1
|
Kancherla V, Rhoads A, Conway KM, Suhl J, Langlois PH, Hoyt AT, Shaw GM, Evans SP, Moore CA, Luben TJ, Michalski A, Feldkamp ML, Romitti PA. Maternal periconceptional exposure to drinking water disinfection by-products and neural tube defects in offspring. Birth Defects Res 2024; 116:e2370. [PMID: 38888449 PMCID: PMC11295258 DOI: 10.1002/bdr2.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Associations between maternal periconceptional exposure to disinfection by-products (DBPs) in drinking water and neural tube defects (NTDs) in offspring are inconclusive, limited in part by exposure misclassification. METHODS Maternal interview reports of drinking water sources and consumption from the National Birth Defects Prevention Study were linked with DBP concentrations in public water system monitoring data for case children with an NTD and control children delivered during 2000-2005. DBPs analyzed were total trihalomethanes, the five most common haloacetic acids combined, and individual species. Associations were estimated for all NTDs combined and selected subtypes (spina bifida, anencephaly) with maternal periconceptional exposure to DBPs in public water systems and with average daily periconceptional ingestion of DBPs accounting for individual-level consumption and filtration information. Mixed effects logistic regression models with maternal race/ethnicity and educational attainment at delivery as fixed effects and study site as a random intercept were applied. RESULTS Overall, 111 case and 649 control children were eligible for analyses. Adjusted odds ratios for maternal exposure to DBPs in public water systems ranged from 0.8-1.5 for all NTDs combined, 0.6-2.0 for spina bifida, and 0.7-1.9 for anencephaly; respective ranges for average daily maternal ingestion of DBPs were 0.7-1.1, 0.5-1.5, and 0.6-1.8. Several positive estimates (≥1.2) were observed, but all confidence intervals included the null. CONCLUSIONS Using community- and individual-level data from a large, US, population-based, case-control study, we observed statistically nonsignificant associations between maternal periconceptional exposure to total and individual DBP species in drinking water and NTDs and subtypes.
Collapse
Affiliation(s)
- V. Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - A. Rhoads
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - K. M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - J. Suhl
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - P. H. Langlois
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health – Austin Campus, Austin, Texas, USA
| | - A. T. Hoyt
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - G. M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - S. P. Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C. A. Moore
- Goldbelt Professional Services LLC, Chesapeake, Virginia, USA
| | - T. J. Luben
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - A. Michalski
- New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Albany, New York, USA
| | - M. L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - P. A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | | |
Collapse
|
2
|
Koley S, Dash S, Khwairakpam M, Kalamdhad AS. Perspectives and understanding on the occurrence, toxicity and abatement technologies of disinfection by-products in drinking water. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 351:119770. [PMID: 38096765 DOI: 10.1016/j.jenvman.2023.119770] [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: 08/21/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 01/14/2024]
Abstract
Disinfection by-products (DBPs) are one of the significant emerging contaminants that have caught the attention of researchers worldwide due to their pervasiveness. Their presence in drinking water, even in shallow concentrations (in levels of parts per billion), poses considerable health risks. Therefore, it is crucial to understand their kinetics to understand better their formation and persistence in the water supply systems. This manuscript demonstrates different aspects of research carried out on DBPs in the past. A systematic approach was adopted for the bibliographical research that started with choosing appropriate keywords and identifying the most relevant manuscripts through the screening process. This follows a quantitative assessment of the extracted literature sample, which included the most productive and influential journal sources, the most widely used keywords, the most influential authors active in the research domain, the most cited articles, and the countries most actively engaged in the research field. Critical observations on the literature sample led to the qualitative assessment, wherein the past and current research trends were observed and reported. Finally, we identified the essential gaps in the available literature, which further led to recommending the course ahead in the research domain. This study will prove fruitful for young and established researchers who are or wish to work in this emerging field of research.
Collapse
Affiliation(s)
- Sumona Koley
- Centre for the Environment, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India.
| | - Siddhant Dash
- Department of Civil Engineering, School of Engineering and Sciences, SRM University-AP, Andhra Pradesh, 522502, India; Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterey, Monterrey, 64849, Nuevo Leon, Mexico.
