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Luo Q, Miao Y, Liu C, Bei E, Zhang JF, Zhang LH, Deng YL, Qiu Y, Lu WQ, Wright JM, Chen C, Zeng Q. Maternal exposure to nitrosamines in drinking water during pregnancy and birth outcomes in a Chinese cohort. CHEMOSPHERE 2023; 315:137776. [PMID: 36623593 DOI: 10.1016/j.chemosphere.2023.137776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Maternal exposure to regulated disinfection by-products (DBPs) during pregnancy has been linked with adverse birth outcomes. However, no human studies have focused on drinking water nitrosamines, a group of emerging unregulated nitrogenous DBPs that exhibits genotoxicity and developmental toxicity in experimental studies. This cohort study included 2457 mother-infant pairs from a single drinking water supply system in central China, and maternal trimester-specific and entire pregnancy exposure of drinking water nitrosamines were evaluated. Multivariable linear and Poisson regression models were used to estimate the associations between maternal exposure to nitrosamines in drinking water and birth outcomes [birth weight (BW), low birth weight (LBW), small for gestational age (SGA) and preterm delivery (PTD)]. Elevated maternal N-nitrosodimethylamine (NDMA) exposure in the second trimester and N-nitrosopiperidine (NPIP) exposure during the entire pregnancy were associated with decreased BW (e.g., β = -88.6 g; 95% CI: -151.0, -26.1 for the highest vs. lowest tertile of NDMA; p for trend = 0.01) and increased risks of PTD [e.g., risk ratio (RR) = 2.16; 95% CI: 1.23, 3.79 for the highest vs. lowest tertile of NDMA; p for trend = 0.002]. Elevated maternal exposure of N-nitrosodiethylamine (NDEA) in the second trimester was associated with increased risk of SGA (RR = 1.80; 95% CI: 1.09, 2.98 for the highest vs. lowest tertile; p for trend = 0.01). Our study detected associations of maternal exposure to drinking water nitrosamines during pregnancy with decreased BW and increased risks of SGA and PTD. These findings are novel but require replication in other study populations.
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Affiliation(s)
- Qiong Luo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Miao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chong Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Er Bei
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, PR China
| | - Jin-Feng Zhang
- Maternal and Child Health Care Service Centre of Xiaonan District, Xiaogan City, Hubei, PR China
| | - Ling-Hua Zhang
- Maternal and Child Health Care Service Centre of Xiaonan District, Xiaogan City, Hubei, PR China
| | - Yan-Ling Deng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Qiu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, PR China
| | - Wen-Qing Lu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - J Michael Wright
- Office of Research and Development, U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Cincinnati, OH, USA
| | - Chao Chen
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, PR China.
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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An SL, Xiong SM, Shen XB, Ni YQ, Chen W, He CD, Zhou YZ. The associations between exposure to trihalomethanes during pregnancy and adverse birth outcomes: A systematic review and meta-analysis. CHEMOSPHERE 2022; 293:133524. [PMID: 34990723 DOI: 10.1016/j.chemosphere.2022.133524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
The study aimed to examine the associations between the level of trihalomethanes and its metabolites in pregnancy and the risks of adverse birth outcomes. We searched the databases of the China National Knowledge Infrastructure, WanFang, Vip, PubMed, and Elsevier Science Direct from database establishment to July 14, 2021 and performed a systematic review and meta-analysis of observational studies reporting associations between trihalomethanes level and abnormally low birth weight and preterm birth. The pooled odds ratio (OR), pooled risk ratio, and pooled risk difference with their 95% confidence interval (CI) were calculated for risk estimates. A total of 24 studies involving 1,118,037 pregnant women were finally enrolled in the present systematic review and meta-analysis. Our research found that abnormally low birth weight was associated with higher levels of total trihalomethanes (OR = 2.45, 95% CI: 1.28, 4.68; P = 0.007). Unexpectedly, the meta-analysis indicated that higher total trihalomethanes level was associated with lower odds of preterm birth (OR = 0.90, 95% CI: 0.81, 0.99; P = 0.03). Our findings indicate that trihalomethanes exposure might be a risk factor for abnormally low birth weight and that it would be prudent to minimize exposure to trihalomethanes during pregnancy because of the risk of abnormally low birth weight. Given some limitations of the systematic review and meta-analysis, our results should be interpreted with caution.
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Affiliation(s)
- Song-Lin An
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Shi-Min Xiong
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Xu-Bo Shen
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Yun-Qiao Ni
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Wei Chen
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Cai-Die He
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China
| | - Yuan-Zhong Zhou
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563060, PR China.
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Säve-Söderbergh M, Toljander J, Donat-Vargas C, Åkesson A. Drinking Water Disinfection by-Products and Congenital Malformations: A Nationwide Register-Based Prospective Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:97012. [PMID: 34585603 PMCID: PMC8480150 DOI: 10.1289/ehp9122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Drinking water chlorination by-products have been associated with adverse reproductive outcomes, although the findings for congenital malformations are still inconclusive. OBJECTIVE We conducted a nationwide register-based prospective study to assess whether first trimester maternal exposure to the four most common trihalomethanes [total trihalomethanes (TTHM)] via municipal drinking water was associated with risk of congenital malformation among newborns. METHODS We included all births during 2005-2015 (live and stillbirths) of mothers residing in Swedish localities having >10,000 inhabitants, two or fewer operating water works, and sufficient municipal TTHM monitoring data. Individual maternal first trimester exposure was obtained by linking TTHM measurements to residential information, categorized into no chlorination and <5, 5-15, and >15μg TTHM/L. We also made chlorination treatment-specific analyses (exclusive use of chloramine or hypochlorite). Outcomes and covariates were obtained via linkage to health care and administrative registers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. RESULTS Based on 623,468 births and a prevalence of congenital malformation of ∼2 cases/100 births, we observed associations between TTHM exposure in areas using chloramine and malformations of the nervous system (OR=1.82; 95% CI: 1.07, 3.12), urinary system (OR=2.06; 95% CI: 1.53, 2.78), genitals (OR=1.77; 95% CI: 1.38, 2.26), and limbs (OR=1.34; 95% CI: 1.10, 1.64), comparing the highest exposed category with the unexposed. No associations were observed in areas using exclusively hypochlorite as the primary water treatment method. By contrast, for malformations of the heart, a significant inverse association was observed only in areas using hypochlorite. DISCUSSION TTHM exposure was associated with the increased risk of malformations of the nervous system, urinary system, genitals, and limbs in areas exclusively using chloramine. An association between chloramine-related chlorination by-products and congenital malformations has not previously been highlighted and needs further attention. https://doi.org/10.1289/EHP9122.
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Affiliation(s)
- Melle Säve-Söderbergh
- Science Division, Swedish Food Agency, Uppsala, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Carolina Donat-Vargas
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto Madrileño de Estudios Avanzados (IMDEA)-Alimentación, Campus of International Excellence, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas (CEI UAM+CSIC), Madrid, Spain
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Säve-Söderbergh M, Toljander J, Donat-Vargas C, Berglund M, Åkesson A. Exposure to Drinking Water Chlorination by-Products and Fetal Growth and Prematurity: A Nationwide Register-Based Prospective Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:57006. [PMID: 32438832 PMCID: PMC7263457 DOI: 10.1289/ehp6012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Chlorination is globally used to produce of safe drinking water. Chlorination by-products are easily formed, and there are indications that these are associated with adverse reproductive outcomes. OBJECTIVES We conducted a nationwide register-based prospective study to assess whether gestational exposure to the four most common chlorination by-products [total trihalomethanes (TTHMs)] via tap water was associated with risk of small for gestational age (SGA), preterm delivery, and very preterm delivery. To date, this is one of the largest studies assessing drinking water TTHM-associated adverse reproductive outcomes. METHODS We included all singleton births 2005-2015 (live and stillbirths) of mothers residing in Swedish localities having >10,000 inhabitants, ≤2 operating waterworks, adequate information on chlorination treatment, and a sufficient number of routine TTHM measurements in tap water. Individual maternal second and third trimester exposure was obtained by linking TTHM measurements to residential history, categorized into no chlorination, <5, 5-15, and >15μg TTHM/L. Outcomes and covariates were obtained via the linkage to Swedish health and administrative registers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression using inverse probability weighting. We stratified the analyses by chlorination treatment (chloramine, hypochlorite). RESULTS Based on approximately 500,000 births, we observed a TTHM dose-dependent association with increased risk of SGA, confined to treatment with hypochlorite, corresponding to a multivariable-adjusted OR=1.20 (95% CI: 1.08, 1.33) comparing drinking water TTHM >15μg to the unexposed. Similar results were obtained when, instead of unexposed, the lowest exposure category (<5μg/L TTHM) was used as reference. No clear associations were observed for preterm delivery and very preterm delivery. DISCUSSION Chlorination by-products exposure via drinking water was associated with increased risk of SGA in areas with hypochlorite treatment. https://doi.org/10.1289/EHP6012.
