Exposure to certain chemicals and pollutants before and during your pregnancy may have an effect on you and your unborn baby.
You can take simple steps to reduce your exposure to harmful substances often found in and around the home.
Things you may want to reduce use of or use with more caution include:
- Plastic storage containers or toys that are not BPA-free or PVC-free.
- Oil-based paints and thinners.
- Lead from pipes and renovation projects.
- Cleaning products with ammonia, bleach, and turpentine.
Alternatives could include:
- Glass food-storage containers or plastic products labelled as BPA-free.
- Toys labelled as phthalate-free or PVC-free.
- Latex paint and low-VOC paint or VOC-free paint.
- Baking soda or vinegar mixed with water as a cleaning agent.
Other helpful tips to minimize the risks of harmful substances in and around your home include:
- Airing out new plastic items before their use.
- Dusting or mopping your home frequently.
- Using lead-free products for hobbies such as painting, stained glass, and glazing pottery.
- Removing shoes at the door.
- Using a dry cleaner that does not use solvents.
- Ventilating your home when cleaning or painting.
- Reducing activity outdoors during Air Quality Index advisories.
Some personal care products may not be safe during pregnancy.
Contact Motherisk (see below) or speak to your health care provider if you have questions regarding personal care products or herbal products. Just because something is labelled as natural does not mean it is safe in pregnancy.
Some personal care products you may have questions about include:
- Tanning products.
- Nail polish and nail polish remover.
- Hairspray and hair dye.
- Skin products that contain .
- Cosmetics that contain toxic ingredients.
- Insect repellents.
- Natural health products or herbal substances (pills, teas).
Use seatbelts and airbags properly when travelling by car during pregnancy.
It is important to use your seatbelt while pregnant. You may need to adjust your seatbelt as your body changes. Use a seatbelt with a lap and shoulder belt. Make sure there is no slack at your pelvis and shoulder. If the car has airbags keep at least 25 cm (9.75 inches) between you and the steering wheel or dashboard.
Make safe travel plans if you need to travel during your pregnancy.
Discuss any travel plans with your health care provider.
Things for you to think about when planning to travel during your pregnancy include:
- When it is safest to travel during your pregnancy.
- Method of travel. When travelling requires sitting for a long time, it is important to get up and walk around every one to two hours.
- Health facilities available to you at your destination.
- Vaccines you may need to protect yourself and your unborn baby.
- Extra insurance in case you need to see a health care provider.
Carry your prenatal records and your health care providerâs contact information with you when travelling away from home in case of emergency.
Most women can continue to work safely throughout their pregnancy.
Things to consider about your workplace to ensure a comfortable and safe pregnancy include:
- If possible, adjust your workstation to suit your work and your changing body.
- Avoid heavy lifting, pushing, pulling or carrying.
- Take breaks if you have to sit or stand for long periods.
- If possible, reduce your stress levels.
- Avoid extended exposure to loud noise and very hot temperatures.
- Use precautions when working with X-rays.
- Use caution regarding exposures to infections. Make sure your vaccinations are up to date and practice good hygiene.
- Follow guidelines when working with chemicals and contaminants.
Discuss your work environment with your health care provider. Speak with your employer about any concerns that are raised. Discuss if modifications are needed to ensure your health and the health of your unborn baby. You may also check workplaceguidelines and speak with your companyâs occupational health and office if they have one.
Caring for pets when you are pregnant may pose a health risk to you or your unborn baby.
The following is a list of precautions to take when caring for your pet.
- Avoid handling soiled cat litter to reduce the risk of infection with . If you cannot avoid it, wear gloves and wash your hands well afterwards. This is important.
- Get medical attention if you are bitten by an animal, including pets such as dogs, cats, or rodents.
- Avoid handling exotic animals if possible. If unable to avoid, find out how you can handle your exotic pet safely during your pregnancy.
Learn more aboutduring pregnancy.
You can find out more about Resources and Links section.during pregnancy from the following resources. More suggestions can be found in the
Most babies are born healthy. The majority of women strive to have a healthy pregnancy; however, some may unknowingly have harmful exposures that could have been avoided or minimized. Certain prenatal exposures may have lifelong impacts including Appendix A is a depiction of when the fetus is most vulnerable during development. Risks to the fetus exist in greater amounts during the first trimester.
It is estimated that three to five percent of children in Canada are born with a major birth defect. 1 That rate rises to seven percent when major defects discovered after the neonatal period (e.g., at one year of age) are included.1Exposure to medications, drugs, or a chemical in pregnancy is estimated to cause less than one percent of.2Table 1 lists causes of and their relative frequency.
