Exposure to Disinfection By-products, Fetal Growth, and Prematurity: A Systematic Review and Meta-analysis

High Molecular-Weight Organics as Precursors for Toxic Iodinated Disinfection Byproducts during Chloramination

Iodinated DBPs (I-DBPs), many more toxic than regulated chlorinated and/or brominated DBPs, are a major challenge in the supply of safe drinking water. While over 800 DBPs have been identified, the occurrence and precursors of toxic I-DBPs remain poorly understood. Herein, natural organic matter from two raw drinking waters was fractionated using ultrafiltration membranes into different groups based on molecular weight (MW). The <1 kDa fraction exhibited the highest levels of cytotoxicity and genotoxicity after disinfection. However, in the presence of iodide, the 10-100 kDa fraction had the highest toxicity/dissolved organic carbon values. FT-ICR MS analysis showed high reactivity between hypoiodous acid and the 10-100 kDa fraction, and a shift from aromatic and unsaturated molecules to more saturated and oxidized molecules during chloramination of 10-100 kDa fraction. Based on nontarget analysis using orbitrap MS, four I-DBPs with high peak intensities during chloramination of 10-100 kDa fraction were identified and then confirmed using chemical standards: 4-hydroxy-3-iodo-5-nitrobenzonitrile, 2,4,5-triiodoimidazole, 3,5-diiodo-4-hydroxybenzonitrile, and 2,6-diiodo-4-nitrophenol. The first two have been first identified in drinking water. The concentrations of the four DBPs ranged from Collapse

Key Words

• chloramination
• cytotoxicity
• disinfection byproducts
• genotoxicity
• iodide
• molecular weight

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MESH Headings

• Disinfection
• Water Purification
• Molecular Weight
• Drinking Water/chemistry
• Water Pollutants, Chemical/chemistry
• Water Pollutants, Chemical/toxicity
• Disinfectants/chemistry
• Disinfectants/toxicity

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Affiliation(s)

Wenyuan Yang State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China Ministry of Education Key Laboratory of Yangtze River Water Environment, Tongji University, Shanghai 200092, China Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
Tom Bond Water Research Centre, Frankland Road, Swindon SN5 8YF, U.K
Chao Fang State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China Key Laboratory of Rare Earths, Ganjiang Innovation Academy, Chinese Academy of Sciences, Ganzhou, Jiangxi 341119, China
Zhenqi Du State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China Ministry of Education Key Laboratory of Yangtze River Water Environment, Tongji University, Shanghai 200092, China Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
Wenhai Chu State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China Ministry of Education Key Laboratory of Yangtze River Water Environment, Tongji University, Shanghai 200092, China Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China

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Chloronitramide anion is a decomposition product of inorganic chloramines

Inorganic chloramines are commonly used drinking water disinfectants intended to safeguard public health and curb regulated disinfection by-product formation. However, inorganic chloramines themselves produce by-products that are poorly characterized. We report chloronitramide anion (Cl-N-NO2-) as a previously unidentified end product of inorganic chloramine decomposition. Analysis of chloraminated US drinking waters found Cl-N-NO2- in all samples tested (n = 40), with a median concentration of 23 micrograms per liter and first and third quartiles of 1.3 and 92 micrograms per liter, respectively. Cl-N-NO2- warrants occurrence and toxicity studies in chloraminated water systems that serve more than 113 million people in the US alone.

Revealing the impact of sample enrichment method on concentration and cytotoxicity of volatile disinfection byproducts in drinking water: A quantitative study for liquid-liquid extraction

Liquid-liquid extraction (LLE) combined with the N2 blow-down method is a promising tool for bioanalysis of drinking water. However, detailed information on which disinfection byproduct (DBP) classes are retained in LLE extracts is currently unavailable. In this study, the recovery of seven classes of volatile DBPs and total adsorbable organic halogens (TOX) during the LLE method, combined with three common N2 blow-down methods, for bioanalysis in real tap water was analyzed at a 2-L scale, along with their corresponding cytotoxicity. The total concentration of seven classes of volatile DBPs in drinking water in Suzhou ranged from 64.6 to 83.0 µg/L, with the majority contributed by trihalomethanes (THMs: 59.9 µg/L), haloaldehydes (HALs: 5.4 µg/L), haloacetamides (HAMs: 3.4 µg/L), and haloacetonitriles (HANs: 3.2 µg/L). During the LLE - N2 blow-down process for bioanalysis, about 69-85 % of targeted volatile DBPs and 64-75 % of TOX were lost, respectively. Seven classes of volatile DBPs accounted for 52.8-64.3 % and 23.8-61.3 % of TOX in tap water and LLE - N2 blow-down samples, respectively, suggesting that targeted aliphatic DBPs are the key contributors to TOX. Furthermore, although LLE - solvent exchange had a better recovery performance than other N2 blow-down methods, the recoveries of volatile DBPs using this method were still not ideal. For example, HALs and HAMs had a slightly better recovery (>50 %), while most volatile DBPs had a poor recovery, including iodo-trihalomethanes (I-THMs, 0 %), haloketones (28 %), THMs (26 %), halonitromethanes (33 %), and HANs (38 %). During LLE - solvent exchange, 31 % and 36 % of targeted DBPs and TOX, respectively, in real tap water can be retained, which shows better performance than non-ionic macroporous copolymers (XAD). More importantly, the water volume required in this method for cytotoxicity analysis is 2 L, which greatly reduces the burden of water sample collection, transport, and pre-treatment compared to XAD (which typically requires 5 or 10 L). In general, this paper reveals the fate of volatile DBPs during LLE - N2 blow-down and indicates that LLE - solvent exchange is a good substitute for the XAD method in bioanalysis.