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Affiliation(s)
- Melle Säve-Söderbergh
- Science Division, Swedish Food Agency, Uppsala, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Carolina Donat-Vargas
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marika Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Liu C, Wang YX, Chen YJ, Sun Y, Huang LL, Cheng YH, Liu EN, Lu WQ, Messerlian C. Blood and urinary biomarkers of prenatal exposure to disinfection byproducts and oxidative stress: A repeated measurement analysis. ENVIRONMENT INTERNATIONAL 2020; 137:105518. [PMID: 32018134 DOI: 10.1016/j.envint.2020.105518] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/04/2020] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Toxicological studies have demonstrated that disinfection by-products (DBPs) can induce oxidative stress, a proposed mechanism that is relevant to adverse birth outcomes. OBJECTIVE To examine the associations of blood trihalomethanes (THMs) and urinary haloacetic acids (HAAs) with urinary biomarkers of oxidative stress among pregnant women. METHODS From 2015 to 2017, a total of 4150 blood and 4232 urine samples were collected from 1748 Chinese women during pregnancy. We determined concentrations of 4 blood THMs [chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM)] and 2 urinary HAAs [dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA)]. The summary measures of exposure for brominated THMs (Br-THMs; a molar sum of BDCM, DBCM, and TBM) and total THMs (TTHMs; a molar sum of TCM and Br-THMs) were also calculated. Associations of categorical (i.e., tertiles) and continuous measures of DBPs with urinary concentrations of oxidative stress (OS) biomarkers, 8-hydroxy-2-deoxyguanosine (8-OHdG), 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA), and 8-iso-prostaglandin F2α (8-isoPGF2α), were assessed using linear mixed regression models. RESULTS After adjusting for relevant confounding factors, we observed positive dose-response relationships between blood Br-THM tertiles and urinary HNE-MA (P for trend < 0.001). We also found positive associations between tertiles of blood TCM and TTHMs and urinary 8-OHdG and HNE-MA (all P for trend < 0.05). Urinary HAAs were also positively associated with 8-OHdG, HNE-MA, and 8-isoPGF2α in a dose-response manner (all P for trend < 0.001). These associations were further confirmed when we modeled DBP exposures as continuous variables in linear mixed regression models, as well as in penalized regression splines based on generalized additive mixed models. CONCLUSIONS Exposure to DBPs during pregnancy may increase maternal OS status.
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Affiliation(s)
- Chong Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi-Xin Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ying-Jun Chen
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yang Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Li-Li Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Hui Cheng
- Department of Gynecology and Obstetrics, Xiaonan Maternal and Child Care Service Centre, Xiaogan City, Hubei, PR China
| | - Er-Nan Liu
- Wuhan Center for Disease Prevention and Control, Wuhan, Hubei, PR China
| | - Wen-Qing Lu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Carmen Messerlian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Environmental Contaminants Exposure and Preterm Birth: A Systematic Review. TOXICS 2019; 7:toxics7010011. [PMID: 30832205 PMCID: PMC6468584 DOI: 10.3390/toxics7010011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/04/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Abstract
Preterm birth is an obstetric condition associated with a high risk of infant mortality and morbidities in both the neonatal period and later in life, which has also a significant public health impact because it carries an important societal economic burden. As in many cases the etiology is unknown, it is important to identify environmental factors that may be involved in the occurrence of this condition. In this review, we report all the studies published in PubMed and Scopus databases from January 1992 to January 2019, accessible as full-text articles, written in English, including clinical studies, original studies, and reviews. We excluded articles not written in English, duplicates, considering inappropriate populations and/or exposures or irrelevant outcomes and patients with known risk factors for preterm birth (PTB). The aim of this article is to identify and summarize the studies that examine environmental toxicants exposure associated with preterm birth. This knowledge will strengthen the possibility to develop strategies to reduce the exposure to these toxicants and apply clinical measures for preterm birth prevention.
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Williams AL, Bates CA, Pace ND, Leonhard MJ, Chang ET, DeSesso JM. Impact of chloroform exposures on reproductive and developmental outcomes: A systematic review of the scientific literature. Birth Defects Res 2018; 110:1267-1313. [PMID: 30350414 DOI: 10.1002/bdr2.1382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
AIMS We assessed the animal and epidemiological data to determine if chloroform exposure causes developmental and/or reproductive toxicity. RESULTS AND DISCUSSION Initial scoping identified developmental toxicity as the primary area of concern. At levels producing maternal toxicity in rats and mice, chloroform caused decrements in fetal weights and associated delays in ossification. In a single mouse inhalation study, exposure to a high concentration of chloroform was associated with small fetuses and increased cleft palate. However, oral exposure of mice to chloroform at a dose 4 times higher was negative for cleft palate; multiple inhalation studies in rats were also negative. Epidemiologic data on low birth weight and small for gestational age were generally equivocal, preventing conclusions from being drawn for humans. The animal data also show evidence of very early (peri-implantation) total litter losses at very high exposure levels. This effect is likely maternally mediated rather than a direct effect on the offspring. Finally, the epidemiologic data indicate a possible association of higher chloroform exposure with lower risk of preterm birth (<37 weeks gestation). CONCLUSIONS The available animal data suggest that exposures lower than those causing maternal toxicity should be without developmental effects in the offspring. Also, most studies in humans rely on group-level geographic exposure data, providing only weak epidemiologic evidence for an association with development outcomes and fail to establish a causal role for chloroform in the induction of adverse developmental outcomes at environmentally relevant concentrations.
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Affiliation(s)
| | | | | | | | | | - John M DeSesso
- Exponent, Inc., Alexandria, Virginia.,Georgetown University School of Medicine, Washington, District of Columbia
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Mashau F, Ncube EJ, Voyi K. Drinking water disinfection by-products exposure and health effects on pregnancy outcomes: a systematic review. JOURNAL OF WATER AND HEALTH 2018; 16:181-196. [PMID: 29676755 DOI: 10.2166/wh.2018.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Epidemiological studies have found that maternal exposure to disinfection by-products (DBPs) may lead to adverse pregnancy outcomes although the findings tend to be inconsistent. The objective of this study was to systematically review the evidence in associated with drinking water DBP exposure in relation to adverse pregnancy outcomes. Peer-reviewed articles were identified using electronic databases searched for studies published in the English language. Studies selected for review were evaluated for exposure assessment, confounders, and analyses risks of bias in the selection, outcomes assessment, and attrition. A comprehensive search and screening yielded a total of 32 studies, of which 12 (38%) reported a statistical association between maternal exposure to DBPs and adverse pregnancy outcomes. A maternal exposure to trihalomethanes (THMs) shows an increased risk of small for gestational age (SGA) and slightly increased risk of pregnancy loss. Risks of bias were low among the studies included in the review. Evidence on association relating to adverse pregnancy outcomes to DBP exposure is still less significant. There is a need for future robust research in this field, with the use of urinary trichloroacetic acid (TCAA) biomarkers as a direct exposure assessment method for this field.
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Affiliation(s)
- Funanani Mashau
- School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa E-mail:
| | - Esper Jacobeth Ncube
- School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa E-mail:
| | - Kuku Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa E-mail:
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Zeng Q, Cao WC, Zhou B, Yang P, Wang YX, Huang Z, Li J, Lu WQ. Predictors of Third Trimester Blood Trihalomethanes and Urinary Trichloroacetic Acid Concentrations among Pregnant Women. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:5278-5285. [PMID: 27095243 DOI: 10.1021/acs.est.5b05971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Prenatal exposure to disinfection byproducts (DBPs) has been associated with a variety of adverse birth outcomes. However, little is known about predictors of prenatal biomarkers of exposure to DBPs among pregnant women. We aimed to identify predictors of third trimester blood trihalomethanes (THMs) and urinary trichloroacetic acid (TCAA) concentrations, two biomarkers of exposure to DBPs, among pregnant women. Blood samples, urine samples, and questionnaires on individual characteristics and water-use activities were collected from 893 pregnant women in a Chinese cohort study. Maternal blood THM [chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM)] and urinary TCAA concentrations were measured. We used multivariable linear regression to identify the predictors of third trimester blood THM and creatinine-adjusted urinary TCAA concentrations. The geometric mean of blood TTHM (sum of TCM, BDCM, DBCM, and TBM) and creatinine-adjusted urinary TCAA concentrations were 51.90 ng/L and 9.66 μg/g creatinine, respectively. Study city was the strongest significant predictors of blood THM and creatinine-adjusted urinary TCAA concentrations. Prenatal body mass index (BMI) was associated with decreased blood THM and decreased creatinine-adjusted urinary TCAA concentrations. Age was associated with increased blood Br-THM (sum of BDCM, DBCM, and TBM) concentrations. Intake of boiled water and passive smoking were associated with lower blood THM concentrations. The predictors of blood THM and urinary TCAA concentrations identified in this study provide potential health implications on how to reduce DBP exposure during pregnancy.
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Affiliation(s)
- Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Wen-Cheng Cao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Bin Zhou
- College of Public Health, University of South China , Hengyang, Hunan 421001, PR China
| | - Pan Yang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Yi-Xin Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Zhen Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Jin Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
| | - Wen-Qing Lu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei 430030, PR China
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Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MB. Birth Weight, Ethnicity, and Exposure to Trihalomethanes and Haloacetic Acids in Drinking Water during Pregnancy in the Born in Bradford Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:681-9. [PMID: 26340797 PMCID: PMC4858386 DOI: 10.1289/ehp.1409480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 08/31/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately. OBJECTIVES We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort. METHODS Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity. RESULTS Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ≥ 1.82 vs. < 1.05 μg/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption. CONCLUSIONS To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa. CITATION Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MB. 2016. Birth weight, ethnicity, and exposure to trihalomethanes and haloacetic acids in drinking water during pregnancy in the Born in Bradford cohort. Environ Health Perspect 124:681-689; http://dx.doi.org/10.1289/ehp.1409480.