Martin, B., & Morin, C. (2007). Connaissances de base sur l’utilisation de mĂ©dicaments au cours de la grossesse. In E. Ferreira, Grossesse et allaitement: Guide thĂ©rapeutique (pp. 35-52). MontrĂ©al, QC: Ăditions du CHU Sainte-Justine.
Exposure to Pollution and Toxic Chemicals
Plastics containing BPA and phthalates are found in many items used daily. Over time, these harmful chemicals can leach into the surrounding environment. Neurological and hormonal problems have been associated with exposure to these chemicals by the fetus and young children. 3,4
Most Canadians are exposed to very low levels of BPA that are not expected to pose a general health risk. The Canadian government has initiated extra precautions such as packaging and import controls to increase protection for those most vulnerable: newborns and infants. 5,6
To decrease the risks associated with plastics, encourage pregnant women to:
- Avoid or reduce exposure to items with a recycling symbol #3 because they contain phthalates. Examples include soft plastic toys, bags and backpacks with PVC, shower curtains, and flooring.7,8
- Avoid or reduce exposure to items with a recycling symbol #7 because they contain BPA. Examples include water bottles, baby bottles, and the lining of food and beverage cans.9
- Use glass food-storage containers as safe alternatives for plastic food-storage containers.3,10
Attempt to keep the home free from dust to reduce exposure to chemicals from deteriorating plastics.8
Oil-based paints and strippers contain volatile organic compounds (VOCs) which can harm the developing fetus.3,11, slow growth, developmental disabilities, and an increased cancer risk have been reported with a substantial exposure to VOCs.3
To decrease the risks associated with oil-based paints and paint strippers, if painting is required, encourage pregnant women to:
- Use latex paint or if available VOC-low or VOC-free paint. 3,10
- Ventilate rooms when painting. 3
- Paint outdoors when painting moveable items (when possible).3
- Avoid hobbies that require the frequent exposure to solvents.3
Lead is a soft metal that is toxic to the developing fetus. During pregnancy, elevated levels of lead in a womanâs blood may result in premature births, smaller babies, decreased mental ability in the infant, learning difficulties, and reduced growth in young children.12 Although there have been government restrictions on its use in Canada, it is still possible for people to come into contact with lead. Lead pipes may be found in homes built before 1975.11 Lead can also be found in toys, costume jewelry, and old painted surfaces. Lead was a common chemical in household paint before 1990.11
To decrease the risks associated with lead exposure, encourage pregnant women to:
- Refrain from participating in renovation projects like painting or sanding in old homes. 3,13
- Follow safe guidelines for personal water consumption. These guidelines are available on the Health Canada website.12
- Use lead-free products for hobbies such as painting, stained glass, and glazing pottery.11
- Dust the home regularly and remove shoes at the door to minimize contaminants such as lead in the home.11,15
Outdoor air contains many pollutants that, under certain conditions (e.g., smoke and smog), may be harmful to the unborn child. Smog has been linked to an increase in neural tube defects and .14
Indoor air has also been found to contain numerous pollutants.15
To decrease the risks associated with poor air quality, encourage pregnant women to:
- Visit airhealth.ca for updates on Air Quality Index advisories.3
- Reduce outdoor activity during Air Quality Index advisories.3
- Keep the home free of dust.15
- Keep the home well-ventilated.15
- Ensure that fuel-burning appliances are well-maintained and inspected yearly.16
- Reduce the use of aerosol sprays indoors.17
Some cleaning products may contain chemicals that can affect health. In animals, neurological and sexual development have been decreased with chemical exposure.3
To decrease the risks associated with unsafe chemicals in cleaning products, encourage pregnant women to:
- Reduce the use of products containing ammonia, bleach, or turpentine or use these products with caution.3
- Ventilate the area or room when using cleaning products and use products sparingly.3
- Use products that have been labelled eco, non-toxic, safe, or EcoLogo as safer alternatives.3
- If using a dry cleaning service often, switch to one that does not use solvents.18
- Use vinegar and water or baking soda as safe cleaning-product alternatives.3
Pesticides are commonly used in and around homes to rid the environment of pests such as insects. They contain chemicals that may alter fetal growth and impair neurological development. Pesticides can also be found on fruits and vegetables and in insect repellents.
To decrease the risks associated with pesticides, encourage pregnant women to:
- Prevent pest infestations by:
- Clearing the home of food waste.
- Sealing cracks in homes.
