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Clinical opinion Obstetrics| Volume 207, ISSUE 3, P164-173, September 2012

Toxic environmental chemicals: the role of reproductive health professionals in preventing harmful exposures

Published:March 12, 2012DOI:https://doi.org/10.1016/j.ajog.2012.01.034
      Every pregnant woman in the United States is exposed to many and varied environmental chemicals. Rapidly accumulating scientific evidence documents that widespread exposure to environmental chemicals at levels that are encountered in daily life can impact reproductive and developmental health adversely. Preconception and prenatal exposure to environmental chemicals are of particular importance because they may have a profound and lasting impact on health across the life course. Thus, prevention of developmental exposures to environmental chemicals would benefit greatly from the active participation of reproductive health professionals in clinical and policy arenas.

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      References

        • Wolff M.S.
        • Teitelbaum S.L.
        • Pinney S.M.
        • et al.
        Investigation of relationships between urinary biomarkers of phytoestrogens, phthalates, and phenols and pubertal stages in girls.
        Environ Health Perspect. 2010; 118: 1039-1046
        • Swan S.H.
        • Hertz-Picciotto I.
        Reasons for infecundity.
        Fam Plann Perspect. 1999; 31: 156-157
        • Brett K.
        Fecundity in 2002 NSFG women 15-24 years of age.
        National Center for Health Statistics, Hyattsville, MD2008
        • Bhutta A.T.
        • Cleves M.A.
        • Casey P.H.
        • Cradock M.M.
        • Anand K.
        Cognitive and behavioral outcomes of school-aged children who were born preterm.
        JAMA. 2002; 288: 728-737
        • Hamilton B.E.
        • Martin J.A.
        • Ventura M.A.
        • et al.
        Births: preliminary data for 2009.
        (Accessed Feb. 14, 2012)
        • Donahue S.
        • Kleinman K.P.
        • Gillman M.W.
        • Oken E.
        Trends in birth weight and gestational length among singleton term births in the United States: 1990-2005.
        Obstet Gynecol. 2010; 115: 357-364
        • Vu L.T.
        • Nobuhara K.K.
        • Laurent C.
        • Shaw G.M.
        Increasing prevalence of gastroschisis: population-based study in California.
        J Pediatr. 2008; 152: 807-811
        • Prevalence of autism spectrum disorders
        Autism and Developmental Disabilities Monitoring Network, United States, 2006.
        MMWR Surveill Summ. 2009; 58: 1-20
        • US Environmental Protection Agency
        America's children and the environment.
        USEPA, Washington, DC2010 (Accessed Feb. 14, 2012)
        • Centers for Disease Control and Prevention
        Overweight and obesity.
        CDC, Atlanta2011 (Accessed Feb. 14, 2012)
        • Kulkarni S.C.
        • Levin-Rector A.
        • Ezzati M.
        • Murray C.J.L.
        Falling behind: life expectancy in US counties from 2000 to 2007 in an international context.
        Popul Health Metr. 2011; 9: 16
        • Woodruff T.J.
        • Schwartz J.
        • Giudice L.C.
        Research agenda for environmental reproductive health in the 21st century.
        J Epidemiol Community Health. 2010; 64: 307-310
        • Olden K.
        • Freudenberg N.
        • Dowd J.
        • Shields A.E.
        Discovering how environmental exposures alter genes could lead to new treatments for chronic illnesses.
        Health Aff (Millwood). 2011; 30: 833-841
        • Huen K.
        • Harley K.
        • Brooks J.
        • et al.
        Developmental changes in PON1 enzyme activity in young children and effects of PON1 polymorphisms.
        Environ Health Perspect. 2009; 117: 1632-1638
        • Ren C.
        • Park S.K.
        • Vokonas P.S.
        • et al.
        Air pollution and homocysteine: more evidence that oxidative stress-related genes modify effects of particulate air pollution.
        Epidemiology. 2010; 21: 198-206
        • Wright R.J.
        • Visness C.M.
        • Calatroni A.
        • et al.
        Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inner-city cohort.
        Am J Respir Crit Care Med. 2010; 182: 25-33
        • Wright R.O.
        • Schwartz J.
        • Wright R.J.
        • et al.
        Biomarkers of lead exposure and DNA methylation within retrotransposons.
        Environ Health Perspect. 2010; 118: 790-795
        • Guilloteau P.
        • Zabielski R.