| | - Meena Khwairakpam
- School of Agro and Rural Technology, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - Ajay S Kalamdhad
- Centre for the Environment, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India; School of Agro and Rural Technology, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India; Department of Civil Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| |
Collapse
|
3
|
Liu JL, Han X, Zhang J, Wang HJ, Zhou MX, Li SW, Ma X, Wang Y, Liu AL. Total organic halogen in two drinking water supply systems: Occurrence, variations, and relationship with trihalomethanes. CHEMOSPHERE 2022; 288:132541. [PMID: 34648782 DOI: 10.1016/j.chemosphere.2021.132541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
The spatiotemporal presence of overall disinfection by-products (DBPs) in two full-scale drinking water supply systems (DWSSs) were investigated using quantification of total organic halogen (TOX). The relationships of TOX with water quality parameters (especially the most regulated DBPs, trihalomethanes (THMs)) were also evaluated. The TOX levels ranged between 2.6 and 70.3 μg Cl/L and between 46.6 and 205.9 μg Cl/L in raw water and distribution water, respectively. The TOX concentration in water increased by an average of nine times after water treatment and varied slightly during distribution, suggesting that TOX in drinking water was mainly formed during chlorination disinfection rather than distribution. No clear seasonality in TOX level was observed. Positive correlations were found between raw water dissolved organic carbon (DOC) with an increase in TOX in treated water and between DOC level with TOX content in distributed water, emphasizing a key role of organics in TOX formation. Chloroform (TCM) was the dominant THM, followed by bromodichloromethane (BDCM) in the drinking water, and the levels of the other two measured THMs (dibromochloromethane and bromoform) were negligible. THM2 (sum of TCM and BDCM) made up average of 18% of the TOX, and was weakly correlated with TOX content (rs = 0.321; P < 0.05), implying that THM is not a suitable surrogate measure for TOX in drinking water. This study provides basic data on the occurrence and variation of TOX within conventional DWSSs and highlights the importance of using TOX measurements to obtain more accurate information about DBP occurrence, for exposure assessment and regulatory determination.
Collapse
Affiliation(s)
- Jun-Ling Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Wuhan Center for Disease Control and Prevention, Wuhan, 430024, China
| | - Xue Han
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Jie Zhang
- Wuhan Water Group Company Limited, Wuhan, 430015, China
| | - Huai-Ji Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Wuhan Center for Disease Control and Prevention, Wuhan, 430024, China
| | | | - Shi-Wei Li
- Wuhan Water Group Company Limited, Wuhan, 430015, China
| | - Xuan Ma
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ai-Lin Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Zhang SH, Guo AJ, Zhao WX, Gu JL, Zhang R, Wei N. Urinary trichloroacetic acid and high blood pressure: A cross-sectional study of general adults in Shijiazhuang, China. ENVIRONMENTAL RESEARCH 2019; 177:108640. [PMID: 31416009 DOI: 10.1016/j.envres.2019.108640] [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: 06/12/2019] [Revised: 08/02/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
Exposure to trichloroacetic acid (TCAA) and its parent chemicals potentially linked to cardiovascular disease. However, the association between TCAA and blood pressure (BP) has not been studied to date. The purpose of this study was to examine the potential association between urinary TCAA levels and BP in a Chinese population. We measured BP parameters (including systolic BP, diastolic BP and pulse pressure) and TCAA concentrations in the urine of 569 adults from a primary health care clinic in Shijiazhuang, China. Logistic and linear regressions were used to investigate the relationships between the urinary TCAA levels and BP parameters. To evaluate the robustness of the results, we conducted sensitivity analyses by re-analysing data after excluding urine samples with extreme specific creatinine values. We found that urine TCAA levels were positively associated with systolic BP and pulse pressure based on trend tests after adjusting for potential confounders (both p for trend < 0.05). Finally, only the association of TCAA with systolic BP remained significant in the sensitivity analyses (p < 0.05). Our results suggested that TCAA exposure was associated with increased BP in adults. Because urinary TCAA has been proposed as a valid biomarker of disinfection by-product (DBP) ingestion through disinfected drinking water, our results further suggest that exposure to drinking water DBPs may contribute to high BP in humans. Additional research is needed to confirm these findings and to evaluate opportunities for intervention.
Collapse
Affiliation(s)
- Shao-Hui Zhang
- Experiment Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ai-Jing Guo
- Department of Physico-chemical Inspection, Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Wei-Xin Zhao
- Experiment Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia-Ling Gu
- Experiment Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Rong Zhang
- Departments of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China
| | - Ning Wei
- Experiment Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| |
Collapse
|
6
|
Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects. J Occup Environ Med 2019; 60:109-119. [PMID: 29023340 DOI: 10.1097/jom.0000000000001191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (ie, DBP9). METHODS We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case-control study of 366 CFD cases in Massachusetts towns with complete 1999 to 2004 THM and HAA data. RESULTS We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95% CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform. CONCLUSION This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects and DBPs beyond THM4.