- Fixing leaks that can lead to moisture in the home.10
- Avoid entering a pesticide-treated area for the length of time indicated on the pesticide label concerning pregnant women. If the label is unavailable, wait 24 hours before entering the pesticide-treated area.19
- Wash all fruits and vegetables prior to consumption.10
- Consume organic food.
Personal Care Products
Fragrances found in lotions, perfumes, makeup, hairspray, and air fresheners are made of chemicals such as phthalates. In Canada, chemicals are required to be listed in products.20 Some products labeled fragrance-free may, in fact, contain fragrance. The overall exposure to phthalates from the use of cosmetic and personal care products is low and, therefore, unlikely to pose health risks to Canadian consumers.21
Self-tanning lotions have minimal systemic absorption. However, they may be irritating to a pregnant womanâs sensitive skin.22
A pregnant woman’s skin, especially the skin of her face, is more sensitive to the effects of sun exposure. Sunlight may increase(or pregnancy mask) for some pregnant women.
To decrease the risks associated with self-tanning products and sun exposure, encourage pregnant women to:
- Avoid self-tanning lotions if they are irritating.
- Practice safe sun protection. Avoid sun exposure between 11 a.m. and 4 p.m., wear long clothing and a hat, and regularly apply sunscreen with a sun-protection factor (SPF) of at least 15 to the skin and lips.23
Current literature cannot confirm or exclude the risk for hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission in nail salons and barbershops. Existing sanitary requirements are adequate in the majority of the United States, but compliance is needed to prevent HBV/HCV transmission in these businesses.24 According to the Public Health Agency of Canada, there have been no reported cases.
The risk of hepatitis contagion in nail salons cannot be confirmed according to the literature. However, the Public Health Agency of Canada recommends sterilization of all tools prior to use.24,25
Solvents are found in hairsprays, hair dyes, and nail products. Exposure to chemicals from hair dyes or hair products are unlikely to cause harm to the unborn fetus due to their very limited systemic absorption.26 Pregnant women who have three to four chemical hair treatments per pregnancy are not expected to be at an increased risk for adverse effects on the unborn child.26
To decrease the risks associated with solvents in hairspray, hair dye, and nail-care products, including occupational exposure, encourage pregnant women to:
- Discuss the use of these products with their health care provider.
- Use products in a ventilated setting.3
- Wear gloves when in contact with chemical hair-care products.26
- If employed in the salon industry, work no more than 35 hours per week in that setting.26
Triclosan and/or triclocarban are the chemicals found in products labeled as antibacterial. These products include hand soap, lotion, and deodorant. Health Canada reports that Canadians are exposed to levels of triclosan that are too low to be harmful. 27
Regular soap, used properly, is an efficient cleansing agent if a woman chooses to avoid antibacterial soaps.
While the majority of skin-care products do not pose a risk to the fetus, hydroquinone should be used in moderation and retinoids should be avoided.28
To decrease the risks associated with certain chemicals in skin-care products, encourage pregnant women to:
- Read the labels of topical products.
- Refrain or minimize the use of products with topical retinoids.28
Self-medication with natural health productsâ including herbs and plants may put a pregnant woman and her fetus at risk. There may be unknown effects associated with using these products.29
Health Canada provides a list of natural and non-prescription health products that can be referred to.
It is prudent for pregnant women to speak with their health care providers to discuss the use of natural health products during pregnancy.
Mosquito and tick bites may negatively affect the outcome of a womanâs pregnancy by transmitting diseases such as West Nile virus (WNV) which may be harmful to the fetus.33
Most insect repellents contain diethyltoluamide (DEET), a chemical compound whose concentration varies from product to product. Although DEET is recognized as being of low toxicity,27,28,30 limited information is currently available as to its use during pregnancy.31,32,33 Nevertheless, the benefits of applying DEET during pregnancy appear to outweigh the risks of contracting a disease such as West Nile virus.
To decrease their exposure to insect repellents, encourage pregnant women to:
- Reduce exposure to insect and tick bites by wearing long clothing and applying the insect repellent to clothing instead of directly on the skin.
- Use the lowest concentration to provide protection for the time spent outdoors.33
Note that citronella or lavender oil-based products have not been proven effective alternatives to DEET-based insect repellents. They provide only brief protection compared to products containing DEET.34 There is insufficient information available regarding theof these products during pregnancy.35
A certain amount of risk is involved in transportation and travel, even when not pregnant. Although many forms of travel are considered safe during pregnancy, caution should be exercised when involved in boating, snowmobile, or ATV use. Women should be encouraged to speak with their health practitioner about engaging in these activities while pregnant.