        • Hammon H.
        • Metges C.
        Adverse effects of nutritional programming during prenatal and early postnatal life, some aspects of regulation and potential prevention and treatments.
        J Physiol Pharmacol. 2009; 60: 17-35
        • Kordas K.
        Iron, lead, and children's behavior and cognition.
        Annu Rev Nutr. 2010; 30: 123-148
        • Burke M.G.
        • Miller M.D.
        Practical guidelines for evaluating lead exposure in children with mental health conditions: molecular effects and clinical implications.
        Postgrad Med. 2011; 123: 160-168
        • Cheadle A.
        • Samuels S.E.
        • Rauzon S.
        • et al.
        Approaches to measuring the extent and impact of environmental change in three California community-level obesity prevention initiatives.
        Am J Public Health. 2010; 100: 2129-2136
        • Morello-Frosch R.
        • Lopez R.
        The riskscape and the color line: examining the role of segregation in environmental health disparities.
        Environ Res. 2006; 102: 181-196
        • Schneider J.S.
        • Lee M.
        • Anderson D.
        • Zuck L.
        • Lidsky T.
        Enriched environment during development is protective against lead-induced neurotoxicity.
        Brain Res. 2001; 896: 48-55
        • Weiss B.
        • Bellinger D.C.
        Social ecology of children's vulnerability to environmental pollutants.
        Environ Health Perspect. 2006; 114: 1479-1485
        • Wright R.O.
        Neurotoxicology: what can context teach us?.
        J Pediatr. 2008; 152: 155-157
        • Morello-Frosch R.
        • Zuk M.
        • Jerrett M.
        • Shamasunder B.
        • Kyle A.D.
        Understanding the cumulative impacts of inequalities in environmental health: implications for policy.
        Health Aff (Millwood). 2011; 30: 879-887
        • Williams D.R.
        • Sternthal M.
        Understanding racial-ethnic disparities in health.
        J Health Soc Behav. 2010; 51: S15-S27
        • Marmot M.G.
        • Bell R.
        Action on health disparities in the United States Commission on Social Determinants of Health.
        JAMA. 2009; 301: 1169-1171
        • National Research Council Committee on improving risk analysis approaches used by the US EPA, National Research Council Board on Environmental Studies and Toxicology, National Research Council Division on Earth and Life Studies
        Science and decisions: advancing risk assessment.
        The National Academies Press, Washington, DC2009
        • Woodruff T.J.
        • Zota A.R.
        • Schwartz J.M.
        Environmental chemicals in pregnant women in the US: NHANES 2003-2004.
        Environ Health Perspect. 2011; 119: 878-885
        • Sugiura-Ogasawara M.
        • Ozaki Y.
        • Sonta S.
        • Makino T.
        • Suzumori K.
        Exposure to bisphenol A is associated with recurrent miscarriage.
        Human reproduction. 2005; 20: 2325
        • Braun J.M.
        • Yolton K.
        • Dietrich K.N.
        • et al.
        Prenatal bisphenol A exposure and early childhood behavior.
        Environ Health Perspect. 2009; 117: 1945
        • Jedrychowski W.
        • Perera F.
        • Maugeri U.
        • et al.
        Intrauterine exposure to lead may enhance sensitization to common inhalant allergens in early childhood: a prospective prebirth cohort study.
        Environ Res. 2011; 111: 119-124
        • Grandjean P.
        • Weihe P.
        • White R.F.
        • et al.
        Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury.
        Neurotoxicol Teratol. 1997; 19: 417-428
        • Grandjean P.
        • Weihe P.
        • White R.F.
        • Debes F.
        Cognitive performance of children prenatally exposed to “safe” levels of methylmercury.
        Environ Res. 1998; 77: 165-172
        • Davidson P.W.
        • Strain J.
        • Myers G.J.
        • et al.
        Neurodevelopmental effects of maternal nutritional status and exposure to methylmercury from eating fish during pregnancy.
        Neurotoxicology. 2008; 29: 767-775
        • Lederman S.A.
        • Jones R.L.
        • Caldwell K.L.
        • et al.
        Relation between cord blood mercury levels and early child development in a World Trade Center cohort.
        Environ Health Perspect. 2008; 116: 1085
        • Herbstman J.B.
        • Sjödin A.
        • Kurzon M.
        • et al.
        Prenatal exposure to PBDEs and neurodevelopment.
