Adverse Obstetrical Outcomes with in Utero Exposure to Indoor Macrocyclic Trichothecenes, Stachybotyrs and Trichoderma

Background: Produced by indoor Stachybotrys and Trichoderma spp., macrocyclic trichothecenes (MTs), cytotoxic respirable molecules(<0.01–0.03µm) inhibit protein/DNA/RNA production, damage mitochondria, and induce apoptosis. Dust-bound MTs remain toxic despite remediation/disinfection. Upon inhalation, they cross tissue barriers spreading widely, plausibly injurious to placentae and the unborn. Methods: Retrospective epidemiological study of pregnant females and offspring exposed to indoor MTs, Stachybotrys or Trichoderma, correlating professional indoor testing, medical outcomes, exposure variables, mold species, and urine/milk MTs excretion. Results: In eight women from seven MT/mold contaminated homes, with 21 pregnancies, complications occurred in 19 (90%) pregnancies including miscarriages (38%), premature labor (33%). Placental abnormalities in 2 women (25%) from the same home (calcification, chronic villitis, placental infarcts, double placenta, gritty membranitis). Birth defects in infants (38%) included renal hypertrophy, levocardia, patent foramen ovale, ventriculoseptal defect, ptosis, teeth, “goosebump” black/grey skin discoloration. Later abnormalities included developmental delay (46%), oropharyngeal hypotonic dysphagia, refractory eczema, refractory perirectal rash progressing to intussusception. Lactation difficulties included grey-black oronasal drainage, thrush, projectile vomiting, choking, oropharyngeal neurologic damage, apnea, respiratory arrest. Aspergillus +/- Penicillium exposure was documented for all 8 women, Stachybotyrs (75%), Chaetomium (50%) Trichoderma (37%) and indoor MT contamination exposure (75%). Conclusions: In-utero indoor MTs and Stachybotrys exposure correlates strongly with adverse gestational, neonatal complications, including miscarriage, congenital defects, and placental abnormalities. Exposure timing and severity correlate with adverse outcomes. Breastfeeding with indoor exposure appears hazardous. Environmental/human MTs testing appears useful identifying contamination +/or exposure.