Collapse
|
7
|
Weyer P, Rhoads A, Suhl J, Luben TJ, Conway KM, Langlois PH, Shen D, Liang D, Puzhankara S, Anderka M, Bell E, Feldkamp ML, Hoyt AT, Mosley B, Reefhuis J, Romitti PA. Drinking water disinfection byproducts and risk of orofacial clefts in the National Birth Defects Prevention Study. Birth Defects Res 2019; 110:1027-1042. [PMID: 30133956 DOI: 10.1002/bdr2.1348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Maternal exposure to drinking water disinfection byproducts (DBP)s may contribute to orofacial cleft (OFC) development, but studies are sparse and beset with limitations. METHODS Population-based, maternal interview reports of drinking water filtration and consumption for 680 OFC cases (535 isolated) and 1826 controls were linked with DBP concentration data using maternal residential addresses and public water system monitoring data. Maternal individual-level exposures to trihalomethanes (THM)s and haloacetic acids (HAA)s (µg/L of water consumed) were estimated from reported consumption at home, work, and school. Compared to no exposure, associations with multisource maternal exposure <1/2 or ≥1/2 the Maximum Contaminant Levels (MCL)s for total THMs (TTHM)s and HAAs (HAA5) or Maximum Contaminant Level Goals (MCLG)s for individual THMs and HAAs (if non-zero) were estimated for all OFCs and isolated OFCs, cleft palate (CP), and cleft lip ± cleft palate (CL/P) using logistic regression analyses. RESULTS Compared to controls, associations were near or below unity for maternal TTHM, HAA5, and individual THM exposures with all OFCs and isolated OFCs, CP, and CL/P. Associations also were near or below unity for individual HAAs with statistically significant, inverse associations observed with each OFC outcome group except CL/P. CONCLUSIONS This study examined associations for maternal reports of drinking water filtration and consumption and maternal DBP exposure from drinking water with OFCs in offspring. Associations observed were near or below unity and mostly nonsignificant. Continued, improved research using maternal individual-level exposure data will be useful in better characterizing these associations.
Collapse
Affiliation(s)
- Peter Weyer
- Center for Health Effects of Environmental Contamination, Office of the Vice President for Research and Economic Development, University of Iowa, Iowa City, Iowa
| | - Anthony Rhoads
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Jonathan Suhl
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Thomas J Luben
- National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Kristin M Conway
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Dereck Shen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Dong Liang
- Environmental Statistics Collaborative, Chesapeake Biological Laboratories, University of Maryland Center for Environmental Science, Solomons, Maryland
| | - Soman Puzhankara
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Marlene Anderka
- Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts
| | - Erin Bell
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adrienne T Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Bridget Mosley
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Jennita Reefhuis
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | | |
Collapse
|
8
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - John M DeSesso
- Exponent, Inc., Alexandria, Virginia.,Georgetown University School of Medicine, Washington, District of Columbia
| |
Collapse
|
9
|
Wright JM, Evans A, Kaufman JA, Rivera-Núñez Z, Narotsky MG. Disinfection By-Product Exposures and the Risk of Specific Cardiac Birth Defects. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:269-277. [PMID: 27518881 PMCID: PMC5289901 DOI: 10.1289/ehp103] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/02/2016] [Accepted: 07/14/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Epidemiological studies suggest that women exposed to disinfection by-products (DBPs) have an increased risk of delivering babies with cardiovascular defects (CVDs). OBJECTIVE We examined nine CVDs in relation to categorical DBP exposures including bromoform, chloroform, dibromochloromethane (DBCM), bromodichloromethane (BDCM), monobromoacetic acid (MBAA), dichloroacetic acid (DCAA), trichloroacetic acid (TCAA), and summary DBP measures (HAA5, THMBr, THM4, and DBP9). METHODS We calculated adjusted odds ratios (aORs) in a case-control study of birth defects in Massachusetts with complete quarterly 1999-2004 trihalomethane (THM) and haloacetic acid (HAA) data. We randomly matched 10 controls each to 904 CVD cases based on week of conception. Weight-averaged aggregate first-trimester DBP exposures were assigned to individuals based on residence at birth. RESULTS We detected associations for tetralogy of Fallot and the upper exposure categories for TCAA, DCAA, and HAA5 (aOR range, 3.34-6.51) including positive exposure-response relationships for DCAA and HAA5. aORs consistent in magnitude were detected between atrial septal defects and bromoform (aOR = 1.56; 95% CI: 1.01, 2.43), as well as DBCM, chloroform, and THM4 (aOR range, 1.26-1.67). Ventricular septal defects (VSDs) were associated with the highest bromoform (aOR = 1.85; 95% CI: 1.20, 2.83), MBAA (aOR = 1.81; 95% CI: 0.85, 3.84), and DBCM (aOR = 1.54; 95% CI: 1.00, 2.37) exposure categories. CONCLUSIONS To our knowledge, this is the first birth defect study to develop multi-DBP adjusted regression models as well as the first CVD study to evaluate HAA exposures and the second to evaluate bromoform exposures. Our findings, therefore, inform exposure specificity for the consistent associations previously reported between THM4 and CVDs including VSDs. Citation: Wright JM, Evans A, Kaufman JA, Rivera-Núñez Z, Narotsky MG. 2017. Disinfection by-product exposures and the risk of specific cardiac birth defects. Environ Health Perspect 125:269-277; http://dx.doi.org/10.1289/EHP103.