        Environ Health Perspect. 2010; 118: 712-719
        • Wu K.
        • Xu X.
        • Liu J.
        • Guo Y.
        • Li Y.
        • Huo X.
        Polybrominated diphenyl ethers in umbilical cord blood and relevant factors in neonates from Guiyu, China.
        Environ Sci Technol. 2009; 44: 813-819
        • Sagiv S.K.
        • Thurston S.W.
        • Bellinger D.C.
        • Tolbert P.E.
        • Altshul L.M.
        • Korrick S.A.
        Prenatal organochlorine exposure and behaviors associated with attention deficit hyperactivity disorder in school-aged children.
        Am J Epidemiol. 2010; 171: 593-601
        • Verhulst S.L.
        • Nelen V.
        • Den Hond E.
        • et al.
        Intrauterine exposure to environmental pollutants and body mass index during the first 3 years of life.
        Environ Health Perspect. 2009; 117: 122
        • Jacobson J.L.
        • Jacobson S.W.
        Intellectual impairment in children exposed to polychlorinated biphenyls in utero.
        N Engl J Med. 1996; 335: 783-789
        • Washino N.
        • Saijo Y.
        • Sasaki S.
        • et al.
        Correlations between prenatal exposure to perfluorinated chemicals and reduced fetal growth.
        Environ Health Perspect. 2009; 117: 660-667
        • Steinmaus C.
        • Miller M.D.
        • Smith A.H.
        Perchlorate in drinking water during pregnancy and neonatal thyroid hormone levels in California.
        Journal of Occupational and Environmental Medicine. 2010; 52: 1217
        • Rauh V.A.
        • Garfinkel R.
        • Perera F.P.
        • et al.
        Impact of prenatal chlorpyrifos exposure on neurodevelopment in the first 3 years of life among inner-city children.
        Pediatrics. 2006; 118: e1845-e1859
        • Rauh V.
        • Arunajadai S.
        • Horton M.
        • et al.
        Seven-year neurodevelopmental scores and prenatal exposure to chlorpyrifos, a common agricultural pesticide.
        Environ Health Perspect. 2011; 119: 1196-1201
        • Whyatt R.M.
        • Rauh V.
        • Barr D.B.
        • et al.
        Prenatal insecticide exposures and birth weight and length among an urban minority cohort.
        Environ Health Perspect. 2004; 112: 1125
        • Cohn B.A.
        • Cirillo P.M.
        • Christianson R.E.
        Prenatal DDT exposure and testicular cancer: a nested case-control study.
        Arch Environ Occup Health. 2010; 65: 127-134
        • Wigle D.T.
        • Arbuckle T.E.
        • Turner M.C.
        • et al.
        Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants.
        Critical Reviews. 2008; 11: 373-517
        • Swan S.H.
        • Liu F.
        • Hines M.
        • et al.
        Prenatal phthalate exposure and reduced masculine play in boys.
        Int J Androl. 2010; 33: 259-269
        • Swan S.H.
        • Main K.M.
        • Liu F.
        • et al.
        Decrease in anogenital distance among male infants with prenatal phthalate exposure.
        Environ Health Perspect. 2005; 113: 1056
        • Latini G.
        • De Felice C.
        • Presta G.
        • et al.
        In utero exposure to di-(2-ethylhexyl) phthalate and duration of human pregnancy.
        Environ Health Perspect. 2003; 111: 1783
        • Engel S.M.
        • Zhu C.
        • Berkowitz G.S.
        • et al.
        Prenatal phthalate exposure and performance on the Neonatal Behavioral Assessment Scale in a multiethnic birth cohort.
        Neurotoxicology. 2009; 30: 522-528
        • Ahmed P.
        • Jaakkola J.J.K.
        Exposure to organic solvents and adverse pregnancy outcomes.
        Human reproduction. 2007; 22: 2751
        • Wilkins Haug L.
        Teratogen update: toluene.
        Teratology. 1997; 55: 145-151
        • Jones H.E.
        • Balster R.L.
        Inhalant abuse in pregnancy.
        Obstetrics and gynecology clinics of North America. 1998; 25: 153-167
        • Woodruff T.J.
        • Carlson A.
        • Schwartz J.M.
        • Giudice L.C.
        Proceedings of the summit on environmental challenges to reproductive health and fertility: executive summary.
        Fertil Steril. 2008; 89: e1-e20
        • Morin N.J.
        Annual chemical production in the United States.
