Perturbateurs endocriniens – Reproduction et cancers hormono-dépendants

Impact of perinatal environmental health education intervention on exposure to endocrine disruptors during pregnancy-PREVED study: study protocol for a randomized controlled trial

Background

The suspected or actual effects on health of endocrine-disrupting chemicals (EDC) and their ubiquitous presence in everyday life justify the implementation of health promotion interventions. These interventions should ideally be applied during critical windows like pregnancy. Perinatal environmental health education interventions may help to reduce EDC exposure during pregnancy.

Methods/design

PREVED (Pregnancy, PreVention, Endocrine Disruptors) is an open-label randomized controlled trial assessing the impact of environmental health education intervention on EDC exposure during pregnancy. Inclusion, consent, and randomization take place during the first trimester. The participants are randomly allocated into three groups: (i) control group (information leaflet on EDCs), (ii) intervention group in neutral location (information leaflet and workshops in a meeting room), and (iii) intervention group in contextualized location (information leaflet and workshops in a real apartment). Workshops are organized between the second and third trimesters of pregnancy. Main outcome is the percentage of participants who reported consuming manufactured/industrial food. Secondary outcomes are as follows: (i) psycho-social dimensions, (ii) EDC concentrations in urine, (iii) EDC concentration in colostrum, and (iv) percentage of participants who reported consuming paraben-free personal care products.

Discussion

PREVED is a ground-breaking intervention research project dedicated to perinatal environmental health education that aims to identify pollutant sources in daily life and to offer accessible and realistic alternative solutions, by promoting the sharing of know-how and experience in a positive and non-alarmist approach.

Trial registration

ClinicalTrials.gov: NCT03233984 (current status: ongoing). Retrospectively registered on 31 July 2017 (https://clinicaltrials.gov/ct2/show/NCT03233984) because when the first participant was enrolled in this non-drug intervention, ClinicalTrials.gov was centered in therapeutic trials.

The World Health Organization Trial Registration Data Set is in Additional file 1.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05813-5.

Sustained bloodstream release of persistent organic pollutants induced by extensive weight loss after bariatric surgery: Implications for women of childbearing age

BACKGROUND

Lipophilic persistent organic pollutants (POPs) are stored in adipose tissues and released in case of weight loss.

OBJECTIVES

To analyze the kinetics and characteristics of this release during drastic weight loss after bariatric surgery and compare the results in case of women of childbearing age (WCBA) with critical blood concentration thresholds.

METHODS

100 morbidly obese patients (73 women including 53 of childbearing age and 27 men) were screened before and 3, 6 and 12 months after bariatric surgery for serum concentrations of 67 congeners or metabolites of banned or not yet banned organohalogenated persistent pollutants, including highly lipophilic polychlorobiphenyls (PCBs), organochlorine pesticides (OCPs), brominated flame retardants (BFRs), and less lipophilic perfluorinated alkylated substances (PFASs).

RESULTS

Circulating levels of all chemicals, except PFASs, increased progressively after surgery, reaching after one year an increase between 30 and 139% compared to initial pre-surgical levels; median levels increased for PCB153 from 36.8 to 86.4 ng/g lw (+130%), for dichlorodiphenyldichloroethylene (p,p'-DDE) from 59.8 to 136.1 ng/g lw (+120%), and for hexachlorobenzene (HCB) from 9.8 to 20.3 ng/g lw (+110%). Weight loss averaging 30% of initial body weight at 12 months in both sexes (mean: 40.0 kg for men, 36.1 kg for women), was the main parameter related to the concentration increases (3.1 to 3.6% per kilogram weight loss). They were not dependent on initial BMI, presence of metabolic syndrome or type of surgical procedure but influenced by gender and biochemical properties such as degree of chlorination for PCBs and/or lipophilicity since PFASs did not increase at all. ∑PCB₆ in blood after one year exceeded the critical concentration threshold for 24.5% women of childbearing age (13/53) versus 3.6% (2/53) before surgery.

DISCUSSION

Massive weight loss within the first year following bariatric surgery is associated with a sustained increase of circulating lipophilic POPs. Short- and long-term consequences should be considered, mostly for childbearing age obese women, because of potential health risks for the future fetus and breastfeeding infant.

[Endocrine disrupters: Towards an unsatisfying regulation]

Endocrine disruptors commonly make the headlines of newscasts and magazines, which is not without generating questions, even anxieties, with the general public. In a recent survey, 90% of French people considered it desirable to set up regulations concerning endocrine disruptors. However, under pressure from the lobbies of the chemical industry, and also due to scientific conflicts, the European Union is slow to legislate and has even been condemned before the European Court for failing to fulfill its obligations. This article does not intend to be exhaustive on the issue of endocrine disrupters, but rather to give the reader a certain number of keys enabling him to understand why national or European regulators are slow to establish specific regulation.