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INTRODUCTION

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The occurrence of adverse reproductive outcomes is of fundamental concern to the individuals and families affected. This is especially true if the individuals perceive that they are living or working in areas with potential exposure to hazardous agents over which they have little or no control. Concern has been fueled by incidents such as the contamination of fish with methyl mercury in Minamata Bay, Japan, which was caused by a release from a manufacturing plant. Consumption of the contaminated fish by pregnant women resulted in an epidemic of mental retardation, cerebral palsy, and developmental delay in their offspring. Use of polychlorinated biphenyl (PCB)–contaminated cooking oil in Taiwan resulted in intrauterine growth retardation and hyperpigmentation of the skin in infants of exposed women. Effects on that cohort continue to be uncovered today, including on offspring pubertal development. In recent years, there have been concerns about the reproductive effects of occupational exposure to solvents, pesticides, and video-display terminals or electromagnetic fields. A new area of research has sprung up to identify and study chemicals that may act to disrupt the endocrine system, affecting both wildlife and humans.

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Only a few substances are known to have strong associations with adverse reproductive outcomes in humans, but relatively little research has been devoted to these outcomes until the last few decades. A larger number of agents are suspected to cause reproductive harm based on the animal literature and toxicologic assessment. In addition to the emotional stress on affected families, the societal burden of these adverse health outcomes includes high medical costs for compromised children and the increasing use of advanced technology to achieve conception and monitor pregnancy. Another reason to better understand reproductive outcomes is that they may act as sentinels for detecting occupational and environmental hazards because of the relatively short latency between exposure and clinical health event. If workers or community residents are protected from exposures that are harmful to the fetus, they usually will be protected from other health effects associated with these exposures as well. Measures that can be taken to prevent further exposure include substitution or containment of the suspect hazard. Thus, preventing exposure should be a primary goal in the health care provider's overall assessment of the patient's situation.

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POPULATION AT RISK

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In the United States, women comprise greater than 70% of all employees in the following job categories: office and administrative support, education/library, health care provider or support, and personal care and service. Some of the leading occupations for women have potential exposures to known reproductive toxicants (eg, large numbers of women work in the nursing profession or health service occupations with potential exposure to chemotherapeutic agents, anesthetic gases, ionizing radiation, and biologic agents). In addition, there is an increasing number of women in occupations traditionally held by men where there is potential for exposure to reproductive hazards. For example, 2% of construction workers; 4.4% of installation, maintenance, or repair ...

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