        Federal Reserve Board, Washington, DC2011
        • US Environmental Protection Agency
        TSCA chemical substance inventory: basic information.
        USEPA, Washington, DC2011
        • US Environmental Protection Agency; Overview
        Office of Pollution PreventionToxics Programs.
        USEPA, Washington, DC2007 (Accessed Feb. 14, 2012)
        • US Environmental Protection Agency
        Master testing list: introduction.
        USEPA, Washington, DC2011 (Accessed Feb. 14, 2012)
        • Vogel S.A.
        • Roberts J.A.
        Why the toxic substances control act needs an overhaul, and how to strengthen oversight of chemicals in the interim.
        Health Aff (Millwood). 2011; 30: 898-905
        • Wilson M.P.
        • Schwarzman M.R.
        Toward a new US chemicals policy: rebuilding the foundation to advance new science, green chemistry, and environmental health.
        Environ Health Perspect. 2009; 117: 1202-1209
        • Stephenson J.B.
        • US Government Accountability Office
        Actions are needed to improve the effectiveness of EPA's Chemical Review Program: testimony before the Committee on Environment and Public Works, US Senate.
        US Government Accountability Office, Washington, DC2006
        • Council on Environmental Health
        Chemical-management policy: prioritizing children's health.
        Pediatrics. 2011; 127: 983-990
        • Landrigan P.J.
        • Goldman L.R.
        Children's vulnerability to toxic chemicals: a challenge and opportunity to strengthen health and environmental policy.
        Health Aff (Millwood). 2011; 30: 842-850
        • American Medical Association
        Resolution 404: modern chemicals policies.
        in: proceedings of the american medical association house of delegates: 157th Annual Meeting American Medical Association, Chicago2008
        • US Environmental Protection Agency
        Essential principles for reform of chemicals management legislation.
        USEPA, Washington, DC2010 (Accessed Feb. 14, 2012)
        • Safer Chemicals HFC
        The health case for reforming the toxic substances control act, 2011 (vol 2011).
        (Accessed Feb. 14, 2012)
        • American Chemistry Council
        10 principles for modernizing TSCA, 2011 (vol 2011).
        (Accessed Feb. 14, 2012)
        • Woodruff T.J.
        • Zeise L.
        • Axelrad D.A.
        Meeting report: moving upstream—evaluating adverse upstream end points for improved risk assessment and decision-making.
        Environ Health Perspect. 2008; 116: 1568-1575
        • Barr D.B.
        • Bishop A.
        • Needham L.L.
        Concentrations of xenobiotic chemicals in the maternal-fetal unit.
        Reprod Toxicol. 2007; 23: 260-266
        • Rollin H.B.
        • Rudge C.V.
        • Thomassen Y.
        • Mathee A.
        • Odland J.O.
        Levels of toxic and essential metals in maternal and umbilical cord blood from selected areas of South Africa: results of a pilot study.
        J Environ Monit. 2009; 11: 618-627
        • Stern A.H.
        • Smith A.E.
        An assessment of the cord blood: maternal blood methylmercury ratio: implications for risk assessment.
        Environ Health Perspect. 2003; 111: 1465-1470
        • Reuben S.H.
        • President's Cancer Panel
        Reducing environmental cancer risk: what we can do now.
        National Cancer Institute, Bethesda2010
        • Diamanti-Kandarakis E.
        • Bourguignon J.P.
        • Giudice L.C.
        • et al.
        Endocrine-disrupting chemicals: an Endocrine Society scientific statement.
        Endocr Rev. 2009; 30: 293-342
        • Jaga K.
        • Dharmani C.
        Global surveillance of DDT and DDE levels in human tissues.
        Int J Occup Med Environ Health. 2003; 16: 7-20
        • Solomon G.M.
        • Weiss P.M.
        Chemical contaminants in breast milk: time trends and regional variability.
        Environ Health Perspect. 2002; 110: A339-A347
        • National Research Council (US); Committee on the Health Risks of Phthalates
        National Academies Press (US), 2008
        • Crain D.A.
        • Janssen S.J.
        • Edwards T.M.
        • et al.
        Female reproductive disorders: the roles of endocrine-disrupting compounds and developmental timing.
        Fertil Steril. 2008; 90: 911-940
        • Grandjean P.
        • Bellinger D.
        • Bergman A.
        • et al.
        The Faroes statement: human health effects of developmental exposure to chemicals in our environment.