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Affiliation(s)
- Rachel B. Smith
- MRC-PHE (Medical Research Council–Public Health England) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, United Kingdom
| | - Susan C. Edwards
- MRC-PHE (Medical Research Council–Public Health England) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, United Kingdom
| | - Nicky Best
- MRC-PHE (Medical Research Council–Public Health England) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Mark J. Nieuwenhuijsen
- MRC-PHE (Medical Research Council–Public Health England) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, United Kingdom
- Center for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute), CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Barcelona, Spain
| | - Mireille B. Toledano
- MRC-PHE (Medical Research Council–Public Health England) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, United Kingdom
- Address correspondence to M.B. Toledano, Department of Epidemiology and Biostatistics, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK. Telephone: 44 20 7594 3298. E-mail:
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Cao WC, Zeng Q, Luo Y, Chen HX, Miao DY, Li L, Cheng YH, Li M, Wang F, You L, Wang YX, Yang P, Lu WQ. Blood Biomarkers of Late Pregnancy Exposure to Trihalomethanes in Drinking Water and Fetal Growth Measures and Gestational Age in a Chinese Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:536-41. [PMID: 26340795 PMCID: PMC4829983 DOI: 10.1289/ehp.1409234] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 08/13/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Previous studies have suggested that elevated exposure to disinfection by-products (DBPs) in drinking water during gestation may result in adverse birth outcomes. However, the findings of these studies remain inconclusive. OBJECTIVE The purpose of our study was to examine the association between blood biomarkers of late pregnancy exposure to trihalomethanes (THMs) in drinking water and fetal growth and gestational age. METHODS We recruited 1,184 pregnant women between 2011 and 2013 in Wuhan and Xiaogan City, Hubei, China. Maternal blood THM concentrations, including chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM), were measured as exposure biomarkers during late pregnancy. We estimated associations with gestational age and fetal growth indicators [birth weight, birth length, and small for gestational age (SGA)]. RESULTS Total THMs (TTHMs; sum of TCM, BDCM, DBCM, and TBM) were associated with lower mean birth weight (-60.9 g; 95% CI: -116.2, -5.6 for the highest vs. lowest tertile; p for trend = 0.03), and BDCM and DBCM exposures were associated with smaller birth length (e.g., -0.20 cm; 95% CI: -0.37, -0.04 for the highest vs. lowest tertile of DBCM; p for trend = 0.02). SGA was increased in association with the second and third tertiles of TTHMs (OR = 2.91; 95% CI: 1.32, 6.42 and OR = 2.25; 95% CI: 1.01, 5.03; p for trend = 0.08). CONCLUSIONS Our results suggested that elevated maternal THM exposure may adversely affect fetal growth. CITATION Cao WC, Zeng Q, Luo Y, Chen HX, Miao DY, Li L, Cheng YH, Li M, Wang F, You L, Wang YX, Yang P, Lu WQ. 2016. Blood biomarkers of late pregnancy exposure to trihalomethanes in drinking water and fetal growth measures and gestational age in a Chinese cohort. Environ Health Perspect 124:536-541; http://dx.doi.org/10.1289/ehp.1409234.
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Affiliation(s)
- Wen-Cheng Cao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yan Luo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hai-Xia Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Dong-Yue Miao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Li Li
- Department of Gynecology and Obstetrics, Wuhan No.1 Hospital, Wuhan, Hubei, PR China
| | - Ying-Hui Cheng
- Department of Gynecology and Obstetrics, Xiaonan Maternal and Child Care Service Centre, Xiaogan, Hubei, PR China
| | - Min Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fan Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Ling You
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi-Xin Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Pan Yang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Wen-Qing Lu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environment and Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Villanueva CM, Cordier S, Font-Ribera L, Salas LA, Levallois P. Overview of Disinfection By-products and Associated Health Effects. Curr Environ Health Rep 2016; 2:107-15. [PMID: 26231245 DOI: 10.1007/s40572-014-0032-x] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools. Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insufficient or mixed. Numerous studies have evaluated reproductive implications, including sperm quality, time to pregnancy, menstrual cycle, and pregnancy outcomes such as fetal loss, fetal growth, preterm delivery, and congenital malformation. The body of evidence suggests only minor effects from high exposure during pregnancy on fetal growth indices such as small for gestational age (SGA) at birth. Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers. The risk of asthma, wheezing, eczema, and other respiratory outcomes among children attending swimming pools has been the object of extensive research. Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association. Future research should develop methods to evaluate the effects of the DBP mixture and the interaction with personal characteristics (e.g., genetics, lifestyle), clarify the association between swimming pools and respiratory health, evaluate the occurrence of DBPs in low- and middle-income countries, and evaluate outcomes suggested by animal studies that have not been considered in epidemiological investigations.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader 88, 08003, Barcelona, Spain,
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Charisiadis P, Andra SS, Makris KC, Christophi CA, Skarlatos D, Vamvakousis V, Kargaki S, Stephanou EG. Spatial and seasonal variability of tap water disinfection by-products within distribution pipe networks. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 506-507:26-35. [PMID: 25460936 DOI: 10.1016/j.scitotenv.2014.10.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 04/14/2023]
Abstract
Gradually-changing shocks associated with potable water quality deficiencies are anticipated for urban drinking-water distribution systems (UDWDS). The impact of structural UDWDS features such as, the number of pipe leaking incidences on the formation of water trihalomethanes (THM) at the geocoded household level has never been studied before. The objectives were to: (i) characterize the distribution of water THM concentrations in households from two district-metered areas (DMAs) with contrasting UDWDS characteristics sampled in two seasons (summer and winter), and (ii) assess the within- and between-household, spatial variability of water THM accounting for UDWDS characteristics (household distance from chlorination tank and service pipe leaking incidences). A total of 383 tap water samples were collected from 193 households located in two DMAs within the UDWDS of Nicosia city, Cyprus, and analyzed for the four THM species. The higher intraclass correlation coefficient (ICC) values for water tribromomethane (TBM) (0.75) followed by trichloromethane (0.42) suggested that the two DMAs differed with respect to these analytes. On the other hand, the low ICC values for total THM levels between the two DMAs suggested a large variance between households. The effect of households nested under each DMA remained significant (p<0.05) for TBM (not for the rest of the THM species) in the multivariate mixed-effect models, even after inclusion of pipe network characteristics. Our results could find use by water utilities in overcoming techno-economic difficulties associated with the large spatiotemporal variability of THM, while accounting for the influence of UDWDS features at points of water use.
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Affiliation(s)
- Pantelis Charisiadis
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Syam S Andra
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus; Harvard-Cyprus Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Dimitrios Skarlatos
- Department of Civil Engineering and Geomatics, Cyprus University of Technology, Limassol, Cyprus
| | - Vasilis Vamvakousis
- Department of Civil Engineering and Geomatics, Cyprus University of Technology, Limassol, Cyprus
| | - Sophia Kargaki
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion 71003, Greece
| | - Euripides G Stephanou
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion 71003, Greece
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Evaluation of exposure to trihalomethanes in tap water and semen quality: A prospective study in Wuhan, China. Reprod Toxicol 2014; 46:56-63. [DOI: 10.1016/j.reprotox.2014.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 01/08/2014] [Accepted: 03/04/2014] [Indexed: 11/21/2022]
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15
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Evans AM, Wright JM, Meyer A, Rivera-Núñez Z. Spatial variation of disinfection by-product concentrations: exposure assessment implications. WATER RESEARCH 2013; 47:6130-6140. [PMID: 23993731 DOI: 10.1016/j.watres.2013.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/27/2013] [Accepted: 07/21/2013] [Indexed: 06/02/2023]
Abstract
The use of public water system (PWS) average trihalomethane (THM) and haloacetic acid (HAA) concentrations as surrogates of "personal" exposures in epidemiological studies of disinfection by-products (DBPs) may result in exposure misclassification bias from various sources of measurement error including intra-system variation of DBPs. Using 2000-2004 data from 107 PWSs in Massachusetts, we assessed two approaches for characterizing DBP spatial variability by identifying PWSs with low spatial variability (LSV) and examining differences in LSV across DBP groups and by type of source water and primary disinfectant. We also used spatial differences to examine the association between THM concentrations and indices of social disadvantage; however, we found no correlations or statistically significant differences based on the available data. We observed similar patterns for the percentage of quarterly sampling dates with LSV across different types of source water for all DBPs but not across disinfectants. We found there was little overlap between sites classified as having LSV across different DBP groups. In the main analysis, we found moderate correlations between both approaches (φ(THM4) = 0.55; φ(BrTHM) = 0.64; φ(HAA5) = 0.67); although Method 1 (based on concentration differences between samples) may be better suited for identifying PWSs for inclusion in epidemiological studies because it is more easily adapted to study-specific exposure gradients than Method 2 (based on categorical exposure percentiles). These data reinforce the need to consider different exposure assessment approaches when examining the spatial variation of multiple DBP surrogates as they can represent different DBP mixtures.
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Affiliation(s)
- Amanda M Evans
- Oak Ridge Institute for Science and Education, 26 West Martin Luther King Blvd (MS-A110), Cincinnati, OH 45268, USA.
