It's winter along the Wasatch Front. Between storms, the cold air stagnates in the valleys. We complain about the dirty air, but we continue to drive our cars.
If the inversion persists, the Utah Division of Air Quality issues a warning about outdoor exercise, especially for those who are young or old or who have asthma.
No one mentions pregnant mothers. No one says "too much exposure to air pollutants may cause your baby to be born too small."
State health officials are careful about the warnings they give, careful to make sure their warnings are warranted.
In her book, "Having Faith: An Ecologist's Journey To Motherhood," biologist Sandra Steingraber doesn't necessarily advocate air-pollution warnings. Nor does she advocate warning labels on tuna cans — though she knows that ocean fish contain mercury, and she has seen studies linking a fetus' methylmercury exposure to deficiencies in learning when the child is 7 years old.
The reason Steingraber wrote the book was not so much to advocate anything. She wrote it to turn other mothers into advocates. She figures everyone should know what biologists know about the environment. Then the moms of the world can take it from there.
Steingraber is a poet as well as a biologist and is currently on the faculty at Cornell University. The day she found out she was pregnant with her daughter, Faith, she was 38 years old, and she and her husband were both visiting professors at Illinois Wesleyan University.
Some women might rush to the library the moment they learn they are pregnant, excited to read about how their baby grows. As for Steingraber, when she saw the little test stick turn lavender, she decided to write her own book about the biology of motherhood. (She felt some confidence with this project, having already written "Living Downstream," a book about environmental toxins.)
In "Having Faith," Steingraber tells her own story interspersed with scientific descriptions of fetal development, labor and breast-feeding. She alternates these happy passages with reports of medical studies on the impact of environmental toxins on the fetus and the nursing baby.
Steingraber is perhaps braver than most pregnant women. When she went to the library, her research quickly took her to the topic of thalidomide babies. Early in her pregnancy, she spent hours looking at photos of children with birth defects.
Her book begins with the history of the placenta. Steingraber explains that in the United States as late as the 1950s, some doctors were taught that the placenta was an impervious membrane. A fetus was thought to be protected from anything its mother ate or drank or breathed into her own body.
As for thalidomide, it was a relaxant, introduced in Europe and promoted by its manufacturer as having no side effects. Studies did show that some adults had tingling in their hands and feet when they took it. Still, to most in the medical field back then, it seemed perfect for women with morning sickness.
Even as doctors in Germany and England began to wonder about tragic malformations in babies whose mothers used the drug, it continued to be marketed in Canada. In 1960, an Ohio pharmaceutical company applied to distribute thalidomide in the United States. A new scientist at the Food and Drug Administration single-handedly held up the application. Steingraber heralds this public employee, one Frances Kelsey, and uses her example of caution as a metaphor for the entire book.
"Having Faith" is about having caution.
Steingraber cites studies showing how pesticides, mercury, industrial oils, nicotine, dioxin, nickel (from car exhaust) and lead pass through the placenta. She quotes study after study. Some are inconclusive, others show no harm from certain levels of chemicals, other studies show behavioral rather than physical effects from certain levels of exposure.
Some studies she quotes are downright alarming.
Steingraber cites studies from Beijing and Los Angeles showing that exposure to high levels of carbon monoxide during the final months of pregnancy increases the risk for low birth weight. According to studies done in Poland by U.S. researchers, a fetus absorbs more of the airborne chemicals than its mother does.
Steingraber cites studies in North Carolina and Michigan showing that high levels of PCBs (industrial pollutants) in the umbilical cord at birth correspond to a toddler's poor performance on motor-skill and memory tests. In these U.S. studies, the lag disappeared as the child got older. Long-term studies in the Netherlands show more long-lasting effects.
The bottom line of the studies? "The principle of biomagnification means that a persistent poison concentrates as it moves up the food chain," she writes. She adds, in italics:"Of all members of a human population, fetuses are most vulnerable to toxic harm."
Utah experts who have read Steingraber's book welcome a chance to put her work into perspective.
Julia Robertson, a counselor with the state's pregnancy risk hotline, believes "Having Faith" might cause pregnant women some stress. (She says she'd like to talk to moms who read the book about any data they find worrisome. The Utah Pregnancy Riskline number is 1-800-822-BABY.) Robertson does, however, think it's an important book and recommended it to everyone she works with, locally and nationally.
Here's an example of what Robertson might tell a pregnant woman: Say you called about Steingraber's report that the health departments of eight states have advised women of childbearing age to avoid fresh and frozen tuna and to limit their intake of canned tuna to one can per week. You're also concerned about groups that tell women of childbearing age not to eat swordfish at all.
Robertson would then give the Utah caller the FDA recommendations for tuna and swordfish — which in this case are similar to the recommendations Steingraber cited in her book: No swordfish. Canned tuna once a week.
Aquatic biologist Michelle Baker, from Utah State University, found no fault with Steingraber's book and in fact found it fascinating. Baker says she has long understood what it means to be at the top of the food chain and understands that humans eat and absorb the chemicals that reside in the bodies of those lower on the chain. She has always been careful about what fish she eats. She routinely avoids dairy products, unless they come from the organic section of the supermarket.