Collapse
Affiliation(s)
- J. Michael Wright
- National Center for Environmental Assessment (NCEA), Office of Research and Development (ORD), U.S. Environmental Protection Agency (EPA), Cincinnati, Ohio, USA
- Address correspondence to J.M. Wright, U.S. EPA, National Center for Environmental Assessment, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati, OH 45268 USA. Telephone: (513) 569-7922. E-mail:
| | - Amanda Evans
- School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - John A. Kaufman
- ASPPH/EPA Environmental Health Fellowship Program, hosted by NCEA, ORD, U.S. EPA, Cincinnati, Ohio, USA
| | - Zorimar Rivera-Núñez
- Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Michael G. Narotsky
- National Health and Environmental Effects Research Laboratory, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| |
Collapse
|
10
|
Grazuleviciene R, Kapustinskiene V, Vencloviene J, Buinauskiene J, Nieuwenhuijsen MJ. Risk of congenital anomalies in relation to the uptake of trihalomethane from drinking water during pregnancy. Occup Environ Med 2013; 70:274-82. [PMID: 23404756 PMCID: PMC3607117 DOI: 10.1136/oemed-2012-101093] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Congenital anomalies have been inconsistently associated with maternal crude estimated exposure to drinking water trihalomethane (THM). We investigated the relationship between individual THM uptake during the first trimester of pregnancy and congenital anomalies. METHODS We estimated maternal THM uptake for 3074 live births using residential tap water concentrations, drinking water ingestion, showering and bathing, and uptake factors of THM in the blood. Multiple logistic regression was used to investigate the association of THM exposure with congenital anomalies. RESULTS We observed no statistically significant relationships between congenital anomalies and the total THM internal dose. We found little indication of a dose-response relationship for brominated THM and congenital heart anomalies. The relationship was statistically significant for bromodichloromethane (BDCM) (OR=2.16, 95% CI 1.05 to 4.46, highest vs lowest tertile) during the first month of pregnancy. During the first trimester of pregnancy, the probability of developing heart anomalies increased for every 0.1 μg/d increase in the BDCM and for every 0.01 μg/d increase in the internal dibromochloromethane (DBCM) dose (OR 1.70, 95% CI 1.09 to 2.66, and OR 1.25, 95% CI 1.01 to 1.54, respectively). A dose-response relationship was evident for musculoskeletal anomalies and DBCM exposure during the first and second months of pregnancy, while BDCM exposure tended to increase the risk of urogenital anomalies. CONCLUSIONS This study shows some evidence for an association between the internal dose of THM and the risk of congenital anomalies. In particular, increased prenatal exposure to brominated THM might increase the risk of congenital heart and musculoskeletal anomalies.
Collapse
Affiliation(s)
- Regina Grazuleviciene
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytauto DidŽiojo universitetas, Kaunas, Lithuania.
| | | | | | | | | |
Collapse
|
11
|
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]
|
12
|
Nieuwenhuijsen MJ, Martinez D, Grellier J, Bennett J, Best N, Iszatt N, Vrijheid M, Toledano MB. Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses. CIENCIA & SAUDE COLETIVA 2010. [DOI: 10.1590/s1413-81232010000800015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aims to review epidemiologic evidence of the association between exposure to chlorination disinfection by-products (DBPs) and congenital anomalies. All epidemiologic studies that evaluated a relationship between an index of DBP exposure and risk of congenital anomalies were analyzed. For all congenital anomalies combined, the meta-analysis gave a statistically significant excess risk for high versus low exposure to water chlorination or TTHM (17%; 95% CI, 3-34) based on a small number of studies. The meta-analysis also suggested a statistically significant excess risk for ventricular septal defects (58%; 95% CI, 21-107), but based on only three studies, and there was little evidence of an exposure-response relationship. It was observed no statistically significant relationships in the other meta-analyses and little evidence for publication bias, except for urinary tract defects and cleft lip and palate. Although some individual studies have suggested an association between chlorination disinfection by-products and congenital anomalies, meta-analyses of all currently available studies demonstrate little evidence of such association.
Collapse
Affiliation(s)
- Mark J. Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology, Spain; Municipal Institute of Medical Research, Spain; CIBER Epidemiologia y Salud Pública, Spain; Imperial College London, United Kingdom
| | - David Martinez
- Centre for Research in Environmental Epidemiology, Spain; Municipal Institute of Medical Research, Spain; CIBER Epidemiologia y Salud Pública, Spain
| | | | | | | | | | - Martine Vrijheid
- Centre for Research in Environmental Epidemiology, Spain; Municipal Institute of Medical Research, Spain; CIBER Epidemiologia y Salud Pública, Spain
| | | |
Collapse
|
13
|
|
14
|
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.