Studies have shown that many pregnant women are uninformed about proper seatbelt use.36,37 A car accident during pregnancy may result in serious injury to the pregnant woman and her unborn baby. Many studies show that pregnant women who are given information about proper seatbelt use are more likely to wear their seatbelt and to position it correctly.
To decrease the risks associated with inappropriate use of seatbelts, encourage pregnant women to:
- Wear a three-point seatbelt (at hips and shoulder) positioned correctly without slack, at every stage of pregnancy.38
- Position the lap belt at the pelvis under the belly.
- Position the shoulder belt at the collar bone, not on the neck.
Deactivating the airbag is not recommended for pregnant women. Studies have shown that the protection provided by the airbag, in addition to the protection provided by a seatbelt, is maintained during pregnancy.39,40 Transport Canada recommends that all people who are over the age of 13, short, tall, or pregnant are safer travelling with an airbag than without one.41
To optimize the effectiveness of airbags, encourage pregnant women to:
- Maintain at least 25 cm between their sternum and the centre of the steering wheel (or the dashboard if the woman is not driving).
- Move the seat back to maximize the distance between herself and the steering wheel as her abdomen grows.
The Government of Canada states that air travel is considered safest from the 18th to the 24th week of pregnancy.42 Airlines usually allow pregnant women to travel up to one month before their due date.42 Certain airlines may impose restrictions. It is advisable to seek information from the airline prior to making travel arrangements.
Airport metal detectors and body scanners do not pose a risk to the pregnant woman or her fetus.43
To minimize discomfort and risks of deep vein( ) during air travel, encourage pregnant women to:
- Consult their health care provider prior to making travel plans.
- Stand up and move around about once every one to two hours.
- Stretch their legs while seated.
- Select an aisle seat if possible.
- Wear comfortable clothing and shoes.
- Consult a health care provider about the need to wear compression stockings.42
- Check with the airline regarding regulations for pregnant passengers.42
Pregnant women planning international travel should be encouraged to:
- Consult their health care provider prior to making travel plans to an international destination.
- Visit a travel health clinic if recommended by their health care provider.
- Avoid live vaccines (e.g., measles, mumps and rubella) unless the benefits outweigh the risks; however, inactivated vaccines are considered safe (e.g., hepatitis B).42
- If possible, avoid travel to areas where malaria transmission occurs.42
- Obtain travel/health insurance appropriate for their travel plans and pregnancy stage.
- Carry a letter stating the due date for immigration or airline purposes.
Most jobs do not pose concerns during pregnancy. However, a few small changes at work can make a big difference to a womanâs comfort and the health of the unborn child.
Pregnant women are protected under the Canadian Human Rights Act against discrimination and undue hardship (e.g. health andrisks).44 It is the responsibility of the employer to ensure that pregnant women are accommodated in their area of work to ensure the and well-being of the pregnant woman and her unborn child.
Some jobs may require a woman to stop working or change to a different type of work during her pregnancy. This can be prompted by risks associated with her work or work environment, problems with a previous pregnancy, or problems during the current pregnancy.
Stress can come from many things, including concerns about the amount or type of work, the work schedule, or commuting. Stress can also come from trying to balance the needs of work and family. Being pregnant can be a source of worry. High levels of stress may increase the risk of problems during pregnancy such as preterm birth and.45
To decrease the potential risk associated with the stress in the workplace, encourage pregnant women to:
- Reduce her workload and/or shift work if necessary/possible.
- Seek assistance from others to relieve stress in the workplace or home.
- Speak with her health care provider and employer regarding her work stress.
A variety of physical factors can affect workduring pregnancy.
- High levels of radiation exposure may increase the risk for and other adverse pregnancy outcomes.46
- Although data is inconclusive, occupational exposure to loud noise has been associated with preterm labour, , and (in animal data) to hearing loss for the unborn baby.47
- during the first trimester has been associated with an increased risk for .48
- Sitting for long periods of time may cause legs and feet to swell and cause muscle strain and tension.
- Some studies suggest a possibility for increased risk for preterm delivery with prolonged standing.49
- There is no strong evidence to suggest that computers can harm an unborn child.50
To decrease the potential risks associated with the various physical factors in the workplace, encourage pregnant women to:
- Use precautions if working with X-rays.
- Avoid extended periods of loud noise when possible.
- Avoid long exposure to very hot temperatures.
- Drink enough fluids.
