Parents’ Concerns About Endocrine Disruptors in Perinatal Health

Technical Summary: Parents' Concerns About Endocrine Disruptors in Perinatal Health

Problem Statement
Endocrine disruptors (EDs) represent an emerging risk to human health, potentially contributing to cancers, reproductive anomalies, developmental disorders, and metabolic diseases. The perinatal period is identified as a critical window of vulnerability, where exposure can significantly impact the unborn child. Despite the existence of recommendations for reducing fetal exposure and establishing preconception environmental consultations, current literature indicates that affected populations—specifically women of reproductive age, pregnant women, and mothers—remain inadequately informed. Furthermore, communication between healthcare providers and patients regarding environmental prevention is often lacking due to perceived knowledge gaps, contradictory research findings, and a lack of official recommendations. This study addresses the specific context of La Réunion Island to assess parents' experiences, awareness, and expectations regarding EDs and chemical pollution in the perinatal context.

Methodology
The research employed a qualitative, phenomenological design conducted between June 2023 and February 2024. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

• Participants: Nine participants were recruited using homogeneous purposive sampling with a maximum variation criterion to ensure diverse socioeconomic and family profiles. Inclusion criteria required participants to be adults planning a pregnancy, currently pregnant, or parents of a child under two years old. Exclusion criteria included minors, non-French or non-Creole speakers, and individuals with cognitive impairments.
• Data Collection: Data was gathered through open-ended individual interviews, conducted either face-to-face in a medical office or via video chat. Recruitment utilized the investigator's professional network and snowball sampling until data saturation was reached.
• Instrument: A semi-structured interview guide, initially containing three open-ended questions, was iteratively refined to clarify inquiries regarding lifestyle, risk perception, and information sources.
• Analysis: Interviews were audio-recorded, transcribed, and analyzed using interpretative phenomenological analysis. The process involved manual coding to identify recurring themes, followed by the development of open and axial coding books overseen by a thesis supervisor to ensure consistency.
• Ethics: The study was approved by the University of La Réunion thesis committee. Under French regulations (Jardé Law, Category 3), ethics committee approval was not required, though a data protection application was filed with the CNIL.

Key Contributions and Results
The study identified four primary thematic areas: Lifestyle, Risk Assessment, Behavior Management, and Critical Approach.

1. Intuitive Awareness vs. Specific Knowledge: While approximately half of the participants were familiar with the concept of endocrine disruptors, their knowledge was often vague and based on general assumptions rather than scientific facts. Awareness was highest regarding food and cosmetics (e.g., avoiding processed foods or "too perfect" produce) but lower regarding textiles and cleaning products. Participants displayed an intuitive understanding that certain substances could cross the placental barrier, a shift from previous perceptions of the placenta as a complete shield.
2. Information Sources and Trust: The medical profession was largely absent from the information landscape, despite participants identifying physicians as the most legitimate and desirable source of information. Participants reported a lack of interest, insufficient training, and inconsistent messaging from healthcare professionals. Consequently, parents turned to alternative sources, including social networks, the internet, and books.
3. Barriers to Behavior Change: Participants expressed frustration and mental overload when attempting to modify behaviors to reduce exposure. Significant barriers included the high cost of organic or "clean" products, limited availability, and contradictory advice. Many participants felt forced to make trade-offs, choosing the "least bad" option rather than an ideal one. Some adopted creative but unsustainable strategies, such as making their own products or using rating apps (e.g., Yuka).
4. Critical Engagement with Information: Faced with conflicting data and potential misinformation, participants developed critical approaches to verify sources. They actively compared multiple websites, sought medical opinions to resolve contradictions, and expressed skepticism toward commercial influences and industry lobbying.

Significance and Claims
The authors claim this study is innovative for its focus on the specific context of La Réunion, noting that it aligns with broader literature while highlighting local nuances. The study underscores that while parents are intuitively aware of endocrine disruptors, they lack reliable, benevolent, and unbiased information to act effectively.

The paper posits that the current gap in professional guidance forces parents to rely on media-driven and often questionable sources. The authors argue that to improve perinatal health, there is an urgent need to:

• Enhance training for healthcare professionals in environmental health.
• Combat online medical misinformation and conflicts of interest more effectively.
• Improve access to reliable data while respecting personal choices and acknowledging the obstacles parents face.

The study concludes that environmental health must be prioritized as a public health measure within perinatal care, aiming to encourage behavioral changes without inducing undue alarm. The authors modestly suggest that further research is needed to explore other populations and areas of environmental health, acknowledging limitations such as the investigator's inexperience with phenomenology and a sample biased toward females and paramedical professionals.