The rising number of mothers dying during childbirth in California and the steep increase in child obesity may originate in the environment.
That is the contention of obstetrician and Roseville Kaiser assistant physician-in-chief Jeanne Conry, who has made it her mission to spread the word that the health of any baby - and that of its mother during delivery - begins with awareness about environmental issues. Optimally, that awareness should begin months before conception, said Conry.
"We should always err on the side of caution, especially in the first trimester, to minimize exposure to all sorts of environmental toxins," said Conry, who lives in Granite Bay. "I describe these toxins in many ways to include alcohol, tobacco, drugs and chemicals in the environment."
Conry's assertion that environmental issues are key for expectant mothers sets her apart from many a past obstetrician. Her advocacy has drawn the attention of the U.S. Environmental Protection Agency, which recently awarded Conry the 2012 Environmental Justice Award.
"I think it's great that the EPA is acknowledging the relationship between medicine and environmental aspects," said Conry. "In medicine we often don't pay attention to environmental research."
She believes the link between medicine and the environment is in its infancy. That may change soon, however, given that Conry is now president-elect of the American Congress of Obstetricians and Gynecologists. That means that in 2013 she becomes the elected leader of the nation's top organization dedicated to women's reproductive health.
Conry believes the importance of environmental factors to a pregnant mother has been mostly off the radar because of a dearth of compelling science. But now she believes obstetricians need to take note.
Recent research suggests a strong link to environmental toxins and the health of newborns, such as a study by the UCLA Institute of the Environment and Sustainability of births from 1990 to 2003 of women residing in Southern California.
That study consistently found that mothers exposed to high levels of air pollution during pregnancy were at higher risk of adverse birth outcomes, including preterm delivery, low birth weight, and children with congenital heart defects.
"Over the last 15 or 20 years there has been a growing importance on how important it is to protect the most vulnerable population from exposure to chemicals," said Tracey Woodruff, associate professor and director of UCSF's Program on Reproductive Health and the Environment.
Woodruff nominated Conry for the EPA award because she believes that enlightened physicians should work in closer orbit with scientists, researchers and the EPA, she said.
"Conry recognizes that there is a tipping point on the science on environmental chemical exposure – particularly during pregnancy," Woodruff said.
Studies have shown that environmental factors such as air pollution have the greatest impact on a fetus during the first month of gestation.
And a new field of study – called epigenetics – is looking at how environmental factors can change the way genes are expressed – such as when a fetal cell makes the decision to become a bone or fat cell during pregnancy. The suggestion is that industrial pollutants may be at play in the steep rise on childhood obesity.
Bruce Blumberg a UC Irvine developmental biologist contends that lifestyle alone does not account for the obesity epidemic. He has studied how the chemical tributyltin – a substance used in paint for the hull of ships – can cause a bone cell to be expressed as a fat cell in mice.
The issue of obesity – in mothers and children are factors that are never far from Conry's mind now that she has entered her 23rd year as an obstetrician.
"What I have seen a lot more now is women that are overweight at the start of a pregnancy," said Conry. "Now I see women with a body mass index of 40 at the start of pregnancy, and women weighing 350 pounds at the start of a pregnancy – I did not see that before."
Conry contends that being overweight at pregnancy brings with it the possibility of delivery complications – for both mother and child.
The rising maternal mortality rate in California is also a vexing development that is dovetailing with the rise in overweight expectant mothers. The state's maternal mortality rate was 49 percent higher in 2006-2008 than in 1999-2001, according to the state's Department of Public Health data.
To counteract such trends, Conry believes that proper preconception health needs to begin early. "We now know that their blood sugar three months before they get pregnant impacts a pregnancy. Women need to be healthy before they conceive."
However, the reality is that most women never give that timeline a thought, she said.
Take folic acid, for example. Research shows that only about one in four women takes folic acid before conception, Conry said, adding that she thinks that estimate is high.
"A lot of women come in and say they have to start taking their vitamins," she said, "but I tell them I needed them to start taking their vitamins three months ago because they needed that extra folic acid."