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Kumar S, Forand S, Babcock G, Hwang SA. Total Trihalomethanes in Public Drinking Water Supply and Birth Outcomes: A Cross-Sectional Study. Matern Child Health J 2013; 18:996-1006. [DOI: 10.1007/s10995-013-1328-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Danileviciute A, Grazuleviciene R, Vencloviene J, Paulauskas A, Nieuwenhuijsen MJ. Exposure to drinking water trihalomethanes and their association with low birth weight and small for gestational age in genetically susceptible women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:4470-85. [PMID: 23222181 PMCID: PMC3546772 DOI: 10.3390/ijerph9124470] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/21/2012] [Accepted: 12/03/2012] [Indexed: 01/03/2023]
Abstract
Little is known about genetic susceptibility to individual trihalomethanes (THM) in relation to adverse pregnancy outcomes. We conducted a nested case-control study of 682 pregnant women in Kaunas (Lithuania) and, using individual information on drinking water, ingestion, showering and bathing, and uptake factors of THMs in blood, estimated an internal THM dose. We used logistic regression to evaluate the relationship between internal THM dose, birth outcomes and individual and joint (modifying) effects of metabolic gene polymorphisms. THM exposure during entire pregnancy and specific trimesters slightly increased low birth weight (LBW) risk. When considering both THM exposure and maternal genotypes, the largest associations were found for third trimester among total THM (TTHM) and chloroform-exposed women with the GSTM1–0 genotype (OR: 4.37; 95% CI: 1.36–14.08 and OR: 5.06; 95% CI: 1.50–17.05, respectively). A test of interaction between internal THM dose and GSTM1–0 genotype suggested a modifying effect of exposure to chloroform and bromodichloromethane on LBW risk. However, the effect on small for gestational age (SGA) was not statistically significant. These data suggest that THM internal dose may affect foetal growth and that maternal GSTM1 genotype modifies the THM exposure effects on LBW.
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Affiliation(s)
- Asta Danileviciute
- Department of Environmental sciences, Vytautas Magnus University, K. Donelaicio g. 58, LT-44248, Kaunas, Lithuania; E-Mails: (A.D.); (J.V.); (A.P.)
| | - Regina Grazuleviciene
- Department of Environmental sciences, Vytautas Magnus University, K. Donelaicio g. 58, LT-44248, Kaunas, Lithuania; E-Mails: (A.D.); (J.V.); (A.P.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +370-6502-7090; Fax: +370-3732-7904
| | - Jone Vencloviene
- Department of Environmental sciences, Vytautas Magnus University, K. Donelaicio g. 58, LT-44248, Kaunas, Lithuania; E-Mails: (A.D.); (J.V.); (A.P.)
| | - Algimantas Paulauskas
- Department of Environmental sciences, Vytautas Magnus University, K. Donelaicio g. 58, LT-44248, Kaunas, Lithuania; E-Mails: (A.D.); (J.V.); (A.P.)
| | - Mark J. Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003, Barcelona, Spain; E-Mail:
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Costet N, Garlantézec R, Monfort C, Rouget F, Gagnière B, Chevrier C, Cordier S. Environmental and urinary markers of prenatal exposure to drinking water disinfection by-products, fetal growth, and duration of gestation in the PELAGIE birth cohort (Brittany, France, 2002-2006). Am J Epidemiol 2012; 175:263-75. [PMID: 22156019 DOI: 10.1093/aje/kwr419] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although prenatal exposure to water disinfection by-products does not appear to affect the duration of gestation, its impact on fetal growth remains an open question. The authors studied the associations between prenatal exposure to disinfection by-products and fetal growth restriction (FGR) and preterm birth in the PELAGIE cohort, a French birth cohort comprising 3,421 pregnant women recruited between 2002 and 2006. Exposure was assessed by estimating levels of trihalomethanes (THMs) in tap water during pregnancy and maternal water use and by measuring maternal urinary levels of trichloroacetic acid (TCAA) during early pregnancy in a nested case-control design that compared 174 FGR cases, 114 preterm births, and 399 controls. Higher uptake of THMs (especially brominated THMs) was associated with a higher risk of FGR. Women with TCAA detected in their urine (>0.01 mg/L) had a higher risk of FGR than those with TCAA levels below the detection limit (adjusted odds ratio = 1.8, 95% confidence interval: 0.9, 3.7) and had an odds ratio for preterm birth below 1 (adjusted odds ratio = 0.8, 95% confidence interval: 0.3, 2.6). Results from this prospective study, the first to use a biomarker of disinfection by-product exposure, suggest that prenatal exposure affects fetal growth, but the causal agent or agents remain to be identified.
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Affiliation(s)
- Nathalie Costet
- INSERM U, Institut de Recherches sur la Santé, l’Environnement et le Travail, University of Rennes, Institut Fédératif de Recherches, France.
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Zhou WS, Xu L, Xie SH, Li YL, Li L, Zeng Q, Du YK, Lu WQ. Decreased birth weight in relation to maternal urinary trichloroacetic acid levels. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 416:105-110. [PMID: 22225821 DOI: 10.1016/j.scitotenv.2011.10.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND The effect of exposure to disinfection by-products (DBPs) during pregnancy on newborn's birth weight has been commonly described in animal studies. However, epidemiological evidence was not consistent. OBJECTIVES To investigate the relationship between exposure to DBPs and newborn's birth weight in a Chinese population, we conducted a cross-sectional study in Wuhan, China. METHODS A total number of 398 women who had given birth to a live singleton with a gestational age between 37 to 42 weeks were recruited from a local hospital between November 2008 and May 2009. Basic information for all mothers and newborns was obtained from clinic birth records. Among these subjects, 180 women also gave further information including maternal medical history, social status and water-use behaviors by a face-to-face interview. Urinary creatinine (Cr) adjusted trichloroacetic (TCAA) was used as an exposure biomarker. RESULTS No statically significant results were found in the linear regression for both 398 participants and 180 participants who finished questionnaires. However, both the crude and adjusted results showed that the mean birth weight of the subjects in the third and top quartiles of Cr-adjusted urinary TCAA concentrations was decreased compared with those in the lowest quartile. Subjects in the top quartiles had the lowest mean birth weight compared to those in other quartiles. In addition, a weak correlation was observed among 82 subjects between drinking water ingestion and urinary Cr-adjusted TCAA (r=0.23, P=0.04). CONCLUSION Our findings suggested that elevated exposure to DBPs may affect fetal growth. The effect of exposure to DBPs during pregnancy on birth weight still warrants further investigations.
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Affiliation(s)
- Wen-Shan Zhou
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Villanueva CM, Gracia-Lavedán E, Ibarluzea J, Santa Marina L, Ballester F, Llop S, Tardón A, Fernández MF, Freire C, Goñi F, Basagaña X, Kogevinas M, Grimalt JO, Sunyer J. Exposure to trihalomethanes through different water uses and birth weight, small for gestational age, and preterm delivery in Spain. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1824-30. [PMID: 21810554 PMCID: PMC3261969 DOI: 10.1289/ehp.1002425] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 08/02/2011] [Indexed: 05/18/2023]
Abstract
BACKGROUND Evidence associating exposure to water disinfection by-products with reduced birth weight and altered duration of gestation remains inconclusive. OBJECTIVE We assessed exposure to trihalomethanes (THMs) during pregnancy through different water uses and evaluated the association with birth weight, small for gestational age (SGA), low birth weight (LBW), and preterm delivery. METHODS Mother-child cohorts set up in five Spanish areas during the years 2000-2008 contributed data on water ingestion, showering, bathing, and swimming in pools. We ascertained residential THM levels during pregnancy periods through ad hoc sampling campaigns (828 measurements) and regulatory data (264 measurements), which were modeled and combined with personal water use and uptake factors to estimate personal uptake. We defined outcomes following standard definitions and included 2,158 newborns in the analysis. RESULTS Median residential THM ranged from 5.9 μg/L (Valencia) to 114.7 μg/L (Sabadell), and speciation differed across areas. We estimated that 89% of residential chloroform and 96% of brominated THM uptakes were from showering/bathing. The estimated change of birth weight for a 10% increase in residential uptake was -0.45 g (95% confidence interval: -1.36, 0.45 g) for chloroform and 0.16 g (-1.38, 1.70 g) for brominated THMs. Overall, THMs were not associated with SGA, LBW, or preterm delivery. CONCLUSIONS Despite the high THM levels in some areas and the extensive exposure assessment, results suggest that residential THM exposure during pregnancy driven by inhalation and dermal contact routes is not associated with birth weight, SGA, LBW, or preterm delivery in Spain.