Collapse
Affiliation(s)
- Christelle Legay
- Ecole supérieure d'aménagement du territoire de l'Université Laval, Pavillon Antoine Savard, Université Laval, Québec City, Québec, Canada
| | | | | | | |
Collapse
|
15
|
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.
Collapse
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.
| | | | | | | | | | | | | |
Collapse
|
16
|
Nieuwenhuijsen MJ, Martinez D, Grellier J, Bennett J, Best N, Iszatt N, Vrijheid M, Toledano MB. Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1486-93. [PMID: 20019896 PMCID: PMC2790500 DOI: 10.1289/ehp.0900677] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 06/15/2009] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The aim of this study was to review epidemiologic evidence, provide summary risk estimates of the association between exposure to chlorination disinfection by-products (DBPs) and congenital anomalies, and provide recommendations for future studies. DATA SOURCES AND EXTRACTION We included all published epidemiologic studies that evaluated a relationship between an index of DBP exposure (treatment, water source, DBP measurements, and both DBP measurements and personal characteristics) and risk of congenital anomalies. When three or more studies examined the same exposure index and congenital anomaly, we conducted a meta-analysis to obtain a summary risk estimate comparing the highest exposure group with the lowest exposure group. When five or more studies examined total trihalomethane (TTHM) exposure and a specific congenital anomaly, we conducted a meta-analysis to obtain exposure-response risk estimates per 10 microg/L TTHM. DATA SYNTHESIS For all congenital anomalies combined, the meta-analysis gave a statistically significant excess risk for high versus low exposure to water chlorination or TTHM [17%; 95% confidence interval (CI), 3-34] based on a small number of studies. The meta-analysis also suggested a statistically significant excess risk for ventricular septal defects (58%; 95% CI, 21-107), but this was based on only three studies, and there was little evidence of an exposure-response relationship. We observed no statistically significant relationships in the other meta-analyses. We found little evidence for publication bias, except for urinary tract defects and cleft lip and palate. CONCLUSION Although some individual studies have suggested an association between chlorination disinfection by-products and congenital anomalies, meta-analyses of all currently available studies demonstrate little evidence of such an association.
Collapse
|
17
|
Chisholm K, Cook A, Bower C, Weinstein P. Risk of birth defects in Australian communities with high levels of brominated disinfection by-products. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1267-73. [PMID: 18795174 PMCID: PMC2535633 DOI: 10.1289/ehp.10980] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 04/16/2008] [Indexed: 05/09/2023]
Abstract
BACKGROUND By international standards, water supplies in Perth, Western Australia, contain high trihalomethane (THM) levels, particularly the brominated forms. Geographic variability in these levels provided an opportunity to examine cross-city spatial relationships between THM exposure and rates of birth defects (BDs). OBJECTIVES Our goal was to examine BD rates by exposure to THMs with a highly brominated fraction in metropolitan locations in Perth, Western Australia. METHODS We collected water samples from 47 separate locations and analyzed them for total and individual THM concentrations (micrograms per liter), including separation into brominated forms. We classified collection areas by total THM (TTHM) concentration: low (< 60 microg/L), medium (> 60 to < 130 microg/L), and high (> or = 130 microg/L). We also obtained deidentified registry-based data on total births and BDs (2000-2004 inclusive) from post codes corresponding to water sample collection sites and used binomial logistic regression to compare the frequency of BDs aggregately and separately for the TTHM exposure groups, adjusting for maternal age and socioeconomic status. RESULTS Total THMs ranged from 36 to 190 microg/L. A high proportion of the THMs were brominated (on average, 92%). Women living in high-TTHM areas showed an increased risk of any BD [odds ratio (OR) = 1.22; 95% confidence interval (CI), 1.01-1.48] and for the major category of any cardiovascular BD (OR = 1.62; 95% CI, 1.04-2.51), compared with women living in low-TTHM areas. CONCLUSIONS Brominated forms constituted the significant fraction of THMs in all areas. Small but statistically significant increases in risks of BDs were associated with residence in areas with high THMs.