        Basic Clin Pharmacol Toxicol. 2008; 102: 73-75
        • Woodruff T.J.
        • Jansssen S.J.
        • Guillette L.J.
        • Giudice L.C.
        Environmental impacts on reproductive health and fertility.
        Cambridge University Press, Cambridge; New York2010
        • Newbold R.
        • Heindel J.
        Developmental exposures and implications for disease.
        in: Woodruff T.J. Jansssen S.J. Guillette L.J. Giudice L.C. Environmental impacts on reproductive health and fertility. Cambridge University Press, Cambridge, UK2010
        • Miller M.D.
        • Marty M.A.
        • Arcus A.
        • Brown J.
        • Morry D.
        • Sandy M.
        Differences between children and adults: implications for risk assessment at California EPA.
        Int J Toxicol. 2002; 21: 403-418
        • Rice D.
        • Barone Jr, S.
        Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models.
        Environ Health Perspect. 2000; 108: 511-533
        • US Food and Drug Administration
        This week in FDA history: July 15, 1962.
        USFDA, Washington, DC2009 (Accessed Feb. 14, 2012)
        • McBride W.G.
        Thalidomide and congenital abnormalities.
        Lancet. 1961; 2: 291-293
        • McBride W.G.
        Thalidomide embryopathy.
        Teratology. 1977; 16: 79-82
        • Hoover R.N.
        • Hyer M.
        • Pfeiffer R.M.
        • et al.
        Adverse health outcomes in women exposed in utero to diethylstilbestrol.
        N Engl J Med. 2011; 365: 1304-1314
        • Newbold R.R.
        Lessons learned from perinatal exposure to diethylstilbestrol.
        Toxicol Appl Pharmacol. 2004; 199: 142-150
        • Palmer J.R.
        • Wise L.A.
        • Hatch E.E.
        • et al.
        Prenatal diethylstilbestrol exposure and risk of breast cancer.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 1509-1514
        • Kavlock R.J.
        • Daston G.P.
        • DeRosa C.
        • et al.
        Research needs for the risk assessment of health and environmental effects of endocrine disruptors: a report of the US EPA-sponsored workshop.
        Environ Health Perspect. 1996; 104: 715-740
        • The Endocrine Disruption Exchange
        TEDX list of potential endocrine disruptors.
        2011 (Paonia, CO) (Accessed Feb. 14, 2012)
        • Colborn T.
        • Dumanoski D.
        • Myers J.P.
        Our stolen future.
        Penguin Books USA, Inc, New York1997
        • Colborn T.
        • vom Saal F.S.
        • Soto A.M.
        Developmental effects of endocrine-disrupting chemicals in wildlife and humans.
        Environ Health Perspect. 1993; 101: 378-384
        • Miller M.D.
        • Marty M.A.
        Impact of environmental chemicals on lung development.
        Environ Health Perspect. 2010; 118: 1155-1164
        • Chevrier J.
        • Eskenazi B.
        • Holland N.
        • Bradman A.
        • Barr D.B.
        Effects of exposure to polychlorinated biphenyls and organochlorine pesticides on thyroid function during pregnancy.
        Am J Epidemiol. 2008; 168: 298-310
        • Miller M.D.
        • Crofton K.M.
        • Rice D.C.
        • Zoeller R.T.
        Thyroid-disrupting chemicals: interpreting upstream biomarkers of adverse outcomes.
        Environ Health Perspect. 2009; 117: 1033-1041
        • The Endocrine Society
        Position statement: endocrine-disrupting chemicals.
        Endocrine Society, Chevy Chase, MD2009
        • Herbstman J.B.
        • Sjodin A.
        • Apelberg B.J.
        • et al.
        Determinants of prenatal exposure to polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) in an urban population.
        Environ Health Perspect. 2007; 115: 1794-1800
        • Crofton K.M.
        Thyroid disrupting chemicals: mechanisms and mixtures.
        Int J Androl. 2008; 31: 209-223
        • Cory-Slechta D.A.
        Studying toxicants as single chemicals: does this strategy adequately identify neurotoxic risk?.
        Neurotoxicology. 2005; 26: 491-510
        • Slotkin T.A.
        • Seidler F.J.
        • Fumagalli F.
        Exposure to organophosphates reduces the expression of neurotrophic factors in neonatal rat brain regions: similarities and differences in the effects of chlorpyrifos and diazinon on the fibroblast growth factor superfamily.