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Colman J, Rice GE, Wright JM, Hunter ES, Teuschler LK, Lipscomb JC, Hertzberg RC, Simmons JE, Fransen M, Osier M, Narotsky MG. Identification of developmentally toxic drinking water disinfection byproducts and evaluation of data relevant to mode of action. Toxicol Appl Pharmacol 2011; 254:100-26. [DOI: 10.1016/j.taap.2011.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 04/22/2010] [Accepted: 04/22/2010] [Indexed: 12/26/2022]
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Parvez S, Rivera-Núñez Z, Meyer A, Wright JM. Temporal variability in trihalomethane and haloacetic acid concentrations in Massachusetts public drinking water systems. ENVIRONMENTAL RESEARCH 2011; 111:499-509. [PMID: 21316653 DOI: 10.1016/j.envres.2010.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 05/30/2023]
Abstract
Previous epidemiological studies in Massachusetts have reported a risk of adverse health outcomes in relation to disinfection by-product (DBP) exposures. Measurement error due to the use of indirect exposure surrogates can lead to misclassification bias in epidemiological studies; therefore, it is important to characterize exposure variability in these populations to assess the potential for exposure misclassification. We used 19,944 trihalomethane (THM) samples and 9291 haloacetic acid (HAA) samples collected in 201 public water systems (PWSs) in Massachusetts to examine temporal variability under different drinking water sources and disinfection types. Annual and seasonal variability was also examined in 46 PWSs with complete quarterly THM4 (i.e., the sum of 4 individual THMs) data from 1995 to 2004 and 19 PWSs with complete HAA5 (i.e., the sum of 5 individual HAAs) data from 2001 to 2004. The quarterly ratio of THM4 and HAA5 and correlations between THM4, HAA5 and individual DBP species were examined to determine the adequacy of using different exposure surrogates in epidemiological studies. Individual PWSs were used to examine monthly variability in relation to quarterly averages. Based on all available matched samples (n=9003) from 1995 to 2004 data, we found a correlation of 0.52 for THM4 and HAA5. The correlation was stronger among the 62 ground water systems (r(s)=0.62) compared to the 81 surface water (r(s)=0.45) and 40 mixed water (r(s)=0.39) systems. Mean THM4 levels were fairly stable over the 10-year study period for 46 PWSs including 39 PWSs that did not change disinfection. Large reductions (∼40 μg/L) in mean THM4 data were found among seven systems that switched from chlorination to alternative disinfectants. As expected, the highest mean THM4 values were detected for Quarter 3, while the lowest values were found in Quarter 1. The highest HAA5 values were detected in Quarters 2 and 3 and the lowest was found in Quarter 4. Data from four systems showed mean differences up to 66 μg/L (67% change) in successive months and by 46 μg/L compared to quarterly mean concentrations. Although longer-term disinfection by-product temporality may be minimal in this study population, the use of monthly average concentrations for exposure assessment may be needed for some PWSs to minimize misclassification of narrow critical periods of exposure in epidemiological studies.
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Affiliation(s)
- Shahid Parvez
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Road, Oak Ridge, TN 37830, USA
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Grazuleviciene R, Nieuwenhuijsen MJ, Vencloviene J, Kostopoulou-Karadanelli M, Krasner SW, Danileviciute A, Balcius G, Kapustinskiene V. Individual exposures to drinking water trihalomethanes, low birth weight and small for gestational age risk: a prospective Kaunas cohort study. Environ Health 2011; 10:32. [PMID: 21501533 PMCID: PMC3100244 DOI: 10.1186/1476-069x-10-32] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 04/19/2011] [Indexed: 05/24/2023]
Abstract
BACKGROUND Evidence for an association between exposure during pregnancy to trihalomethanes (THMs) in drinking water and impaired fetal growth is still inconsistent and inconclusive, in particular, for various exposure routes. We examined the relationship of individual exposures to THMs in drinking water on low birth weight (LBW), small for gestational age (SGA), and birth weight (BW) in singleton births. METHODS We conducted a cohort study of 4,161 pregnant women in Kaunas (Lithuania), using individual information on drinking water, ingestion, showering and bathing, and uptake factors of THMs in blood, to estimate an internal dose of THM. We used regression analysis to evaluate the relationship between internal THM dose and birth outcomes, adjusting for family status, education, smoking, alcohol consumption, body mass index, blood pressure, ethnic group, previous preterm, infant gender, and birth year. RESULTS The estimated internal dose of THMs ranged from 0.0025 to 2.40 mg/d. We found dose-response relationships for the entire pregnancy and trimester-specific THM and chloroform internal dose and risk for LBW and a reduction in BW. The adjusted odds ratio for third tertile vs. first tertile chloroform internal dose of entire pregnancy was 2.17, 95% CI 1.19-3.98 for LBW; the OR per every 0.1 μg/d increase in chloroform internal dose was 1.10, 95% CI 1.01-1.19. Chloroform internal dose was associated with a slightly increased risk of SGA (OR 1.19, 95% CI 0.87-1.63 and OR 1.22, 95% CI 0.89-1.68, respectively, for second and third tertile of third trimester); the risk increased by 4% per every 0.1 μg/d increase in chloroform internal dose (OR 1.04, 95% CI 1.00-1.09). CONCLUSIONS THM internal dose in pregnancy varies substantially across individuals, and depends on both water THM levels and water use habits. Increased internal dose may affect fetal growth.
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Affiliation(s)
| | | | - Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | | | - Stuart W Krasner
- The Metropolitan Water District of Southern California, La Verne, CA, USA
| | - Asta Danileviciute
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Gediminas Balcius
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
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Lewis C, Hoggatt KJ, Ritz B. The impact of different causal models on estimated effects of disinfection by-products on preterm birth. ENVIRONMENTAL RESEARCH 2011; 111:371-376. [PMID: 21256482 DOI: 10.1016/j.envres.2010.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 10/13/2010] [Accepted: 12/17/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Previous epidemiologic studies of preterm birth and drinking water disinfection by-products (DBP) reported inconsistent results especially for third trimester exposures. These inconsistencies may have been due to differences in the underlying causal model assumed and methodological issues, including the method of analysis (cumulative vs. density-sampling of controls and matching on gestational age) and appropriate control of confounding. METHODS We use data from previously published research to illustrate how different causal models, methods of analysis, and the choice of covariates to control impact results. RESULTS Exposure at high measured TTHM levels (≥ 60 μg/l) during the last trimester - with cumulatively sampled controls - corresponded to negative effect estimates when comparing preterm to term births and averaging exposure over different length periods. In contrast, density-sampling of controls with an exposure truncated at 36 weeks gestation and adjustment for possible confounding by exposures experienced in prior trimesters led to moderate changes in risk at the highest level of exposure averaged over the four weeks prior to birth. CONCLUSIONS We recommend that future research on an exposure to DBPs and risk of preterm birth explore the sensitivity of their findings to different model specifications, specifically: (1) cumulative vs. density-sampling of controls when evaluating third trimester or whole pregnancy exposures, taking into account exposure-averaging length; (2) short-term peak exposures vs. long-term exposures; and (3) adjustment for exposure during prior pregnancy periods when evaluating later trimester exposures to account for possible 'priming' effects of early exposures.
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Affiliation(s)
- Chad Lewis
- Environmental Science and Engineering Program, Department of Environmental Health Sciences, School of Public Health, University of California, Los Angeles, CA, USA.
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Xie SH, Li YF, Tan YF, Zheng D, Liu AL, Xie H, Lu WQ. Urinary trichloroacetic acid levels and semen quality: a hospital-based cross-sectional study in Wuhan, China. ENVIRONMENTAL RESEARCH 2011; 111:295-300. [PMID: 21238955 DOI: 10.1016/j.envres.2010.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 12/14/2010] [Accepted: 12/28/2010] [Indexed: 05/30/2023]
Abstract
Toxicological studies indicate an association between exposure to disinfection by-products (DBPs) and impaired male reproductive health in animals. However, epidemiological evidence in humans is still limited. We conducted a hospital-based cross-sectional study to investigate the effect of exposure to DBPs on semen quality in humans. Between May 2008 and July 2008, we recruited 418 male partners in sub-fertile couples seeking infertility medical instruction or assisted reproduction services from the Tongji Hospital in Wuhan, China. Major semen parameters analyzed included sperm concentration, motility, and morphology. Exposure to DBPs was estimated by their urinary creatinine-adjusted trichloroacetic (TCAA) concentrations that were measured with the gas chromatography/electron capture detection method. We used linear regression to assess the relationship between exposure to DBPs and semen quality. According to the World Health Organization criteria (<20 million/mL for sperm concentration and <50% motile for sperm motility) and threshold value recommended by Guzick (<9% for sperm morphology), there were 265 men with all parameters at or above the reference values, 33 men below the reference sperm concentration, 151 men below the reference sperm motility, and 6 men below the reference sperm morphology. The mean (median) urinary creatinine-adjusted TCAA concentration was 9.2 (5.1) μg/g creatinine. Linear regression analyses indicated no significant association of sperm concentration, sperm count, and sperm morphology with urinary TCAA levels. Compared with those in the lowest quartile of creatinine-adjusted urinary TCAA concentrations, subjects in the second and third quartiles had a decrease of 5.1% (95% CI: 0.6%, 9.7%) and 4.7% (95% CI: 0.2%, 9.2%) in percent motility, respectively. However, these associations were not significant after adjustment for age, abstinence time, and smoking status. The present study provides suggestive but inconclusive evidence of the relationship between decreased sperm motility and increased urinary TCAA levels. The effect of exposure to DBPs on human male reproductive health in Chinese populations still warrants further investigations.
