Talks, 2017

Marie Lyon, Chair of the ACDHPT, on Primodos pregnancy testing drug evidence

Hundreds of UK families have been battling for compensation over claims hormone-based drug ‘Primodos’ led to severe birth defects.

Reference : nzherald, 7:00 AM, 20 Mar 2017.

More information

  • All our posts tagged primodos. More than 60 videos ref primodos.
  • Studies :
    • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
    • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, see this post comment section.

Air pollution linked to higher risk of miscarriage

Acute effects of air pollutants on spontaneous pregnancy loss: a case-crossover study

2019 Study Abstract

Objective
To investigate the relationship between acute exposure to air pollutants and spontaneous pregnancy loss.

Design
Case-crossover study from 2007 to 2015.

Setting
An academic emergency department in the Wasatch Front area of Utah.

Patient(s)
A total of 1,398 women who experienced spontaneous pregnancy loss events.

Intervention(s)
None.

Main Outcome Measure(s)
Odds of spontaneous pregnancy loss.

Result(s)
We found that a 10-ppb increase in 7-day average levels of nitrogen dioxide was associated with a 16% increase in the odds of spontaneous pregnancy loss (odds ratio [OR] = 1.16; 95% confidence interval [CI] 1.01–1.33; P=.04). A 10-μg/m3 increase in 3-day and 7-day averages of fine particulate matter were associated with increased risk of spontaneous pregnancy loss, but the associations did not reach statistical significance (OR3-day average = 1.09; 95% CI 0.99–1.20; P=.05) (OR7-day average = 1.11; 95% CI 0.99–1.24; P=.06). We found no evidence of increased risk for any other metrics of nitrogen dioxide or fine particulate matter or any metric for ozone.

Conclusions
We found that short-term exposure to elevated levels of air pollutants was associated with higher risk for spontaneous pregnancy loss.

Maternal antidepressant use associated with increased risk of miscarriage

Major depression, antidepressant use, and male and female fertility : Cohort study

2018 Study Abstract

Objective
To determine if maternal major depression (MD), antidepressant use, or paternal MD are associated with pregnancy outcomes after non-IVF fertility treatments.

Design
Cohort study, DOI: https://doi.org/10.1016/j.fertnstert.2018.01.029, May 2018.

Setting
Clinics.

Patient(s)
Participants in two randomized trials: PPCOS II (clomiphene citrate versus letrozole for polycystic ovary syndrome), and AMIGOS (gonadotropins versus clomiphene citrate versus letrozole for unexplained infertility).

Intervention(s)
Female and male partners completed the Patient Health Questionnaire (PHQ-9). Female medication use was collected. PHQ-9 score ≥10 was used to define currently active MD.

Main Outcome Measure(s)
Primary outcome: live birth. Secondary outcomes: pregnancy, first-trimester miscarriage. Poisson regression models were used to determine relative risks after adjusting for age, race, income, months trying to conceive, smoking, and study (PPCOS II versus AMIGOS).

Result(s)
Data for 1,650 women and 1,608 men were included. Among women not using an antidepressant, the presence of currently active MD was not associated with poorer fertility outcomes (live birth, miscarriage), but rather was associated with a slightly increased likelihood of pregnancy. Maternal antidepressant use (n = 90) was associated with increased risk of miscarriage, and male partners with currently active MD were less likely to achieve conception.

Conclusion(s)
Currently active MD in the female partner does not negatively affect non-IVF treatment outcomes; however, currently active MD in the male partner may lower the likelihood of pregnancy. Maternal antidepressant use is associated with first-trimester pregnancy loss, which may depend upon the type of antidepressant.

Ambient air pollution and the risk of pregnancy loss

A prospective cohort study, January 2018

2018 Study Abstract

Objective
To estimate the association of pregnancy loss with common air pollutant exposure. Ambient air pollution exposure has been linked to adverse pregnancy outcomes, but few studies have investigated its relationship with pregnancy loss.