- Seek comfort at work such as using a cushion and/or a footstool, rotating sitting and standing tasks, moving around in the workspace, and wearing loose clothing.
If a woman has concerns that her working environment (i.e., hours of work, ergonomics, etc.) may adversely affect her pregnancy then she should speak to her occupational health representative or equivalent regarding modifying her duties/environment. If there is no occupational health individual, she should speak to her health care provider and/or employer.47
Women who work with animals, young children, or in a health care setting are more likely to be exposed to infectious agents. Exposure to certain infections such as rubella (German measles); varicella (chicken pox);; cytomegalovirus (CMV); Listeria; parvovirus B19 (fifth disease); hepatitis B; and hepatitis C may increase the risk for adverse pregnancy outcomes.51,52,53
To decrease the potential risks caused by some infectious agents in the workplace, encourage pregnant women to:
- Ensure they are immunized prior to pregnancy if possible.
- Avoid contact with infectious people.
- Use necessary protection like masks or gloves as required.
- Wash their hands frequently.
More information about immunization recommendations for pregnant and breastfeeding women is available on the Public Health Agency of Canada website.
Although the evidence is conflicting, occupational exposure to solvents during pregnancy has been associated with an increased risk of major malformations.54,55 Other chemicals that a pregnant woman should be aware of in her workplace are the presence of lead, mercury, or pesticides, etc.
To decrease the potential risks associated with chemicals in the workplace, encourage pregnant women to:
- Reduce or avoid exposure to organic solvents or other chemicals.55
- Follow appropriate guidelines.
- Use proper equipment.
- Wash hands before eating.
- Discuss safer alternatives (if available) with her employer.
If a woman has concerns regarding exposures to chemicals at work, she should speak to her occupational health representative or equivalent regarding reducing exposure. If there is no occupational health individual, she should speak to her health care provider and/or employer.
The vertical transmission of Toxoplasma gondii to the unborn child is a serious health risk. Severe neurological or ocular disease in the fetus may occur with maternal infection of this organism. In addition, it can lead to fetal cardiac and cerebral anomalies Cats are one of the carriers of this organism, and maternal infection can be contracted via contact with oocyst-infected cat faeces.51
Lymphocytic choriomeningitis (LCMV)
LCMV is a rare virus transmitted via rodent urine, droppings, saliva, or the nesting material of infected rodents through direct contact with broken skin; the nose, eyes or mouth; or by a bite from an infected animal.56 Infection may cause severeor .56
To decrease the potential risks associated with caring for pets, encourage pregnant women to:
- Avoid caring for soiled cat litter. If unable to avoid, use gloves when handling soiled cat litter or wash hands thoroughly.51
- To reduce the risk of infection cat litter boxes should be cleaned daily.
- Avoid contact with wild or pet rodents, such as pet mice and guinea pigs.56
- Seek medical attention if bitten by an animal.
- Follow hygienic and dietary recommendations to avoid Appendix B.51 infection as per the Society of Obstetricians and Gynaecologists of Canada (SOGC) in
The following women should be referred to appropriate resources:
- Those with concerns about the effect of their work environment on their pregnancy.
- Those complaining of any medical concerns or conditions.
- Those planning travel.
Women who require assistance in the above-mentioned situations can be referred to the following sources:
- Her health care provider (obstetrician, family physician, Nurse Practitioner, or midwife).
- Her local public health unit 1-866-532-3161.
- An employer or health and representative at her place of work.
- Occupational Health Clinics for Ontario Workers 1-877-817-0336.
- Ontario Human Rights Commission 1-800-387-9080.
- Motherisk 1-877-439-2744.
Resources & Links
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
- Clinical Practice Guideline: Immunization in Pregnancy (2009)
- Clinical Practice Guideline: Parvovirus B19 Infection in Pregnancy (2014)
- Clinical Practice Guideline: in Pregnancy: Prevention, Screening, and Treatment (2013)
- Policy Statement: Maternity Leave in Normal Pregnancy (2011)
- Canadian Paediatric Society (CPS)
- Canadian Partnership for Children’s Health and Environment (CPCHE)
- Centers for Disease Control and Prevention (CDC)
- Environment Canada: Air Quality Health Index (AQHI)
- Health Canada
- Occupational Health Clinic for Ontario Workers (OHCOW)
- Ontario Human Rights Commission (OHRC)
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
Prenatal Education Provider Tools
- Best Start Resource Centre (BSRC)
Client Resources and Handouts
- Best Start Resource Centre (BSRC)
- Canadian Partnership for Children’s Health and Environment (CPCHE)
- Canadian Partnership for Children’s Health and Environment (CPCHE)
This figure shows critical periods of fetal vulnerability. The dark grey bars denote highly sensitive periods; light grey bars indicate stages that are less sensitive to. The concept of vulnerability is complex, and this figure does not provide sufficient information to attribute causes of a particular health outcome such as or cancer.
