Early Pregnancy Loss; simple changes to reduce your risk

 

One of the most challenging problems to diagnose and treat for couples trying to conceive is the problem of recurrent early pregnancy loss (REPL). As fertility specialists, we spend a tremendous amount of time and energy making sure that we control all of the variables that might improve the chances that a pregnancy gets a healthy start. New evidence shows that women can—and should—make some simple changes in their lifestyle to also improve their chances for a successful outcome.

 

A study presented at the 2015 meeting of the American Society for Reproductive Medicine recently highlighted the potential impact of a chemical called phthalates on the pregnancies of women going through IVF. This was part of a study called the EARTH study; an investigation on how environmental and lifestyle can impact reproductive health. They measured phthalate levels in the urine of about 250 women going through fertility treatment and then followed these levels in nearly 300 pregnancies. What they found was that women going through fertility treatment that had higher levels of this chemical in their body had a much higher chance of miscarrying then the fertility patients with lower levels. In fact, their risk could be as much as three to four times higher—depending upon their level of exposure.

 

An important aspect of modern research is to pose the question of “why?” In this case, the question would be “why would phthalates increase the risk of miscarriage.” The answer to that question is by interfering with the ability of ovary to support the development of the early pregnancy. Specifically, after an egg is released from the ovary; the cells that remain at the site of the egg’s origin form a hormone producing unit called a corpus luteum (CL). The function of this CL is to help get the pregnancy off to a strong start until the placenta is large enough to take over hormone production. In 2014 a well designed study found that phthalates directly interfere with the ability of the CL to perform this critical role.

 

A recent multi-centered clinical study found that women pursuing Advanced Reproductive Treatments (ART) like IVF had lower levels of phthalate in their body than infertility patients pursuing other forms of treatment. The believed explanation for this finding was that patients undergoing IVF may pursue healthier lifestyle choices. For instance, it is estimated that at least 90% of the phthalates in our bodies are due to dietary intake. By reducing processed foods and decreasing consumption of animal fats, phthalate levels fall rapidly. In fact, our bodies are able to eliminate phthalates after only 6 to 12 hours. So it is only through the continued exposure that these chemicals persist in the bloodstream. So by making better choices, patients may be able to reduce their risk of miscarriage by 75%.

 

Here are some easy steps that you can take to begin reducing your phthalate level today:

  • Only use nail polishes that are phthalate free—most add a phthalate called DBP to reduce chipping
  • Don’t microwave or cook your food in plastic containers or use plastic utensils to eat hot foods—heat leaches this chemical out of the plastics and into food—the easiest pathway into your body
  • Avoid plastic bottles—seek out glass or metal instead. When you must use plastic seek out bottles with the #2, #4 and #5 in the recycle triangle
  • Avoid perfumes and scented products—phthalates (DEP) are used to prolong fragrances
  • Don’t use air fresheners—most contain phthalates
  • Avoid vinyl containing products—many products like lawn furniture, rain coats or shower curtains can not only release phthalates that can be inhaled but they can also be absorbed through the skin as well.

Lead in Lipstick!?! Whose idea was that?

There have long been rumors that lipstick contains lead and but since cosmetic producers are not mandated to release the ingredients of their products, this fact remained hidden for many years. Back in 2007 the Campaign for Safe Cosmetics [r1] sent 33 brands of lipstick to an independent lab for testing and found that 61% tested positive for up to 0.65 parts per million of lead. What’s more they found top selling brands—including one that sold for $24 each—had the highest lead content! They reported their results to FDA and were promised an investigation.

It took the FDA two years and a letter from 3 US Senators to perform a follow up study. They found lead in every brand that they tested[r2] . Some of the brands had four times more lead in them then the Campaign study results. Despite these findings, the FDA did not take any action to protect consumers. More recently, an expanded analysis found lead levels as high as 7.19ppm. Even more surprising 5 of the top 10 most heavily contaminated brands were made by a one manufacturer[r3] , Loreal USA. Why aren’t consumers being made aware that something as toxic as lead is being sold to apply to their lips? That’s a hard question to answer.

