The clinical content of preconception care: environmental exposures

Environmental origins of disease risk and harm to health have been increasingly acknowledged for numerous outcomes, in both adult and pediatric populations. Adverse reproductive and developmental effects have also been linked to environmental exposures. In addition to the current queries about a patient's alcohol and smoking history, key determinants of a future pregnancy outcome should also be elicited during the preconception visit. These determinants include: (1) mercury intake via fish consumption; (2) nitrate exposure from well water sources; (3) exposure to chemical, physical, or biologic hazards on the job; and (4) lead and other toxic exposures—possibly from hobbies or the use of lead-glazed dinnerware in the home. Eliciting a detailed environmental history permits tailored recommendations to optimize the woman's health and that of her future pregnancy.