Reprinted from The Developing Human: Clinically Oriented Embryology, Moore and Persaud, page 98, Copyright (1973), with permission from Elsevier.
- Public Health Agency of Canada (2013). http://www.phac-aspc.gc.ca/publicat/hpcdp-pspmc/35-1/ar-04-eng.php anomalies in Canada 2013: A perinatal health surveillance report. Ottawa, ON: Author. Retrieved from
- Martin, B., & Morin, C. (2007). Connaissances de base sur l’utilisation de mĂ©dicaments au cours de la grossesse. In E. Ferreira (Ed.), Grossesse et allaitement: Guide thĂ©rapeutique (pp. 35-52). MontrĂ©al, QC: Ăditions du CHU Sainte-Justine.
- Toronto Public Health. (2009). Hidden exposures: Informing pregnant women and families about harmful environmental exposures. Retrieved from http://www.healthyenvironmentforkids.ca/resources/hidden-exposures-booklet
- Ashley-Martin, J., Dodds, L., Arbuckle, T. E., Ettinger, A. S., Shapiro, G. D., âŠ Fraser, W. D. (2014). A birth cohort study to investigate the association between prenatal phthalate and bisphenol A exposures and fetal markers of metabolic dysfunction. Environmental Health, 13(84). doi: 10.1186/1476-069X-13-84
- Government of Canada. (2013). Bisphenol A (BPA). Retrieved from http://healthycanadians.gc.ca/healthy-living-vie-saine/environment-environnement/home-maison/bisphenol_a-eng.php?_ga
- Canadian Food Inspection Agency. (2013). All infant formulae and foods tested for Bisphenol A (BPA) found free from BPA and safe for human consumption. Retrieved from http://www.inspection.gc.ca/about-the-cfia/newsroom/news-releases/2013-05-21/eng/1369152187993/1369152195012
- Government of Canada. (2010). 1,2-Benzenedicarboxylic acid, bis(2-methoxyethyl) ester (di(methoxyethyl)phthalate, DMEP). Retrieved from http://www.chemicalsubstanceschimiques.gc.ca/challenge-defi/summary-sommaire/batch-lot-6/117-82-8-eng.php
- Childrenâs Health and Environment Partnership. (2015). Phthalates. Retrieved from http://www.childrensenvironment.ca/sources-of-contamination/phthalates/
- Government of Canada. (2008). Bisphenol A â Fact sheet. Retrieved from http://www.chemicalsubstanceschimiques.gc.ca/fact-fait/bisphenol-a-eng.php
- Best Start Resource Centre & Canadian Partnership for Childrenâs Health and Environment. (2006). Playing it safe: Service provider strategies to reduce environmental risks to preconception, prenatal and child health. Retrieved from http://www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/enviro_strategies.pdf
- Government of Canada. (2012). Reduce your exposure to lead. Retrieved from http://healthycanadians.gc.ca/healthy-living-vie-saine/environment-environnement/home-maison/lead-plomb-eng.php
- Health Canada. (2007). Minimizing exposure to lead from drinking water distribution systems. Retrieved from http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/lead-plomb-eng.php
- Health Canada. (2008). Lead. Retrieved from http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/lead_plomb-eng.php
- Padula, A. M., Mortimer, K., Hubbard, A., Lurmann, F., Jerrett, M., & Tager, I. B. (2012). Exposure to traffic-related air pollution during pregnancy and term : Estimation of causal associations in a semiparametric model. American Journal of Epidemiology, 176(9), 815â24. doi: 10.1093/aje/kws148
- Health Canada. (2010). Indoor air. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/promotion/public-publique/home-maison/fn-pn/air-eng.php
- Health Canada. (2009). Indoor air quality and health. Retrieved from http://www.hc-sc.gc.ca/ewh-semt/air/in/qual/index-eng.php
- Health Canada. (2013). Healthy environments for children â What you can do! Retrieved from http://www.hc-sc.gc.ca/hl-vs/pubs/child-enfant/safe-sain/index-eng.php
- Health Canada. (1995). Tetrachloroethylene. Retrieved from http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/tetrachloroethylene/index-eng.php
- Health Canada. (2013). Homeowner guidelines for pesticides. Retrieved from http://www.hc-sc.gc.ca/cps-spc/pubs/pest/_fact-fiche/home-maison/index-eng.php