Collapse
Affiliation(s)
- Kimberley Chisholm
- Environmental Determinants of Chronic Disease Group, School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
| | | | | | | |
Collapse
|
18
|
Nieuwenhuijsen MJ, Toledano MB, Bennett J, Best N, Hambly P, de Hoogh C, Wellesley D, Boyd PA, Abramsky L, Dattani N, Fawell J, Briggs D, Jarup L, Elliott P. Chlorination disinfection by-products and risk of congenital anomalies in England and Wales. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:216-22. [PMID: 18288321 PMCID: PMC2235225 DOI: 10.1289/ehp.10636] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 11/06/2007] [Indexed: 05/09/2023]
Abstract
BACKGROUND Increased risk of various congenital anomalies has been reported to be associated with trihalomethane (THM) exposure in the water supply. OBJECTIVES We conducted a registry-based study to determine the relationship between THM concentrations and the risk of congenital anomalies in England and Wales. METHODS We obtained congenital anomaly data from the National Congenital Anomalies System, regional registries, and the national terminations registry; THM data were obtained from water companies. Total THM (< 30, 30 to < 60, > or =60 microg/L), total brominated exposure (< 10, 10 to < 20, > or =20 microg/L), and bromoform exposure (< 2, 2 to < 4, > or =4 microg/L) were modeled at the place of residence for the first trimester of pregnancy. We included 2,605,226 live births, stillbirths, and terminations with 22,828 cases of congenital anomalies. Analyses using fixed- and random-effects models were performed for broadly defined groups of anomalies (cleft palate/lip, abdominal wall, major cardiac, neural tube, urinary and respiratory defects), a more restricted set of anomalies with better ascertainment, and for isolated and multiple anomalies. Data were adjusted for sex, maternal age, and socioeconomic status. RESULTS We found no statistically significant trends across exposure categories for either the broadly defined or more restricted sets of anomalies. For the restricted set of anomalies with isolated defects, there were significant (p < 0.05) excess risks in the high-exposure categories of total THMs for ventricular septal defects [odds ratio (OR) = 1.43; 95% confidence interval (CI), 1.00-2.04] and of bromoform for major cardiovascular defects and gastroschisis (OR = 1.18; 95% CI, 1.00-1.39; and OR = 1.38; 95% CI, 1.00-1.92, respectively). CONCLUSION In this large national study we found little evidence for a relationship between THM concentrations in drinking water and risk of congenital anomalies.
Collapse
Affiliation(s)
- Mark J. Nieuwenhuijsen
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Mireille B. Toledano
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - James Bennett
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Nicky Best
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Peter Hambly
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Cornelis de Hoogh
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Diana Wellesley
- British Isles Network of Congenital Anomaly Registers, BINOCAR Management Committee, Newcastle-Upon-Tyne, United Kingdom
| | - Patricia A. Boyd
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Lenore Abramsky
- British Isles Network of Congenital Anomaly Registers, BINOCAR Management Committee, Newcastle-Upon-Tyne, United Kingdom
- North Thames Perinatal Public Health Unit, Northwick Park Hospital, Harrow, United Kingdom
| | | | - John Fawell
- Independent Consultant, High Wycombe, Buckinghamshire, United Kingdom
| | - David Briggs
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Lars Jarup
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
| | - Paul Elliott
- Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, London, United Kingdom
- Address correspondence to P. Elliott, Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, St. Mary’s Campus, Norfolk Place, London W2 1PG, U.K. Telephone: 44 (0)20 7594 3328. Fax: 44 (0)20 7262 1034. E-mail:
| |
Collapse
|
19
|
Armstrong BG, Dolk H, Pattenden S, Vrijheid M, Loane M, Rankin J, Dunn CE, Grundy C, Abramsky L, Boyd PA, Stone D, Wellesley D. Geographic variation and localised clustering of congenital anomalies in Great Britain. Emerg Themes Epidemiol 2007; 4:14. [PMID: 17617898 PMCID: PMC1939702 DOI: 10.1186/1742-7622-4-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 07/06/2007] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Environmental pollution as a cause of congenital anomalies is sometimes suspected because of clustering of anomalies in areas of higher exposure. This highlights questions around spatial heterogeneity (clustering) in congenital anomaly rates. If spatial variation is endemic, then any one specific cluster is less remarkable, though the presence of uncontrolled geographically clustered risk factors is suggested. If rates are relatively homogeneous across space other than around specific hazards, then evidence for these hazards causing the clusters is strengthened. We sought to estimate the extent of spatial heterogeneity in congenital anomaly rates in the United Kingdom. METHODS The study population covered about one million births from five registers in Britain from 1991-1999. We estimated heterogeneity across four geographical levels: register area, hospital catchment, electoral ward, and enumeration district, using a negative binomial regression model. We also sought clusters using a circular scan statistic. RESULTS Congenital anomaly rates clearly varied across register areas and hospital catchments (p < 0.001), but not below this level (p > 0.2). Adjusting for socioeconomic deprivation and maternal age made little difference to the extent of geographical variation for most congenital anomaly subtypes. The two most significant circular clusters (of four ano-rectal atresias and six congenital heart diseases) contained two or more siblings. CONCLUSION The variation in rates between registers and hospital catchment area may have resulted in part from differences in case ascertainment, and this should be taken into account in geographical epidemiological studies of environmental exposures. The absence of evidence for variation below this level should be interpreted cautiously in view of the low power of general heterogeneity tests. Nevertheless, the data suggest that strong localised clusters in congenital anomalies are uncommon, so clusters around specific putative environmental hazards are remarkable when observed. Negative binomial models applied at successive hierarchical levels provide an approach of intermediate complexity to characterising geographical heterogeneity.