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Affiliation(s)
- Shao-Hua Xie
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, 430030 Wuhan, People's Republic of China
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Legay C, Rodriguez MJ, Sérodes JB, Levallois P. The assessment of population exposure to chlorination by-products: a study on the influence of the water distribution system. Environ Health 2010; 9:59. [PMID: 20929560 PMCID: PMC2958998 DOI: 10.1186/1476-069x-9-59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 10/07/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND The relationship between chlorination by-products (CBPs) in drinking water and human health outcomes has been investigated in many epidemiological studies. In these studies, population exposure assessment to CBPs in drinking water is generally based on available CBP data (e.g., from regulatory monitoring, sampling campaigns specific to study area). Since trihalomethanes (THMs) and haloacetic acids (HAAs) are the most documented CBP classes in drinking water, they are generally used as indicators of CBP exposure. METHODS In this paper, different approaches to spatially assign available THM and HAA concentrations in drinking water for population exposure assessment purposes are investigated. Six approaches integrating different considerations for spatial variability of CBP occurrence within different distribution systems are compared. For this purpose, a robust CBP database (i.e., high number of sampling locations selected according to system characteristics) corresponding to nine distribution systems was generated. RESULTS AND CONCLUSION The results demonstrate the high impact of the structure of the distribution system (e.g., presence of intermediary water infrastructures such as re-chlorination stations or reservoirs) and the spatial variability of CBPs in the assigned levels for exposure assessment. Recommendations for improving the exposure assessment to CBPs in epidemiological studies using available CBP data from water utilities are also presented.
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Affiliation(s)
- Christelle Legay
- École supérieure d'aménagement du territoire, Université Laval, Pavillon Antoine Savard, Québec City, QC., G1K 7P4, Canada
| | - Manuel J Rodriguez
- École supérieure d'aménagement du territoire, Université Laval, Pavillon Antoine Savard, Québec City, QC., G1K 7P4, Canada
| | - Jean Baptiste Sérodes
- Département de Génie Civil, Université Laval, 2917B Pavillon Pouliot, Québec City, QC., G1K 7P4, Canada
| | - Patrick Levallois
- Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Québec City, QC., G1V 5B3, Canada
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Narotsky MG, Best DS, McDonald A, Godin EA, Hunter ES, Simmons JE. Pregnancy loss and eye malformations in offspring of F344 rats following gestational exposure to mixtures of regulated trihalomethanes and haloacetic acids. Reprod Toxicol 2010; 31:59-65. [PMID: 20850520 DOI: 10.1016/j.reprotox.2010.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 08/09/2010] [Accepted: 08/25/2010] [Indexed: 11/24/2022]
Abstract
Chlorination of drinking water yields hundreds of disinfection by-products (DBPs). Among the DBPs, four trihalomethanes (THMs; chloroform, bromodichloromethane, chlorodibromomethane, bromoform) and five haloacetic acids (HAAs; chloroacetic, dichloroacetic, trichloroacetic, bromoacetic, and dibromoacetic acid) are U.S. EPA regulated. We assessed the combined toxicity of these DBPs. F344 rats were treated with mixtures of the four THMs (THM4), the five HAAs (HAA5), or nine DBPs (DBP9; THM4+HAA5). Mixtures were administered in 10% Alkamuls(®) EL-620 daily by gavage on gestation days 6-20. Litters were examined postnatally. All three mixtures caused pregnancy loss at ≥ 613 μmol/kg/day. In surviving litters, resorption rates were increased in groups receiving HAA5 at 615 μmol/kg/day and DBP9 at 307 μmol/kg/day. HAA5 caused eye malformations (anophthalmia, microphthalmia) at ≥ 308 μmol/kg/day. Thus, both HAAs and THMs contributed to DBP9-induced pregnancy loss. The presence of THMs in the full mixture, however, appeared to reduce the incidence of HAA-induced eye defects.
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Affiliation(s)
- Michael G Narotsky
- Toxicity Assessment Division, National Health and Environmental Effects Research Laboratory, ORD, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Platikanov S, Tauler R, Rodrigues PMSM, Antunes MCG, Pereira D, Esteves da Silva JCG. Factorial analysis of the trihalomethane formation in the reaction of colloidal, hydrophobic, and transphilic fractions of DOM with free chlorine. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2010; 17:1389-1400. [PMID: 20419477 DOI: 10.1007/s11356-010-0320-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 02/24/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND, AIM, AND SCOPE This study focuses on the factors that affect trihalomethane (THMs) formation when dissolved organic matter (DOM) fractions (colloidal, hydrophobic, and transphilic fractions) in aqueous solutions were disinfected with chlorine. MATERIALS AND METHODS DOM fractions were isolated and fractionated from filtered lake water and were characterized by elemental analysis. The investigation involved a screening Placket-Burman factorial analysis design of five factors (DOM concentration, chlorine dose, temperature, pH, and bromide concentration) and a Box-Behnken design for a detailed assessment of the three most important factor effects (DOM concentration, chlorine dose, and temperature). RESULTS The results showed that colloidal fraction has a relatively low contribution to THM formation; transphilic fraction was responsible for about 50% of the chloroform generation, and the hydrophobic fraction was the most important to the brominated THM formation. DISCUSSION When colloidal and hydrophobic fraction solutions were disinfected, the most significant factors were the following: higher DOM fraction concentration led to higher THM concentration, an increase of pH corresponded to higher concentration levels of chloroform and reduced bromoform, higher levels of chlorine dose and temperature produced a rise in the total THM formation, especially of the chlorinated THMs; higher bromide concentration generates higher concentrations of brominated THMs. Moreover, linear models were implemented and response surface plots were obtained for the four THM concentrations and their total sum in the disinfection solution as a function of the DOM concentration, chlorine dose, and temperature. Overall, results indicated that THM formation models were very complex due to individual factor effects and significant interactions among the factors. CONCLUSIONS In order to reduce the concentration of THMs in drinking water, DOM concentrations must be reduced in the water prior to the disinfection. Fractionation of DOM, together with an elemental analysis of the fractions, is important issue in the revealing of the quality and quantity characteristics of DOM. Systematic study composed from DOM fraction investigation and factorial analysis of the responsible parameters in the THM formation reaction can, after an evaluation of the adjustment of the models with the reality, serves well for the evaluation of the spatial and temporal variability in the THM formation in dependence of DOM. However, taking into consideration the natural complexity of DOM, different operations and a strict control of them (like coagulation/flocculation and filtration) has to be used to quantitatively remove DOM from the raw water. RECOMMENDATIONS AND PERSPECTIVES Assuming that this study represents a local case study, similar experiments can be easily applied and will supply with relevant information every local water treatment plant meeting problems with THM formation. The coagulation/flocculation and the filtration stages are the main mechanisms to remove DOM, particularly the colloidal DOM fraction. With the objective to minimize THMs generation, different unit operation designed to quantitatively remove DOM from water must be optimized.
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Affiliation(s)
- Stefan Platikanov
- Department of Environmental Chemistry, IIQAB-CSIC, Jordi Girona 18-26, 08026, Barcelona, Spain
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Bateson TF, Wright JM. Regression calibration for classical exposure measurement error in environmental epidemiology studies using multiple local surrogate exposures. Am J Epidemiol 2010; 172:344-52. [PMID: 20573838 DOI: 10.1093/aje/kwq123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Environmental epidemiologic studies are often hierarchical in nature if they estimate individuals' personal exposures using ambient metrics. Local samples are indirect surrogate measures of true local pollutant concentrations which estimate true personal exposures. These ambient metrics include classical-type nondifferential measurement error. The authors simulated subjects' true exposures and their corresponding surrogate exposures as the mean of local samples and assessed the amount of bias attributable to classical and Berkson measurement error on odds ratios, assuming that the logit of risk depends on true individual-level exposure. The authors calibrated surrogate exposures using scalar transformation functions based on observed within- and between-locality variances and compared regression-calibrated results with naive results using surrogate exposures. The authors further assessed the performance of regression calibration in the presence of Berkson-type error. Following calibration, bias due to classical-type measurement error, resulting in as much as 50% attenuation in naive regression estimates, was eliminated. Berkson-type error appeared to attenuate logistic regression results less than 1%. This regression calibration method reduces effects of classical measurement error that are typical of epidemiologic studies using multiple local surrogate exposures as indirect surrogate exposures for unobserved individual exposures. Berkson-type error did not alter the performance of regression calibration. This regression calibration method does not require a supplemental validation study to compute an attenuation factor.
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Affiliation(s)
- Thomas F Bateson
- National Center for Environmental Assessment, Environmental Protection Agency, 1200 Pennsylvania Avenue NW, Mail Code 8623P, Washington, DC 20460, USA.
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Xie SH, Liu AL, Chen YY, Zhang L, Zhang HJ, Jin BX, Lu WH, Li XY, Lu WQ. DNA damage and oxidative stress in human liver cell L-02 caused by surface water extracts during drinking water treatment in a waterworks in China. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2010; 51:229-235. [PMID: 19844953 DOI: 10.1002/em.20537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Because of the daily and life-long exposure to disinfection by-products formed during drinking water treatment, potential adverse human health risk of drinking water disinfection is of great concern. Toxicological studies have shown that drinking water treatment increases the genotoxicity of surface water. Drinking water treatment is comprised of different potabilization steps, which greatly influence the levels of genotoxic products in the surface water and thus may alter the toxicity and genotoxicity of surface water. The aim of the present study was to understand the influence of specific steps on toxicity and genotoxicity during the treatment of surface water in a water treatment plant using liquid chlorine as the disinfectant in China. An integrated approach of the comet and oxidative stress assays was used in the study, and the results showed that both the prechlorination and postchlorination steps increased DNA damage and oxidative stress caused by water extracts in human derived L-02 cells while the tube settling and filtration steps had the opposite effect. This research also highlighted the usefulness of an integrated approach of the comet and oxidative stress assays in evaluating the genotoxicity of surface water during drinking water treatment.
