Beyond Alcohol and Tobacco Smoke: Are We Doing Enough to Reduce Fetal Toxicant Exposure?

Knowledge and attitudes regarding exposure to brominated flame retardants: a survey of Croatian health care providers

The exposure of pregnant and lactating women and their children to environmental contaminants such as brominated flame retardants (BFRs) is a subject of international concern, but the perception of these contaminants by health providers has not been extensively investigated. The aim of this study was to assess Croatian health care providers' knowledge of exposure to BFRs and their attitudes towards the responsibility to inform the public about the possible negative effects on human health. A cross-sectional survey was conducted from December 2017 to November 2018 with a sample of 400 health care providers. The instrument was a questionnaire consisting of sociodemographic questions, a BFR knowledge test and a BFR attitude assessment. Descriptive and inferential statistical analyses were performed with the STATISTICA 13 software. The results of our study indicate that health providers' knowledge of BFR exposure is lacking, as evidenced by the high frequency of incorrect responses, irrespective of the field of medicine or profession. Neither age nor interest in the topic was significantly correlated with the correctness of answers. Participants expressed a moderate interest in the topic, regardless of the profession or field of medicine. Therefore, we suggest including additional information for health providers about the health effects of BFRs in continuing education programmes organized by Croatian medical associations, nurse associations and other professional bodies as well as in existing high school and university education programmes for health professionals.

Maternal hair testing to disclose self-misreporting in drinking and smoking behavior during pregnancy

This study aimed to objectively verify smoking and drinking behavior during pregnancy and to disclose self-misreporting through maternal hair analysis. A total of 153 women attending a university hospital in Barcelona (Spain) were selected and interviewed after delivery, on their smoking and drinking habits during pregnancy. A 9-cm hair strand was collected and analyzed by liquid chromatography tandem mass spectrometry for the presence of nicotine (NIC) and ethyl glucuronide (EtG) as biomarkers of tobacco and alcohol consumption, respectively. Concentrations of EtG <7 pg/mg hair and ≥30 pg/mg hair in the 0-3-cm hair segment have been used to assess, respectively, total abstinence and chronic excessive consumption in the previous 3 months, with repetitive moderate drinking lying in the interval 7-30 pg EtG per mg hair. Hair NIC less than 1 ng/mg hair indicates non-exposure to tobacco smoke while hair NIC indicates daily active smoking. In the interview, 28.1% of women declared to have smoked occasionally during gestation, while only 2.6% stated to have consumed alcohol on more than one occasion during pregnancy. Hair testing of smoking biomarkers disclosed that 7.2% of women remained active smokers during the whole pregnancy (hair NIC: 3.21-56.98 ng/mg hair), 16.3% were passive non-smokers or occasional smokers (hair NIC: 1.04-2.99 ng/mg hair), while 76.5% were not exposed to any cigarette smoke (hair NIC < limit of quantification - 0.91 ng/mg hair). Conversely, alcohol hair biomarkers showed that only 35.3% of women were totally abstinent during gestation (hair EtG: 3.89-6.73 pg/mg hair), while 62.7% drank a non-negligible amount of alcohol during pregnancy (hair EtG: 7.06-26.57 pg/mg hair), and 2% were chronic excessive drinkers (hair EtG: 35.33-47.52 pg/mg hair). Maternal hair analysis has shown to be significantly more sensitive than interviews in revealing an alarming misreported prevalence of alcohol use during pregnancy. These findings stress the need to use objective measures to assess alcohol exposure and to consider the inclusion of targeted actions to reduce alcohol consumption in maternal-child health policies.