- Health Canada. (2014). Cosmetic advertising, labelling and ingredients. Retrieved from http://healthycanadians.gc.ca/drugs-products-medicaments-produits/consumer-consommation/products-produits/advertising-publicite-eng.php
- Health Canada. (2011). Phthalates in cosmetic and personal care products: Concentrations and possible dermal exposure. Retrieved from http://www.hc-sc.gc.ca/sr-sr/pubs/proj/chemi-chimi-eng.php
- Yourick, J. J., Koenig, M. L., Yourick, D. L., & Bronaugh, R. L. (2004). Fate of chemicals in skin after dermal application: Does the in vitro skin reservoir affect the estimate of systemic absorption? Toxicology and Applied Pharmacology, 195(3), 309-320. doi: 10.1016/j.taap.2003.07.015
- Health Canada. (2014). Sun http://healthycanadians.gc.ca/healthy-living-vie-saine/environment-environnement/sun-soleil/-protection-eng.php basics. Retrieved from
- Yang, J., Hall, K., Nuriddin, A., & Woolard, D. (2014). Risk for hepatitis B and C virus transmission in nail salons and barbershops and state regulatory requirements to prevent such transmission in the United States. Journal of Public Health Management Practice, 20(6), E20-E30. doi: 10.1097/PHH.0000000000000042
- Public Health Agency of Canada. (2014). Frequently asked questions about hepatitis C. Retrieved from http://www.phac-aspc.gc.ca/hepc/faq-eng.php#a8
- Chua-Gocheco, A., Bozzo, P., & Einarson, A. (2008). http://www.cfp.ca/ of hair products during pregnancy: personal use and occupational exposure. Canadian Family Physician, 54(10), 1386-1388. Retrieved from
- Health Canada. (2013). The http://healthycanadians.gc.ca/healthy-living-vie-saine/environment-environnement/home-maison/triclosan-eng.php of triclosan. Retrieved from
- P., Chua-Gocheco, A., & Einerson, A. (2011). http://www.cfp.ca/ of skin care products during pregnancy. Canadian Family Physician, 57(6), 665-667. Retrieved from
- Leak, J. A. (1999). Herbal medicine: Is it an alternative or an unknown? A brief review of popular herbals used by patients in a pain and symptoms management practice setting. Current Review of Pain, 3(3), 226-236. doi: 10.1007/s11916-999-0017-x
- Osimitz, T. G., & Murphy, J. V. (1997). Neurological effects associated with use of the insect repellent N, N-diethyl-m-toluamide (DEET). Clinical Toxicology, 35(5), 435-441. Retrieved from http://informahealthcare.com/journal/ctx
- McGready, R., Hamilton, K. A., Simpson, J. A., Cho, T., Luxemburger, C., âŠ Lindsay, S. W. (2001). http://www.ajtmh.org/ of the insect repellent N, N-diethyl-M-toluamide (DEET) in pregnancy. The American Journal of Tropical Medicine and Hygiene, 65(4), 285-289. Retrieved from
- Dugas, J., Mieuwenhuijsen, M. J., Martinez, D., Iszatt, N., Nelson, P., & Elliott, P. (2010). Use of biocides and insect repellents and risk of hypospadias. Occupational and Environmental Medecine, 67, 196-200. Retrieved from http://oem.bmj.com/
- Organization of Teratology Information Specialists. (2005). DEET (N,N-ethyl-m-toluamide) and pregnancy. Retrieved from http://www.mothertobaby.org/files/DEET.pdf
- Fradin, M. S., & Day, J. F. (2002). Comparative efficacy of insect repellents against mosquito bites. New England Journal of Medicine, 347(1), 13-18. doi: 10.1056/NEJMoa011699
- Kongkaew, C., Sakunrag, I., Chaiyakunapruk, N., & Tawatsin, A. Effectiveness of citronella preparations in preventing mosquito bites: of controlled laboratory experimental studies. Tropical Medicine & International Health, 16(7), 802-810.
- Jamjute, P., Eedarapalli, P., & Jain, S. (2005). Awareness of correct use of a seatbelt among pregnant women and health professionals: A multicentric survey. Journal of Obstetrics & Gynecology, 25(6), 550-553. doi: 10.1080/01443610500231393
- Beck, L. F., Gilbert, B. C., & Shults, R. A. (2005). http://dx.doi.org/10.1016/j.ajog.2004.07.027 of seat belt use among reproductive-aged women and prenatal counseling to wear seat belts. American Journal of Obstetrics and Gynecology, 192(2), 580-585.