Collapse
Affiliation(s)
- Ben G Armstrong
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel St London WC1E7HT, UK
| | - Helen Dolk
- Faculty of Life and Health Sciences, University of Ulster, Shore Rd Newtownabbey BT370QB, UK
| | - Sam Pattenden
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel St London WC1E7HT, UK
| | - Martine Vrijheid
- International Agency for Research on Cancer, 150 Cour Albert Thomas, 69372 Lyon Cedex, France
| | - Maria Loane
- Faculty of Life and Health Sciences, University of Ulster, Shore Rd Newtownabbey BT370QB, UK
| | - Judith Rankin
- University of Newcastle, School of Population and health Studies, Newcastle upon Tyne NE24HH, UK
| | - Chris E Dunn
- Department of Geography, University of Durham, South Road, Durham, DH1 3LE, UK
| | - Chris Grundy
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel St London WC1E7HT, UK
| | - Lenore Abramsky
- Congenital Malformations Register, Perinatal Public Health, Northwick Park Hospital, Watford Rd, Harrow HA13UJ, UK
| | - Patricia A Boyd
- CAROBB, National Perinatal Epidemiology Unit, Institute of Health Sciences, Old Rd, Headington, OX37LF, UK
| | - David Stone
- Paediatric Epidemiology and Community Health (PEACH), Yorkhill Hospital, Glasgow G38SJ, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Services, Princess Anne Hospital, Coxford Rd, Southampton S0165YA, UK
| |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Cristina M Villanueva
- Centre de Recerca en Epidemiologia Ambiental (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, España.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Tardiff RG, Carson ML, Ginevan ME. Updated weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products. Regul Toxicol Pharmacol 2006; 45:185-205. [PMID: 16624462 DOI: 10.1016/j.yrtph.2006.03.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Indexed: 11/16/2022]
Abstract
Disinfection by-products (DBP) are produced when water is treated with chemical disinfectants. Some toxicological and epidemiological studies suggest an association between DBP exposure and adverse reproductive and developmental effects. In a previous critical review, [Graves, C.G., Matanoski, G.M., Tardiff, R.G., 2001. Weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products: a critical review. Regul. Toxicol. Pharmacol. 34, (2) 103-124] evaluated the weight of evidence for this exposure and these effects. This investigation updates the previous evaluation and considers all toxicological and epidemiological evidence since the earlier review and reassesses the weight-of-evidence for all of the data on the various effects, outcome by outcome. The updated toxicity weight of evidence found little indication of previously unreported reproductive or developmental toxicity. In particular, the recently published findings of an exceptionally well conducted cohort study of broad scope found no impact of chlorination by-products on the highly controversial outcome of spontaneous abortion, unlike predecessor studies of more limited methodology, leading the authors to recommend no further epidemiologic pursuit for this hypothesis since the cohort was scrutinized very closely and dispelled any concern of such an association. The updated epidemiologic weight of evidence demonstrated that no association with DBP exposure exists for over a dozen outcomes including low and very low birth weight, preterm delivery, some specific congenital anomalies, and neonatal death. The analysis found inconsistent or very weak results for all congenital anomalies/birth defects, all central nervous system anomalies, neural tube defects, and spontaneous abortion. As in the previous article, the updated weight of evidence suggested a positive association with DBP exposure and some measure of growth retardation such as intrauterine growth retardation, small for gestational age, term low birth weight, and small body length or head circumference. Exposure assessment in most epidemiological studies remains inadequate to definitively demonstrate any association of small magnitude.