Design
Prospective cohort study.

Setting
Not applicable.

Patient(s)
A total of 343 singleton pregnancies in a multisite prospective cohort study with detailed protocols for ovulation and pregnancy testing.

Intervention(s)
None.

Main Outcome Measure(s)
Timing of incident pregnancy loss (from ovulation).

Result(s)
The incidence of pregnancy loss was 28% (n = 98). Pollutant levels at women’s residences were estimated using modified Community Multiscale Air Quality models and averaged during the past 2 weeks (acute) and the whole pregnancy (chronic). Adjusted Cox proportional hazards models showed that an interquartile range increase in average whole pregnancy ozone (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.07–1.17) and particulate matter <2.5 μm (HR 1.13, 95% CI 1.03–1.24) concentrations were associated with faster time to pregnancy loss. Sulfate compounds also appeared to increase risk (HR 1.58, 95% CI 1.07–2.34). Last 2 weeks of exposures were not associated with loss.

Conclusion(s)
In a prospective cohort of couples trying to conceive, we found evidence that exposure to air pollution throughout pregnancy was associated with loss, but delineating specific periods of heightened vulnerability await larger preconception cohort studies with daily measured air quality.

One particular flu vaccine linked with early miscarriages

Association of spontaneous abortion with receipt of inactivated influenza vaccine containing H1N1pdm09 in 2010–11 and 2011–12

A study, funded by the Centers for Disease Control and Prevention, found that women who had received an influenza vaccine containing the 2009 pandemic strain pH1N1 and who were also vaccinated in the next flu season had a statistically significant, 7.7-fold higher odds of spontaneous abortion within 28 days of the second vaccination. Image credit @rich_hurley.

2017 Study Abstract

Introduction
Inactivated influenza vaccine is recommended in any stage of pregnancy, but evidence of safety in early pregnancy is limited, including for vaccines containing A/H1N1pdm2009 (pH1N1) antigen. We sought to determine if receipt of vaccine containing pH1N1 was associated with spontaneous abortion (SAB).

Methods
We conducted a case-control study over two influenza seasons (2010–11, 2011–12) in the Vaccine Safety Datalink. Cases had SAB and controls had live births or stillbirths and were matched on site, date of last menstrual period, and age. Of 919 potential cases identified using diagnosis codes, 485 were eligible and confirmed by medical record review. Exposure was defined as vaccination with inactivated influenza vaccine before the SAB date; the primary exposure window was the 1–28 days before the SAB.

Results
The overall adjusted odds ratio (aOR) was 2.0 (95% CI, 1.1–3.6) for vaccine receipt in the 28-day exposure window; there was no association in other exposure windows. In season-specific analyses, the aOR in the 1–28 days was 3.7 (95% CI 1.4–9.4) in 2010–11 and 1.4 (95% CI 0.6–3.3) in 2011–12. The association was modified by influenza vaccination in the prior season (post hoc analysis). Among women who received pH1N1-containing vaccine in the previous influenza season, the aOR in the 1–28 days was 7.7 (95% CI 2.2–27.3); the aOR was 1.3 (95% CI 0.7–2.7) among women not vaccinated in the previous season. This effect modification was observed in each season.

Conclusion
SAB was associated with influenza vaccination in the preceding 28 days. The association was significant only among women vaccinated in the previous influenza season with pH1N1-containing vaccine. This study does not and cannot establish a causal relationship between repeated influenza vaccination and SAB, but further research is warranted.

Petites-filles DES : malformations utérines, fertilité, reproduction

Professeur Michel Tournaire, Réseau DES France, Forum d’Infertilité 2017

Vidéos en français: Distilbène DES : 60 vidéos à visionner sur YouTube.

Le troisième génération de victimes du médicament Distilbène® arrive aujourd’hui en âge de procréer.

Qu’en est-il au niveau de leur fertilité et risques supplémentaires en cas de grossesse ?

