Adverse Obstetrical Outcomes with In-Utero Exposure to Indoor Macrocyclic Trichothecenes, Stachybotrys, and Trichoderma.

Background: Produced by indoor Stachybotrys and Trichoderma spp., macrocyclic trichothecenes (MTs), a type of cytotoxic respirable molecule (<0.01-0.03 µm), inhibit protein/DNA/RNA production, damage mitochondria, and induce apoptosis. Dust-bound MTs remain toxic despite remediation/disinfection. Inhaled MTs easily cross tissue barriers, potentially reaching the placenta and the unborn. Methods: Retrospective medical record abstraction of pregnant females and offspring cohort exposed to indoor MTs, Stachybotrys, or Trichoderma to correlate professional indoor testing, exposure variables, mold species, environmental MTs, medical symptomatology, outcomes, 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%) and premature labor (33%). Placental abnormalities in two 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, and "goosebump" black/grey skin discoloration. Later abnormalities included developmental delay, oropharyngeal hypotonic dysphagia, refractory eczema, and refractory perirectal rash progressing to intussusception. Lactation difficulties included grey-black oronasal drainage, thrush, projectile vomiting, choking, oropharyngeal neurologic damage, apnea, and respiratory arrest. Aspergillus +/- Penicillium exposure was documented in all, Stachybotrys (75%), Chaetomium (62%), Trichoderma (38%), and indoor MT contamination exposure (75%). Conclusions: In-utero indoor MTs and Stachybotrys exposure correlate strongly with adverse gestational, neonatal complications (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 for identifying MT contaminaion and/or exposure.