Baker understands how chemicals become concentrated in human fat. But until she read Steingraber's book, she says she never made the next connection. She never asked herself what happens to pollutants stored in the fat cells of nursing mothers.
Writes Steingraber, "At least 60 percent of the fat in milk fat globules is drawn from adipose reserves scattered throughout the mother's body — from belly, hips, thighs, buttocks — and only 30 percent comes from the mother's daily diet. (The remaining 10 percent is manufactured on the spot in the mammary gland.) What this means is that a lifetime burden of long-lived fat soluble contaminants becomes mobilized when adipose tissue is called upon to supply fat for breast milk production."
Steingraber contends that human breast milk "typically carries concentrations of organochlorine pollutants that are 10 to 20 times higher than those in cow's milk. Indeed, prevailing levels of chemical contaminants in human milk often exceed legally allowable limits in commercial foodstuffs."
Steingraber cites a 1998 study that found that a U.S. woman who nursed twins for three years had lowered her own body's burden of dioxins by 69 percent. (The twins got her dioxins.)
Gary Chan, a doctor and breast milk researcher at the University of Utah Medical Center, fears Steingraber's chapters on toxins in breast milk may make some mothers afraid to nurse their babies. Chan is reassuring, however, saying that, yes, breast milk does contain toxins, but unless a mother has been living near Love Canal, her milk is fine and much preferable to formula. He knows of no site in Utah that would make anyone's milk unsafe.
"Though we should be concerned about environmental contaminants, we should not misinterpret the findings," he says. "Except for extreme cases of maternal chemical poisoning, mother's milk remains safe. All nutritional and federal agencies have supported breast feeding." He goes on to say that even breast milk with PCBs and dioxins has no effect on a child's neurological development, and he cites two studies to support this statement. (Huisman M., 1995, and Patandin S., 1999).
If even one woman decided not to nurse because of her book, Steingraber would be heartbroken, she says. Steingraber spoke to the Deseret News from Ithaca, N.Y. She was just home from a college campus speaking tour and says most of the pregnant women she met said her book was the kind of prenatal reading they'd looked for but could not find. Steingraber says she believes in nursing. In fact, she is still breast-feeding Faith, who is now 3, along with her new baby boy.
Steingraber also cites Patandin's studies. "It is one thing to document the presence of contaminants in breast milk," she writes. "It is another to document evidence of harm. The later kind of study is much more difficult to conduct, for ideally it would require comparing breast-fed infants receiving contaminated milk with breast-fed infants receiving uncontaminated milk, which does not exist. The best we can do is to compare breast-fed infants receiving highly contaminated milk with those receiving less contaminated milk. Unfortunately for purposes of scientific inquiry, infants who receive highly contaminated breast milk tend also to receive contaminants via their umbilical cords before birth, so we need study designs that try to tease apart the relative effects of prenatal exposures and breast-milk exposures."
She next cites several studies done in the United States that show prenatal exposures to PCBs and pesticides do cause developmental lags, but that post-natal exposures (through breast-feeding) do not.
Steingraber takes the discussion a step farther, citing an ongoing series of studies in the Netherlands (the Patandin studies) that show that breast-fed babies are actually farther ahead, developmentally, at the age of 18 months than their formula-fed counterparts — unless their mothers have high levels of PCBs and dioxins in their milk, in which case their scores on motor and muscular activity are in line with formula-fed infants.
Although breast-fed babies are not worse off than formula-fed babies, Steingraber's point is that they should be better off. Every woman's breast milk should be vastly superior to formula, not merely superior in some aspects.
Steingraber is fairly militant on the subject. If mothers do everything they can to have healthy babies — avoid alcohol and cigarettes, eat a healthy diet and nurse their babies once they are born — then, she believes, the rest of the world should do its part, too. The food and air and water have to be pure, for the mother's sake and for the baby's sake.
When she spoke to the Deseret News, Steingraber said she hopes her book does not make pregnant women afraid but that it gives them a sense of purpose.
"The average pregnant woman is soundproofed away," not hearing about the latest studies. "There hasn't been a public-health campaign that has made this (the relationship between the environment and pregnancy) its centerpiece. There never will be a social movement unless pregnant women know about this." Yes, we need more data, she said. But that doesn't mean we should not act on what we already know.
As Steingraber spoke on the phone, she nursed her new son, saying, "It's not like I wrote this book from some great distance. I'm concerned because I'm in the trenches, reproductively. And I was very wary. I don't want to alarm women unnecessarily. But I felt it was my responsibility to learn about these things, just as it was my responsibility to learn about car seats."
She hopes that mothers will organize themselves. "It is time for mothers around the world to join the campaign for precaution, which is fundamental to our daily lives as parents, and about which we are all experts." She wants women to lobby. "It is time to start divorcing our economy from any chemical that causes birth defects or can get into human milk." She wants women to form an organization similar to MADD, a group that was effective at getting legislation to help stop drunken driving.
Knowledge is power, she says. "The scientific evidence we have is far greater than what the average pregnant woman hears about."