Exposure to drinking water pollutants and non-syndromic birth defects: a systematic review and meta-analysis synthesis

OBJECTIVES

To evaluate the association between drinking water pollutants and non-syndromic birth defects.

DESIGN

Systematic review and meta-analysis synthesis.

DATA SOURCES

A search of MEDLINE, EMBASE and Google Scholar was performed to review relevant citations reporting on birth defects in pregnancies exposed to water pollutants between January 1962 and April 2023.

ELIGIBILITY CRITERIA

Prospective or retrospective cohort, population studies and case-control studies that provided data on exposure to drinking water pollutants around conception or during pregnancy and non-syndromic birth defects. We included studies published in the English language after the Minamata Bay disaster to reflect on contemporary concerns about the effect of environmental pollution and obstetric outcomes.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently read the retrieved articles for content, data extraction and analysis. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale. Included studies were assessed for comparability when considered for meta-analysis.

RESULTS

32 studies met inclusion criteria including 17 cohorts (6 389 097 participants) and 15 case-control studies (47 914 cases and 685 712 controls). The most common pollutants investigated were trihalomethanes (11 studies), arsenic (5 studies) and nitrates (4 studies). The studies varied in design with different estimates of exposure, different stages of gestation age and different durations of exposure to pollutants. 21 articles reported data on any birth defects in their population or study groups and the others on specific birth defects including congenital heart defects, neural tube defects, orofacial defects and hypospadias. An increased risk or higher incidence of overall birth defects was reported by 9 studies and for specific birth defects by 14 studies. Eight studies compared the risk or incidence of birth defects with exposure to different concentrations of the pollutants. The analysis showed an association between higher levels of trihalomethanes (TTMs) and arsenic increase in major birth defects (lower vs higher exposure (OR 0.76, 95% CI 0.65 to 0.89; p<0.001 and OR 0.56, 95% CI 0.39 to 0.82; p<0.005, respectively).

CONCLUSION

The evidence of an association between exposure to average levels of common drinking water chemical pollutants during pregnancy and an increased risk or incidence of birth defects is uncertain. Available evidence indicates that some common chemical pollutants currently found in drinking water may have a direct teratogenic effect at high maternal exposure, however, wide variation in methodology limits the interpretation of the results. Future prospective studies using standardised protocols comparing maternal levels during all three trimesters of pregnancy and cord blood levels at birth are needed to better understand the placental transfer of water pollutants and accurately evaluate individual fetal exposure to drinking water pollutants.

PROSPERO REGISTRATION NUMBER

CRD42018112524.

Fabrication of a ZnFe2O4@Co/Ni-MOF nanocomposite and photocatalytic degradation study of azo dyes

This study addresses the critical issue of removing organic pollutants from water, focusing on the photocatalytic degradation of Congo red (CR) dye using a novel ZnFe2O4@Co-Ni metal-organic framework (MOF) nanocomposite (ZFCNM). The primary aim was to develop a photocatalyst with enhanced efficiency by combining the properties of ZnFe2O4 with Co/Ni-MOF, leading to a low band gap (2.89 eV) and a high surface area (723 m2 g-1). The ZFCNM nanocomposite, synthesized via a hydrothermal method, was characterized by X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM), confirming the formation of face-centered cubic ferrite and hexagonal MOF structures. Fourier-transform infrared spectroscopy (FTIR) verified the presence of carboxyl (-COOH) groups and Fe-O bonds in the composite. Photodegradation efficiency was evaluated under varying conditions, including reaction time, pH, catalyst dosage, contaminant concentration, and light intensity. The ZFCNM photocatalyst, with an equal mass ratio of Co/Ni-MOF and ZnFe2O4, achieved a 98% removal efficiency of CR (75 min reaction time, pH 5, at 25 °C, and visible-light intensity of a 50 W LED lamp) significantly outperforming Co/Ni-MOF (24%) and ZnFe2O4 (36%) alone. The estimated quantum yield (QY) was 3.00 × 10-6 molecules per photon, and kinetic studies revealed a first-order reaction pathway with an R 2 value of 0.9813. These results highlight the potential of ZFCNM as an effective photocatalyst for water purification applications.