        Environ Health Perspect. 2007; 115: 909-916
        • Weinhold B.
        Epigenetics: the science of change.
        Environ Health Perspect. 2006; 114: A160-A167
        • Ferguson-Smith A.C.
        Genomic imprinting: the emergence of an epigenetic paradigm.
        Nat Rev Genet. 2011; 12: 565-575
        • Cassidy S.B.
        • Schwartz S.
        • Miller J.L.
        • Driscoll D.J.
        Prader-Willi syndrome.
        Genet Med. 2012; 14: 10-26
        • Lalande M.
        • Calciano M.A.
        Molecular epigenetics of Angelman syndrome.
        Cell Mol Life Sci. 2007; 64: 947-960
        • Pilsner J.R.
        • Hu H.
        • Ettinger A.
        • et al.
        Influence of prenatal lead exposure on genomic methylation of cord blood DNA.
        Environ Health Perspect. 2009; 117: 1466-1471
        • Woodruff T.
        Bridging epidemiology and model organisms to increase understanding of endocrine disrupting chemicals and human health effects.
        J Steroid Biochem Mol Biol. 2011; 127: 108-117
        • Solomon G.
        • Janssen S.
        Talking with patients and the public about endocrine-disrupting chemicals.
        Endocr Disrupt Chem. 2007; : 289-307
        • Solomon G.M.
        • Janssen S.J.
        Communicating with patients and the public about environmental exposures and reproductive risk.
        in: Woodruff T.J. Janseen S.J. Guillette L.J. Giudice L.C. Environmental impacts on reproductive health and fertility. Cambridge University Press, Cambridge, UK2010: 214-226
        • Wu N.
        • McClean M.D.
        • Brown P.
        • Aschengrau A.
        • Webster T.F.
        Participant experiences in a breastmilk biomonitoring study: a qualitative assessment.
        Environ Health. 2009; 8: 4
        • Wilson S.E.
        • Baker E.R.
        • Leonard A.C.
        • Eckman M.H.
        • Lanphear B.P.
        Understanding preferences for disclosure of individual biomarker results among participants in a longitudinal birth cohort.
        J Med Ethics. 2010; 36: 736-740
        • Etzel R.A.
        • Balk S.J.
        • American Academy of Pediatrics Committee on Environmental Health
        Pediatric environmental health.
        American Academy of Pediatrics, Elk Grove Village, IL2003
        • Chicago Consortium for Reproductive Environmental Health in Minority Communities
        Prenatal environmental exposure history.
        2011 (Chicago, IL) (Accessed Feb. 14, 2012)
        • Agency for Toxic Substances and Disease Registry
        Taking an exposure history.
        2011 (Atlanta) (Accessed Feb. 14, 2012)
        • Huffling K.
        Environmental Exposure Assessment, 2011.
        (Accessed Feb. 14, 2012)
        • Reigart R.
        • Roberts J.
        Chapter 3.
        in: US Environmental Protection Agency Recognition and treatment of pesticide poisoning. USEPA, Washington, DC1999
        • Ondeck M.
        • Focareta J.
        Environmental hazards education for childbirth educators.
        J Perinat Educ. 2009; 18: 31-40
        • Lu C.
        • Toepel K.
        • Irish R.
        • Fenske R.A.
        • Barr D.B.
        • Bravo R.
        Organic diets significantly lower children's dietary exposure to organophosphorus pesticides.
        Environ Health Perspect. 2006; 114: 260-263
        • Rudel R.A.
        • Gray J.M.
        • Engel C.L.
        • et al.
        Food packaging and bisphenol A and bis(2-ethylhexyl) phthalate exposure: findings from a dietary intervention.
        Environ Health Perspect. 2011; 119: 914-920
        • Ji K.
        • Lim Kho Y.
        • Park Y.
        • Choi K.
        Influence of a five-day vegetarian diet on urinary levels of antibiotics and phthalate metabolites: a pilot study with “Temple Stay” participants.
        Environ Res. 2010; 110: 375-382
        • Adler N.E.
        • Stewart J.
        Reducing obesity: motivating action while not blaming the victim.
        Milbank Q. 2009; 87: 49-70
        • Organic Trade Association
        Industry statistics and projected growth.
        2010 (Brattleboro, VT)
        • Bailin P.S.
        • Byrne M.
        • Lewis S.