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Affiliation(s)
- Shao-Hua Xie
- Department of Occupational and Environmental Health and Ministry of Education Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Rahman MB, Driscoll T, Cowie C, Armstrong BK. Disinfection by-products in drinking water and colorectal cancer: a meta-analysis. Int J Epidemiol 2010; 39:733-45. [PMID: 20139236 DOI: 10.1093/ije/dyp371] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is inconclusive evidence from observational studies that disinfection by-products (DBPs) in drinking water are associated with colorectal cancer. METHODS A literature search, without language or time limits, was performed to identify relevant case-control and cohort studies. Separate risk estimates for colon and rectal cancer were extracted from studies meeting the inclusion criteria. Relative risks (RRs) or odds ratios (ORs) comparing the highest exposure category with the lowest were pooled using random effects methods. RESULTS A total of 13 studies (3 cohort and 10 case-control) were analysed. For colon cancer, the pooled RR estimates were 1.11 [95% confidence interval (CI): 0.73-1.70] for cohort studies, 1.33 (95% CI: 1.12-1.57) for case-control studies and 1.27 (95% CI: 1.08-1.50) combining both study types. For rectal cancer, the corresponding RR estimates were 0.88 (0.57-1.35), 1.40 (1.15-1.70) and 1.30 (1.06-1.59). Sensitivity analysis showed these results were not importantly influenced by any single study. Publication bias was not evident for the colon cancer analysis but may have been a minor issue for the rectal cancer analysis. The results for rectal cancer may have been influenced by the quality of the studies. CONCLUSIONS The study findings provide limited evidence of a positive association between colorectal cancer and exposure to DBPs in drinking water. The small number of studies and limitations in study quality prevent causal inference.
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Affiliation(s)
- Md Bayzidur Rahman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.
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Legay C, Rodriguez MJ, Sérodes JB, Levallois P. Estimation of chlorination by-products presence in drinking water in epidemiological studies on adverse reproductive outcomes: a review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 408:456-472. [PMID: 19910022 DOI: 10.1016/j.scitotenv.2009.10.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 10/13/2009] [Accepted: 10/16/2009] [Indexed: 05/28/2023]
Abstract
Chlorination of drinking water is essential to prevent waterborne disease. However, chlorine reacts with organic matter present in surface waters to form various by-products. In the last decade, several epidemiological studies have been conducted to determine the connection between exposure to these chlorination by-products (CBPs) and human health defects, such as adverse reproductive outcomes. However, the methodology used to assess exposure of pregnant women in these studies had serious limitations, particularly in relation to determining CBP presence in the subject's tap water. The purpose of this paper is to critically review of methods used to evaluate the CBP presence in a subject's tap water for exposure assessment purposes in epidemiological studies focused on adverse reproductive outcomes and CBPs in drinking water. Interest is directed more precisely at space-time features related to CBPs for an optimal estimation of their presence in a subject's tap water.
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Affiliation(s)
- Christelle Legay
- Ecole supérieure d'aménagement du territoire de l'Université Laval, Pavillon Antoine Savard, Université Laval, Québec City, Québec, Canada
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Nieuwenhuijsen MJ, Grellier J, Smith R, Iszatt N, Bennett J, Best N, Toledano M. The epidemiology and possible mechanisms of disinfection by-products in drinking water. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2009; 367:4043-4076. [PMID: 19736233 DOI: 10.1098/rsta.2009.0116] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper summarizes the epidemiological evidence for adverse health effects associated with disinfection by-products (DBPs) in drinking water and describes the potential mechanism of action. There appears to be good epidemiological evidence for a relationship between exposure to DBPs, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers including colorectal cancer is inconclusive and inconsistent. There appears to be some evidence for an association between exposure to DBPs, specifically THMs, and little for gestational age/intrauterine growth retardation and, to a lesser extent, pre-term delivery, but evidence for relationships with other outcomes such as low birth weight, stillbirth, congenital anomalies and semen quality is inconclusive and inconsistent. Major limitations in exposure assessment, small sample sizes and potential biases may account for the inconclusive and inconsistent results in epidemiological studies. Moreover, most studies have focused on total THMs as the exposure metric, whereas other DBPs appear to be more toxic than the THMs, albeit generally occurring at lower levels in the water. The mechanisms through which DBPs may cause adverse health effects including cancer and adverse reproductive effects have not been well investigated. Several mechanisms have been suggested, including genotoxicity, oxidative stress, disruption of folate metabolism, disruption of the synthesis and/or secretion of placental syncytiotrophoblast-derived chorionic gonadotropin and lowering of testosterone levels, but further work is required in this area.
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Affiliation(s)
- Mark J Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Parc de Recerca Biomèdica de Barcelona-PRBB (Office 183.05), , C. Doctor Aiguader, 88, 08003 Barcelona, Spain.
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Jones DR, Peters JL, Rushton L, Sutton AJ, Abrams KR. Interspecies extrapolation in environmental exposure standard setting: A Bayesian synthesis approach. Regul Toxicol Pharmacol 2009; 53:217-25. [PMID: 19545504 DOI: 10.1016/j.yrtph.2009.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 01/19/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
Abstract
Currently the extrapolation of evidence from studies of non-human species to the setting of environmental exposure standards for humans includes the imposition of a variety of uncertainty factors reflecting unknown aspects of the procedure, including the relevance of evidence from one species to impacts in another. This paper develops and explores more flexible modelling of aspects of this extrapolation, using models proposed by DuMouchel [DuMouchel, W.H., Harris, J.E., 1983. Bayes methods for combining the results of cancer studies in humans and other species (with comment). J. Am. Statist. Assoc. 78, 293-308.] The approaches are based on Bayesian meta-analysis methods involving explicit modelling of relevance in the prior distributions, estimated using Markov chain Monte Carlo (MCMC) methods. The methods are applied to evidence relating chlorinated by-products exposure to adverse reproductive health effects. The relative merits of various approaches are discussed, and developments and next steps are outlined.
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Affiliation(s)
- David R Jones
- Department of Health Sciences, Adrian Building, University of Leicester, Leicester, LE1 7RH, UK.
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Abstract
BACKGROUND Previous studies suggest that elevated exposure to drinking water disinfection by-products (DBPs)--in particular, total trihalomethanes (TTHMs)--may lead to fetal growth restriction. We examined the effects of exposure to TTHMs, haloacetic acids, and total organic halide on the probability of delivering a small-for-gestational-age (SGA) infant and on birth weight at term. METHODS Women early in pregnancy (< or =12 weeks' gestation) or planning a pregnancy were enrolled in a prospective pregnancy study conducted in 3 US communities from 2000 through 2004. Weekly (or biweekly) water samples were collected at each site as well as individual-level participant data. Associations between DBP exposures (TTHMs, haloacetic acids, total organic halide) and fetal growth were assessed using log-binomial regression for SGA (n = 1958) and linear regression for term birth weight (n = 1854). We conducted a Bayesian analysis to examine associations between individual DBP species and fetal growth. RESULTS Haloacetic acids and total organic halide were not associated with SGA or term birth weight. The probability of delivering an SGA infant was elevated when comparing women with an average third-trimester residential TTHM concentration > or =80 microg/L to women with exposure <80 microg/L (risk ratio = 2.0 [95% confidence interval = 1.1-3.6]), but not when examining other exposure contrasts. Bayesian analyses did not support a consistent association between any DBP species and fetal growth, although these analyses were based on small sample sizes. CONCLUSIONS Our results do not suggest an adverse effect of haloacetic acid or total organic halide exposure on fetal growth. An association of TTHM with SGA was seen only for average residential concentrations above the current regulatory standard.
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Abstract
OBJECTIVE To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy. DESIGN Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW. RESULTS Of 540 infants, 100 (18.5 %) weighed <or=2.5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1.83; 95 % CI 1.09, 3.07) and none or one prenatal visit (adjPR = 2.18; 95 % CI 1.39, 3.43) were associated with LBW. A statistically significant interaction between mothers' mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake <or=208.7 mg/d (adjPR = 10.67; 95 % CI 1.50, 76.02) and mothers with MUAC less than or equal to the median and vitamin C intake <or=208.7 mg/d (adjPR = 13.19; 95 % CI 1.85, 93.79) more likely to give birth to an LBW infant. CONCLUSIONS In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
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Slama R, Morgenstern V, Cyrys J, Zutavern A, Herbarth O, Wichmann HE, Heinrich J. Traffic-related atmospheric pollutants levels during pregnancy and offspring's term birth weight: a study relying on a land-use regression exposure model. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:1283-92. [PMID: 17805417 PMCID: PMC1964922 DOI: 10.1289/ehp.10047] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 05/31/2007] [Indexed: 05/17/2023]
Abstract
BACKGROUND Some studies have suggested that particulate matter (PM) levels during pregnancy may be associated with birth weight. Road traffic is a major source of fine PM (PM with aero-dynamic diameter < 2.5 microm; PM(2.5)). OBJECTIVE We determined to characterize the influence of maternal exposure to atmospheric pollutants due to road traffic and urban activities on offspring term birth weight. METHODS Women from a birth cohort [the LISA (Influences of Lifestyle Related Factors on the Human Immune System and Development of Allergies in Children) cohort] who delivered a non-premature baby with a birth weight > 2,500 g in Munich metropolitan area were included. We assessed PM(2.5), PM(2.5) absorbance (which depends on the blackness of PM(2.5), a marker of traffic-related air pollution), and nitrogen dioxide levels using a land-use regression model, taking into account the type and length of roads, population density, land coverage around the home address, and temporal variations in pollution during pregnancy. Using Poisson regression, we estimated prevalence ratios (PR) of birth weight < 3,000 g, adjusted for gestational duration, sex, maternal smoking, height, weight, and education. RESULTS Exposure was defined for 1,016 births. Taking the lowest quartile of exposure during pregnancy as a reference, the PR of birth weight < 3,000 g associated with the highest quartile was 1.7 for PM(2.5) [95% confidence interval (CI), 1.2-2.7], 1.8 for PM(2.5) absorbance (95% CI, 1.1-2.7), and 1.2 for NO(2) (95% CI, 0.7-1.7). The PR associated with an increase of 1 microg/m(3) in PM(2.5) levels was 1.13 (95% CI, 1.00-1.29). CONCLUSION Increases in PM(2.5) levels and PM(2.5) absorbance were associated with decreases in term birth weight. Traffic-related air pollutants may have adverse effects on birth weight.