The US Center for Disease Control and Prevention states that there is “No safe blood level for lead.” Lead is a neurotoxin. It accumulates in the body and it can even cross the placenta to harm a developing fetus. That’s why the only effective strategy against heavy metal poisoning is to minimize your risk of lead exposure. The effects of lead are well known and include lower IQ scores, behavioral problems, aggression and learning (especially language) disabilities.

More recently, a study demonstrated that high levels of lead can also contribute to infertility. In this study[r4] —conducted by the National Institute of Health—they found that women and men with higher levels of the heavy metals lead and cadmium experienced a nearly 30% reduction in their chance of conceiving. Although their study considered cigarettes to be the primary source of exposure to these toxic metals; their study was completed before the high lead levels in lipstick were revealed. Be a smart consumer and check out your personal care products and cosmetics before you apply: http://www.ewg.org/skindeep/browse/lipstick .

The Ugly Side of Beauty Products: many are loaded with toxic chemicals

Everyone likes to look and smell their best. But what is the real cost of that silky smooth skin and shiny hair? Cosmetics and personal care products contain various combinations of nearly 11,000 chemicals; only 11% of which have been evaluated for their safety. Maybe more concerning is that the Food and Drug Administration (FDA) [r1] has not set any premarketing standards for testing these products or disclosing the results when problems are detected. With the exception of California—which passed the California Safe Cosmetics Act of 2005 (Senate Bill 484)—the production of cosmetics is a self-regulated industry that generates over $50 billion annually. One easy (but inaccurate) way of trying to put consumer’s minds at ease by these companies is by promoting the notion that beauty products are applied externally and therefore have minimal opportunity to impact internal physiology.

Even though personal care products are applied topically; they are absorbed. How much they are absorbed depends upon several factors like, are they are applied near an opening (lipstick and eyeliner for instance gain entry easily); are they applied to a part of the body that is shaved (making for easier absorption); is it a moist or covered area (boosting the amount that penetrates the skin) and how often does is it applied or how long does it linger after application (dose). Another important aspect of a cosmetic’s ability to penetrate has to do with fragrance; the simple rule is if you can smell it, it is getting into your body and often into the bloodstream.

Let’s consider the example phthalates. These chemicals are plasticizing agents that add flexibility and a moisturizing sheen to products like nail polishes/nail hardeners, fragrances, mascara, lotions, shampoos/conditioners and sunscreens. If they appear on labels—not all cosmetics reveal ingredients—they are named for their specific chemical like DEP—most commonly used; DBP—used widely in nail polish; DMP—becoming more popular amongst manufacturers. They are well known for their ability to cause hormonal imbalance in both people and animals. They have been linked to early onset of puberty in girls[r2] , genital malformations in boys[r3]  born to women exposed during pregnancy and now there have been several studies linking them to an elevated risk of obesity[u4] . Most troubling of all, they aren’t even a necessary ingredient.

Nail products tend to be one of the greatest sources of exposure for women. Although one would not think a product could be absorbed through the nail, DBP is water soluble so slight amounts leach out each time the nail is wet. As a result, it can be absorbed by the skin or taken in orally if the leaching takes place during food preparation. In fact, the reason that nail polish becomes brittle and chips over time are due to the loss of DBP which is used to keep polishes flexible. Rest assured, there are phthalate-free products available now, and consumers have the right to be educated on why avoiding such hormone disruptors is important to their reproductive health.

The simplest way to reduce exposure to phthalates is to buy products that don’t contain them. By doing so, you’re also supporting manufacturers that are making more responsible decisions. If you’d like to check out your favorite brands as well as get some leads on healthy alternatives, go the Environmental Working Group’s Skin Deep Cosmetics Database[u5] . They have the lowdown on over 69,000 products.