- American College of Obstetricians and Gynecologists. (2009). Car http://acog.org/-/media/For-Patients/faq018.pdf?dmc=1&ts=20150529T1105333145 for you and your baby. Washington, DC: Author. Retrieved from
- National Highway Traffic http://nhtsa.gov/people/injury/airbags/Internet_Services_Group/ISG-Restricted/Buckle-Up%20America/pregnancybrochure/page1.html Administration. (2002). Should pregnant women wear seat belts? Retrieved from
- Transport Canada. (2013). Airbag deactivation: The air bag on-off decision. Retrieved from http://www.tc.gc.ca/eng/motorvehiclesafety/tp-tp13178-page4_e-184.htm
- Transport Canada. (2013). Air Bag Deactivation: Introduction. Retrieved from https://www.tc.gc.ca/eng/motorvehiclesafety/tp-tp13178-page1_e-181.htm
- Government of Canada. (2014). Traveling while pregnant. Retrieved from http://travel.gc.ca/travelling/health-/travelling-pregnant
- Health Physics Society. (2014). Pregnancy and security screening. Retrieved from http://hps.org/publicinformation/ate/faqs/pregnancyandsecurityscreening.html
- Canadian Human Rights Commission. (2010). Pregnancy and human rights in the workplace: A guide for employers. Retrieved from http://www.chrc-ccdp.ca/sites/default/files/pregnancy_grossesse-eng_0.pdf
- Hobel, C. J., Goldstein, A., & Barrett, E.S. (2008). Psychosocial stress and pregnancy outcome. Clinical Obstetrics & Gynecology, 51(2), 333-348. doi: 10.1097/GRF.0b013e31816f2709
- Ratnapalan, S., Bentur, Y., & Koren, G. (2008). Doctor, will that x-ray harm my unborn child? CMAJ, 179(12), doi: 10.1503/cmaj.080247
- Best Start Resource Centre. (2007). Work and pregnancy do mix. Toronto, ON: Author. Retrieved from beststart.org/resources/wrkplc_health/pdf/preg_work_8p_book_rev09.pdf
- Dreier, J. W., Nybo Anderson, A-M., & Berg-Beckhoff, G. (2014). and meta-analyses: Fever in pregnancy and health impacts in the offspring. Pediatrics. doi: 10.1542/peds.2013-3205
- Palmer, K. T., Bonzini, M., Harris, E. C., Linaker, C., Bonde, J. P. (2013). Work activities and risk of prematurity, and : an updated review with . Occup Environ Med. 2013;70(4):213-222.
- Best Start Resource Centre. (2007). Work and pregnancy do mix. Retrieved from http://beststart.org/resources/wrkplc_health/pdf/pregnancy_work_8p_booklet.pdf
- Pacquet, C., & Yudin, M. H. (2013). http://sogc.org/wp-content/uploads/2013/02/gui285CPG1301E-.pdf in pregnancy: Prevention, screening, and treatment. Journal of Obstetrics & Gynaecology Canada, 35(1 eSuppl A), S1-S7. Retrieved from
- Public Health Agency of Canada. (2014). Frequently asked questions about hepatitis C. Retrieved from http://www.phac-aspc.gc.ca/hepc/faq-eng.php
- Crane, J., Mundle, W., & Boucoiran, I. (2013). Parvovirus B19 infection in pregnancy. Journal of Obstetrics and Gynaecology Canada, 36(12), 1107-1116. Retrieved from http://sogc.org/wp-content/uploads/2014/12/gui3161012E.pdf
- Khattak, S., K-Moghtader, G., McMartin, K., Barrera, M., Kennedy, D., & Koren, G. (1999). Pregnancy outcome following gestational exposure to organic solvent: A prospective controlled study. JAMA, 281(12), 1106-1109. doi: 10.1001/jama.281.12.1106
- Garlantzec, R., Monfort, C., Rouget, F., & Cordier, S. (2009). Maternal occupational exposure to solvents and malformations: A prospective study in the general population. Occupational & Environmental Medicine, 66(7), 456-63. doi: 10.1136/oem.2008.041772
- Centers for Disease Control and Prevention. (2010). Lymphocytic choriomeningitis virus (LCMV) and Pregnancy. Retrieved from http://www.cdc.gov/pregnancy/infections-lcmv.html