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Affiliation(s)
- Rémy Slama
- GSF-National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany.
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Yang CY, Xiao ZP, Ho SC, Wu TN, Tsai SS. Association between trihalomethane concentrations in drinking water and adverse pregnancy outcome in Taiwan. ENVIRONMENTAL RESEARCH 2007; 104:390-5. [PMID: 17324396 DOI: 10.1016/j.envres.2007.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 12/05/2006] [Accepted: 01/12/2007] [Indexed: 05/14/2023]
Abstract
Chlorination has been the major strategy for disinfection of drinking water in Taiwan. Recently there has been interest in the relationship between by-products of disinfection of drinking water and pregnancy outcomes including low birth weight and preterm delivery. We performed a study to examine the effects of exposure to total trihalomethanes (TTHMs) on the risk of term low birth weight (TLBW), small for gestational age (SGA), and preterm delivery in Taiwan. TTHMs data were available for 65 municipalities in Taiwan. The study population comprised 90,848 women residing in the 65 municipalities who had a first parity singleton birth between January 1, 2000 and December 31, 2002, and for which complete information on maternal age, education, gestational age, birth weight, and sex of the baby were available. Maternal TTHMs exposure was estimated from the TTHMs concentration for the municipality of residence at birth. The study results provide no evidence of an increased risk of TLBW, SGA, and preterm delivery at the relatively low concentrations of TTHMs in Taiwan's drinking water.
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Affiliation(s)
- Chun-Yuh Yang
- Institute of Public Health, College of Health Sciences, Kaohsiung Medical University, 100 Shih-Chuan 1st RD, Kaohsiung City, 80708, Taiwan.
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Villanueva CM, Gagniere B, Monfort C, Nieuwenhuijsen MJ, Cordier S. Sources of variability in levels and exposure to trihalomethanes. ENVIRONMENTAL RESEARCH 2007; 103:211-20. [PMID: 17189628 DOI: 10.1016/j.envres.2006.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 10/17/2006] [Accepted: 11/01/2006] [Indexed: 05/13/2023]
Abstract
In the framework of a cohort study of pregnant women conducted in Brittany (France), we assessed the exposure to trihalomethanes (THM) during pregnancy in a subset by evaluating (1) potential sources of variability in household THM levels; (2) the between- and within-subject variability in THM levels; (3) THM levels in swimming pools; and (4) the role of water-related habits on total THM uptake. We visited 109 women from the ongoing cohort study at home for an interview and collection of tap water from October to December 2004. Forty-three of them were re-contacted to obtain a second tap water sample in April-May 2005. We designed a questionnaire to collect individual information on source and amount of drinking water, frequency of showering, bathing, and swimming pool attendance, and household characteristics. We obtained 282 THM measurements, 152 specifically for the study and 130 from a regulatory agency. Personal information and environmental data were combined using two methodologies (method 1 using regulatory data and method 2 using our THM measurements) with a different set of assumptions. We calculated ingestion, showering, bathing, and swimming pool THM uptakes and added up those uptakes to calculate total THM uptake. Average THM levels from our measurements in October, November-December, and April-May were 61.3, 45.1, and 54.5 microg/l, respectively. Geographical variability was low and characteristics of the household did not influence THM levels. Within-subject variability in THM levels was three times higher than between-subject variability. Average THM level in swimming pools was 80.4 microg/l. Average water consumption during pregnancy was 1.9l/day. The source of the household drinking water was 90% bottled, 8% municipal, and 2% from other sources. Forty-seven per cent attended swimming pools during pregnancy. Using method 1, the geometric mean of total THM uptake was 0.93 microg/day. Showering contributed 64%, swimming in pools 23%, bathing 12%, and drinking water 1% to the total THM uptake. In a setting with low geographical variability and limited environmental measurements, individual data is highly relevant to determine personal THM exposure and uptake. In a population that mainly drinks bottled water (e.g., pregnant women), individual THM uptakes are dominated by inhalation and dermal absorption during, showering, swimming in pools, and bathing.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Doctor Aiguader, 88, Barcelona 08003, Spain.
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Lewis C, Suffet IH, Hoggatt K, Ritz B. Estimated effects of disinfection by-products on preterm birth in a population served by a single water utility. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:290-5. [PMID: 17384780 PMCID: PMC1831522 DOI: 10.1289/ehp.9394] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 10/04/2006] [Indexed: 05/14/2023]
Abstract
OBJECTIVES We evaluated the association between drinking-water disinfection by-products and preterm births using improved exposure assessment and more appropriate analysis methods than used in prior studies. METHODS During 1999-2001, vital record data were obtained for a large, racially diverse population residing in 27 Massachusetts communities that received drinking water from a single public utility. This water system was monitored weekly for total trihalomethanes (TTHM), and it maintained geographically stable total TTHM levels system-wide during the study period. We employed proportional hazards regression to examine the effects of trimester-specific and shorter-term peak exposures to TTHM in drinking water late in pregnancy on preterm births in 37,498 singletons. RESULTS For all women, our data suggested no more than a small increase, if any, in risk for delivering a preterm baby when exposed to > or = 60 microg/L TTHM during the 4 weeks before birth [hazard ratio (HR) = 1.13; 95% confidence interval (CI), 0.95-1.35]. However, women who depended on a governmental source of payment for prenatal care were at increased risk when exposed at such levels late in gestation (HR = 1.39; 95% CI, 1.06-1.81). In contrast, exposure to high levels of TTHM during the second trimester and high exposure throughout pregnancy resulted in a 15-18% reduction in risk for preterm delivery in our population. CONCLUSIONS This finding confirms previous reports of a negative association during the second trimester. Our data also suggested a possible positive association with shorter-term third-trimester TTHM exposure in mothers of lower socioeconomic status.
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Affiliation(s)
- Chad Lewis
- Environmental Science and Engineering Program, Department of Environmental Health Sciences, School of Public Health, University of California, Los Angeles, California, USA.
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Villanueva CM, Grimalt JO, Ballester F, Ibarluzea J, Sala M, Tardón A, Romero-Aliaga E, Fernández M, Ribas-Fitó N, Kogevinas M. Medida de contaminantes del agua y usos del agua durante el embarazo en un estudio de cohortes en España. GACETA SANITARIA 2006; 20 Suppl 3:1-9. [PMID: 17433195 DOI: 10.1157/13101084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Exposure to chlorination by-products during pregnancy has been associated with reproductive outcomes but the evidence remains inconclusive. Levels of trihalomethanes, the most prevalent chlorination by-products, are high in some areas of Spain. Within the framework of a follow-up study in pregnant women, we describe: 1) the personal habits of water use and consumption, and 2) trihalomethane levels in the drinking water of the study areas. METHODS We performed a follow-up cohort study in pregnant women in Valencia (n = 800), Sabadell (n = 800), the Basque Country (n = 600), Asturias (n = 500), and Granada (n = 700). Interviews were conducted in the third trimester of pregnancy to obtain individual information on the sources and amounts of drinking water, and on the frequency of showering, bathing, and swimming pool attendance. Water samples were collected to analyze trihalomethane levels. RESULTS The main source of drinking water was bottled water, both inside and outside the home (82% and 94% of the women, respectively). Drinking water for cooking was mainly municipal (91%). Women preferred to take showers (98.2%) and did so, on average, 6.8 times/week for 11.7 minutes. A total of 58.5% of the women went to swimming pools during pregnancy, on average 9.4 times/month to outdoor swimming pools in the summer and 3.1 times/month the rest of the year for 32.6 and 21.7 minutes, respectively. Average trihalomethane levels ranged from 4 microg/l in the province of Granada to 117 microg/l in Sabadell. CONCLUSION These preliminary results suggest that the main routes of trihalomethane exposure during pregnancy are dermal absorption and inhalation. Ingestion is a minor exposure route.
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Affiliation(s)
- Cristina M Villanueva
- Centre de Recerca en Epidemiologia Ambiental (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, España.
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