Collapse
|
22
|
Hunter ES, Rogers E, Blanton M, Richard A, Chernoff N. Bromochloro-haloacetic acids: Effects on mouse embryos in vitro and QSAR considerations. Reprod Toxicol 2006; 21:260-6. [PMID: 16293395 DOI: 10.1016/j.reprotox.2005.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 08/30/2005] [Accepted: 09/13/2005] [Indexed: 11/26/2022]
Abstract
The haloacetic acids (HAA) are a family of chemicals that are drinking water disinfection by-products. We previously reported that haloacetic acids, including several bromo- and chloro-HAAs, alter embryonic development when mouse conceptuses are directly exposed to these xenobiotics in whole embryo culture. Craniofacial dysmorphogenesis was observed in exposed embryos and a quantitative structure activity relationship (QSAR) for induction of cranial neural tube dysmorphogenesis was established for a series of 10 HAAs, which also included fluoro- and iodo-HAA representatives. In the current study, we evaluate the effects of exposing neurulation staged (3-6 somite pairs) CD-1 mouse conceptuses to bromochloro- (BCA), dibromochloro- (DBCA) and bromodichloro-acetic (BDCA) acids in whole embryo culture at concentrations ranging from 50 to 2500 microM. Morphological development was assessed after a 26 h exposure period. Exposure of conceptuses to these HAAs produced dysmorphogenesis, including prosencephalic and pharyngeal arch hypoplasia as well as eye and heart tube abnormalities. Benchmark concentrations for induction of neural tube dysmorphogenesis were 63, 500 and 536 microM for BCA, DBCA and BDCA, respectively. Our previously developed HAA QSAR accurately predicted placement of these three chemicals in the larger context of the previously tested di- and tri-HAAs, also correctly predicting that BCA would be more potent than DBCA and BDCA, and that the latter two HAAs would be near equi-potent. This study describes the concentration-dependent induction of dysmorphogenesis in whole embryo culture by three mixed chloro/bromo-HAAs and demonstrates the ability of the HAA QSAR to predict relative potencies within this family of xenobiotics.
Collapse
Affiliation(s)
- E Sidney Hunter
- Reproductive Toxicology Division, National Health and Environmental Effects Research Lab, US EPA, RTP, NC 27711, USA.
| | | | | | | | | |
Collapse
|
23
|
Toledano MB, Nieuwenhuijsen MJ, Best N, Whitaker H, Hambly P, de Hoogh C, Fawell J, Jarup L, Elliott P. Relation of trihalomethane concentrations in public water supplies to stillbirth and birth weight in three water regions in England. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:225-32. [PMID: 15687062 PMCID: PMC1277869 DOI: 10.1289/ehp.7111] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 10/21/2004] [Indexed: 05/05/2023]
Abstract
We investigated the association between total trihalomethanes (TTHMs) and risk of stillbirth and low and very low birth weight in three water regions in England, 1992-1998; associations with individual trihalomethanes (THMs) were also examined. Modeled estimates of quarterly TTHM concentrations in water zones, categorized as low (< 30 microg/L), medium (30-59 microg/L), or high (> or = 60 microg/L), were linked to approximately 1 million routine birth and stillbirth records using maternal residence at time of birth. In one region, where there was a positive socioeconomic deprivation gradient across exposure categories, there was also a positive, significant association of TTHM with risk of stillbirth and low and very low birth weight. Overall summary estimates across the three regions using a random-effects model to allow for between-region heterogeneity in exposure effects showed small excess risks in areas with high TTHM concentrations for stillbirths [odds ratio (OR) = 1.11; 95% confidence interval (CI), 1.00-1.23), low birth weight (OR = 1.09; 95% CI, 0.93-1.27), and very low birth weight (OR = 1.05; 95% CI, 0.82-1.34). Among the individual THMs, chloroform showed a similar pattern of risk as TTHM, but no association was found with concentrations of bromodichloromethane or total brominated THMs. Our findings overall suggest a significant association of stillbirths with maternal residence in areas with high TTHM exposure. Further work is needed looking at cause-specific stillbirths and effects of other disinfection by-products and to help differentiate between alternative (noncausal) explanations and those that may derive from the water supply.
Collapse
Affiliation(s)
- Mireille B Toledano
- Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Major congenital anomalies are diagnosed in 2-4% of births. In this paper we review epidemiological studies that have specifically looked at congenital anomalies as a possible outcome of community exposure to chemical exposures associated with environmental pollution. These include studies of drinking water contaminants (heavy metals and nitrates, chlorinated and aromatic solvents, and chlorination by-products), residence near waste disposal sites and contaminated land, pesticide exposure in agricultural areas, air pollution and industrial pollution sources, food contamination, and disasters involving accidental, negligent or deliberate chemical releases of great magnitude. We conclude that there are relatively few environmental pollution exposures for which we can draw strong conclusions about the potential to cause congenital anomalies and, if so, the chemical constituents implicated, to provide an evidence base for public health and clinical practice. A precautionary approach should be adopted at both community and individual level. In order to prevent congenital anomalies, one must reduce exposure to potential teratogens before pregnancy is recognized (i.e. preconceptionally and in the first few weeks of pregnancy). It is a challenge to develop effective strategies for preconceptional care within the primary care framework. Prenatal service providers and counsellors need to be aware of the uncertainties regarding environmental pollution when addressing parental concerns.
Collapse
|