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It was an emergency room nurse who first suggested to Sara Frye that Utah's air pollution may have doomed her pregnancy.

Frye had three children in Oregon and she and her husband, Jarem, had been back in Utah for a year in February 2012.

She had just miscarried twins when a nurse told Frye that a winter inversion may have triggered the loss of her children. "I asked, 'Do you see this a lot?' She said, 'Oh, inversion affects moms and miscarriages.' I was shocked. I'd never thought of it."

Obstetricians and gynecologists working with Utah Physicians for a Healthy Environment say pregnant women are increasingly asking questions about air pollution, but many are unaware of the threat.

The physicians kicked off a year-long public education campaign about the connections between air pollution and pregnancy with a forum at Salt Lake City's Main Library auditorium Thursday.

Four obstetricians-gynecologists and two anesthesiologists discussed a growing body of research that air pollution influences fertility, pregnancy viability, fetal development, birth defects and has long-term consequences for childhood development.

Brian Moench, an anesthesiologist and president of Utah Physicians for a Healthy Environment says awareness of the research "has really mushroomed in the past several years."

Hundreds of studies from around the world "are showing all kinds of adverse pregnancy outcomes occurring in higher rates among those exposed," Moench says.

Utah Department of Health managers, however, disagree that the research is conclusive and worry that Utah Physicians' approach will only scare women.

Alfred Romeo, a nurse with the department's Pregnancy Risk Line and MotherToBaby Utah program says the "devil is in the details" of the studies.

"We all want better air quality. We just don't want to scare women in the process," he says. "Increased anxiety can cause bad outcomes and we get calls already from anxious women."

While research may suggest increased risks for heart defects or pre-term births from air pollution, it does not yet show pollution is the definitive cause, says Romeo, who has evaluated 25 of the studies.

For instance, a Scandinavian study found women exposed to air pollution were at higher risk of pre-term birth — 1.03 on a scale where 1.00 is no risk. But the risks from other factors was much higher, Romeo says. If a woman worked more than 40 hours a week, her risk was 2.00, he notes. Women with no pre-natal care were at 14.00.

Moench calls the Department of Health's position "a profound disservice to the thousands of parents and their children who the DOH should be helping to protect."

Romeo disagrees. "If air pollution really is a problem, it is low on the order of things women need to be concerned about."

Jeanette Carpenter, an obstetrician-gynecologist at the University of Utah, agrees that alarming women is not a good idea.

"But you can't hide it any more from them," says Carpenter, who increasingly is quizzed by patients worried about air pollution.

Carpenter is persuaded by the science behind the studies, and is engaged in her own study of the health records of children born to more than 36,000 women in Utah County from 1985 to 1993. Geneva Steel, a significant polluter, operated all but one year of that time, and Carpenter has pollution records from air monitoring stations.

Carpenter says her preliminary findings indicate a correlation between air pollution and children's asthma and pneumonia. And, she says, those who suffered most were children of less-educated women, likely those living closer to freeways.

While the public advisories for who should stay inside on bad-air days typically don't include pregnant women, Carpenter tells her pregnant patients to consider themselves in that "sensitive" group.

At the forum Thursday, anesthesiologist Todd Seymour, offered tips for reducing exposure. Recirculating the air in a vehicle with a cabin filter helps, and so does using both HEPA and carbon activated filters in the home, he said. "Treat your house like a fish tank with very expensive fish."

Kirtly Jones, an obstetrician-gynecologist and fertility expert at the U., told the crowd of about 80 that research shows air pollution can affect the future fertility of both boy and girl babies. Those whose sperm is already marginal may be pushed into infertility, and the eggs girls are born with can be reduced in number and quality.

"Clearly Utah has pretty good fertility, air quality aside," said Jones. "But we're seeing men and women struggling to have the babies they want so we should be doing something to make it better."

Hannele Laine, an obstetrician-gynecologist at the Avenues Women's Center next to LDS Hospital, says proving conclusively that air pollution causes problems with pregnancies is difficult for several reasons. A range of particulates or chemicals are found in various sources of pollution, and the effects may depend on a woman or her baby's susceptibility, she says.

But it's the same for fetal alcohol syndrome, she notes. Not all babies whose mothers drink heavily are affected.

"It takes a lot of time to prove things in medicine," she says. "We're just getting more and more data that is really good. There really are effects from air pollution."

Frye says her February 2012 miscarriage of twins and another miscarriage that September galvanized her to protect future pregnancies.

She and her husband installed three NASA-designed air purifiers in their home, and she avoided bicycling and walking outdoors on days when she could look across Utah Lake from her Saratoga Springs home and see the blanket of smog against the mountains.

She gave birth to her fourth son, Maxwell, in August 2013.

But the family has taken an even more dramatic step for their fifth child, a girl. Frye learned she was pregnant in August, and the family moved the next month to Heber Valley, where winter inversions are not so severe.

"I wish everybody had that option," says Frye. "It's so much better with fresh air."

Frye says the state Health Department should talk more about the risks to pregnancies.

"Frankly, moms would prefer the truth. I didn't learn about it until it was too late (for her earlier pregnancies)."

Cherise Udell, founder of Utah Moms for Clean Air, is hopeful the focus on pregnancies will lead to more laws to curb pollution.

"In a way, it's a great rallying point," she says. "Everyone wants healthy babies.

"The more people raise a ruckus, the more our politicians have to listen."

Twitter: @KristenMoulton —