Le Professeur Michel Tournaire, membre du Conseil Scientifique de Réseau DES France, présente de nouveaux résultats de l’étude Distilbène 3 générations :

  • petites filles DES : malformations utérines.
  • petites filles DES : fertilité et reproduction.

Enregistrement provenant de la 4ème Journée Nationale de l’Infertilité, un forum d’information et d’aide aux personnes infertiles organisé cet automne 2017, Paris 12.

Le Distilbène DES, en savoir plus

Ambient air pollution and the risk of pregnancy loss

Air pollution exposure in early pregnancy linked to miscarriage

Exposure to common air pollutants, such as ozone and fine particles, may increase the risk of early pregnancy loss, according to a new study.

2017 Study Abstract

Objective
To estimate the association of pregnancy loss with common air pollutant exposure. Ambient air pollution exposure has been linked to adverse pregnancy outcomes, but few studies have investigated its relationship with pregnancy loss.

Design
Prospective cohort study.

Setting
Not applicable.

Patient(s)
A total of 343 singleton pregnancies in a multisite prospective cohort study with detailed protocols for ovulation and pregnancy testing.

Intervention(s)
None.

Main Outcome Measure(s)
Timing of incident pregnancy loss (from ovulation).

Result(s)
The incidence of pregnancy loss was 28% (n = 98). Pollutant levels at women’s residences were estimated using modified Community Multiscale Air Quality models and averaged during the past 2 weeks (acute) and the whole pregnancy (chronic). Adjusted Cox proportional hazards models showed that an interquartile range increase in average whole pregnancy ozone (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.07–1.17) and particulate matter <2.5 μm (HR 1.13, 95% CI 1.03–1.24) concentrations were associated with faster time to pregnancy loss. Sulfate compounds also appeared to increase risk (HR 1.58, 95% CI 1.07–2.34). Last 2 weeks of exposures were not associated with loss.

Conclusion(s)
In a prospective cohort of couples trying to conceive, we found evidence that exposure to air pollution throughout pregnancy was associated with loss, but delineating specific periods of heightened vulnerability await larger preconception cohort studies with daily measured air quality.

More Information

  • Ambient air pollution and the risk of pregnancy loss: a prospective cohort study, Fertility and Sterility, dx.doi.org/10.1016/j.fertnstert.2017.09.037, November 16, 2017.
  • Air pollution exposure in early pregnancy linked to miscarriage, NIH study suggests, National Institutes of Health, news-releases, November 16, 2017.
  • Pregnancy loss featured image credit Heather Kittredge

Endometriosis, especially mild disease : a risk factor for miscarriages

Prenatal exposure to estrogenic substances (such as DES) and environmental toxins (such as bisphenols) may increase the incidence of endometriosis in female offspring

2017 Study Abstract

Objective
To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).

Design
Cross-sectional analysis nested in a retrospective observational study (n = 940).

Setting
Hospitals and associated private practices.

Patient(s)
Previously pregnant women (n = 268) within reproductive age in matched pairs.

Intervention(s)
Retrospective analysis of surgical reports and self-administered questionnaires.

Main Outcome Measure(s)
Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months’ time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).

Result(s)
The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%–42.0%]) compared with CW (22.0% [16.7%–27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41–2.75). This remained significant in subfertile WwE (50.0% [40.7%–59.4%]) vs. CW (25.8% [8.5%–41.2%]) but not in fertile WwE (24.5% [16.3%–31.6%]) vs. CW (21.5% [15.9%–26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%–51.4%] vs. rASRM III/IV 30.8% [22.6%–38.7%], compared with 22.0% [16.7%–27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%–53.9%]) compared with ovarian endometriosis (28.6% [17.7%–38.7%]) and deep infiltrating endometriosis (33.9% [21.2%–46.0%]) compared with CW (22.0% [16.7%–27.0%]).

Conclusion(s)
Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.