        • Liroff R.
        Public awareness drives market for safer alternatives: bisphenol a market analysis report.
        Investor Environmental Health Network, Falls Church, VA2008
        • Layton L.
        Wal-Mart turns to ‘retail regulation’ to ban flame retardant.
        The Washington Post. Feb. 27, 2011; : A-4
        • Miller M.
        • Solomon G.
        Environmental risk communication for the clinician.
        Pediatrics. 2003; 112: 211-217
        • Trasande L.
        • Newman N.
        • Long L.
        • et al.
        Translating knowledge about environmental health to practitioners: are we doing enough?.
        Mt Sinai J Med. 2010; 77: 114-123
        • Gould R.
        • Russell C.
        Taking action to prevent harm.
        San Francisco Med. 2010; 83: 27-29
        • Parker C.L.
        Slowing global warming: benefits for patients and the planet.
        Am Fam Physician. 2011; 84: 271-278
        • Centers for Disease ControlPrevention
        Fourth national report on human exposure to environmental chemicals.
        Centers for Disease Control, Atlanta2009
        • Eskenazi B.
        • Rosas L.G.
        • Marks A.R.
        • et al.
        Pesticide toxicity and the developing brain.
        Basic Clin Pharmacol Toxicol. 2008; 102: 228-236
        • Sutton P.
        • Wallinga D.
        • Perron J.
        • Gottlieb M.
        • Sayre L.
        • Woodruff T.
        Reproductive health and the industrialized food system: a point of intervention for health policy.
        Health Aff (Millwood). 2011; 30: 888-897
        • Health Care Without Harm
        Healthy food pledge [Internet].
        (Reston, VA: Health Care Without Harm; [cited 2010 Dec 15]) (Accessed Feb. 14, 2012)
        • Commission on the Precautionary Principle
        Communication from the commission on the precautionary principle.
        European Commission, Brussels2000 (Accessed Feb. 14, 2012)
        • Raffensperger C.
        • Tickner J.
        Protecting public health and the environment: implementing the precautionary principle.
        Island Press, Washington, DC1999
        • Dix D.J.
        • Houck K.A.
        • Martin M.T.
        • Richard A.M.
        • Setzer R.W.
        • Kavlock R.J.
        The ToxCast program for prioritizing toxicity testing of environmental chemicals.
        Toxicol Sci. 2007; 95: 5-12
        • Lein P.
        • Locke P.
        • Goldberg A.
        Meeting report: alternatives for developmental neurotoxicity testing.
        Environ Health Perspect. 2007; 115: 764-768
        • Stokstad E.
        Putting chemicals on a path to better risk assessment.
        Science. 2009; 325: 694-695
        • Judson R.S.
        • Houck K.A.
        • Kavlock R.J.
        • et al.
        In vitro screening of environmental chemicals for targeted testing prioritization: the ToxCast project.
        Environ Health Perspect. 2010; 118: 485-492
        • Martin M.T.
        • Mendez E.
        • Corum D.G.
        • et al.
        Profiling the reproductive toxicity of chemicals from multigeneration studies in the toxicity reference database.
        Toxicol Sci. 2009; 110: 181-190
        • National Research Council
        Toxicity testing in the 21st century: a vision and a strategy.
        The National Academies Press, Washington, DC2007
        • Weiss B.
        • Cory-Slechta D.
        • Gilbert S.G.
        • et al.
        The new tapestry of risk assessment.
        Neurotoxicology. 2008; 29: 883-890
        • Callahan M.A.
        • Sexton K.
        If cumulative risk assessment is the answer, what is the question?.
        Environ Health Perspect. 2007; 115: 799-806
        • Wilson M.P.
        • Chia D.A.
        • Ehlers B.C.
        Green chemistry in California: a framework for leadership in chemicals policy and innovation.
        New Solut. 2006; 16: 365-372
        • Woodruff T.J.
        • Sutton P.
        • The Navigation Guide Work Group
        An evidence-based medicine methodology to bridge the gap between clinical and environmental health sciences.
        Health Aff (Millwood). 2011; 30: 931-937
        • Halvorson G.C.
        Electronic medical records and the prospect of real time evidence development.
        in: McClellan M.B. McGinnis J.M. Nabel E.G. Olsen L.M. Institute of Medicine Annual Meeting: evidence-based medicine and the changing nature of health care. The National Academies Press, Washington, DC2007: 128-132