Widespread Antioxidants during Storm Events Could Serve as Precursors of Regulated, Priority, and New Disinfection Byproducts

Widely used antioxidants can enter the environment via urban stormwater systems and form disinfection byproducts (DBPs) during chlorination in downstream drinking water processes. Herein, we comprehensively investigated the occurrence of 39 antioxidants from stormwater runoff to surface water. After a storm event, the concentrations of the antioxidants in surface water increased by 1.4-fold from 102-110 ng/L to 128-139 ng/L. Widespread antioxidants during the stormwater event could transform into toxic DBPs during disinfection. Moreover, the yields of trihalomethanes, haloacetaldehydes, haloacetonitriles (HANs), and halonitromethanes during the chlorination of widely used antioxidants considerably increased with an increasing chlorine dose and contact time. Specifically, the yields of dichloroacetonitrile during the chlorination of diphenylamine (DPA) and N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (6PPD) were higher than those of most reported amino acid precursors, indicating that DPA and 6PPD might be important precursors of HANs. Exploring the intermediates using GC × GC-time-of-flight high-resolution mass spectrometry helped reveal potential pathways from DPA to HANs, whose formation could be attributed to the intermediate carbazole and indole moieties detected in this study. This study provides insights into the transport and transformation of commonly used antioxidants in a water environment and during water treatment processes, highlighting the potential risks of anthropogenic pollutants from a DBP perspective.

Trihalomethanes in global drinking water: Distributions, risk assessments, and attributable disease burden of bladder cancer

This study aimed to assess the global spatiotemporal variations of trihalomethanes (THMs) in drinking water, evaluate their cancer and non-cancer risks, and THM-attributable bladder cancer burden. THM concentrations in drinking water around fifty years on a global scale were integrated. Health risks were assessed using Monte Carlo simulations and attributable bladder cancer burden was estimated by comparative risk assessment methodology. The results showed that global mean THM concentrations in drinking water significantly decreased from 78.37 μg/L (1973-1983) to 51.99 μg/L (1984-2004) and to 21.90 μg/L (after 2004). The lifestage-integrative cancer risk and hazard index of THMs through all exposure pathways were acceptable with the average level of 6.45 × 10-5 and 7.63 × 10-2, respectively. The global attributable disability adjusted of life years (DALYs) and the age-standardized DALYs rate (ASDR) dropped by 16% and 56% from 1990-1994 to 2015-2019, respectively. A big decline in the attributable ASDR was observed in the United Kingdom (62%) and the United States (27%), while China experienced a nearly 3-fold increase due to the expanded water supply coverage and increased life expectancy. However, China also benefited from the spread of chlorination, which helped reduce nearly 90% of unsafe-water-caused mortality from 1998 to 2018.

Perspectives and understanding on the occurrence, toxicity and abatement technologies of disinfection by-products in drinking water

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.

Stormwater discharge: An overlooked source of disinfection byproduct precursors

Discharge from the stormwater system is as an important pathway for contaminant transport, impacting the quantity and characteristics of dissolved organic matter (DOM) in surface water, and thus the formation of disinfection byproducts (DBPs) during downstream drinking water disinfection. In this study, DOM in stormwater pipes was characterized by size-exclusion chromatography, and the formation of 27 DBPs and halogen-specific total organic halogen (TOX) following chlorination was investigated. Overall, DOM in stormwater pipes was characterized by low molecular weight compounds and microbial-derived organics. Total DBP concentrations in chlorinated stormwaters were ∼1-15 times higher than in chlorinated surface waters. DBPs formed in stormwaters were dominated by trihalomethanes and haloacetic acids. Moreover, the DBP-associated toxicity of chlorinated stormwaters was ∼1-38 times higher than in chlorinated surface waters, and mainly due to the presence of large amount of haloacetaldehydes and haloacetonitriles. Sampling during a rainfall event suggested that stormwater discharge significantly increased DBP precursors in the surface water. The high formation and estimated toxicity of DBPs in stormwater discharge indicates this is an overlooked source of DBP precursors, posing a threat to the aquatic environment and potentially drinking water quality.

Evaluating the Effect of Gestational Exposure to Perfluorohexane Sulfonate on Placental Development in Mice Combining Alternative Splicing and Gene Expression Analyses

BACKGROUND

Perfluorohexane sulfonate (PFHxS) is a frequently detected per- and polyfluoroalkyl substance in most populations, including in individuals who are pregnant, a period critical for early life development. Despite epidemiological evidence of exposure, developmental toxicity, particularly at realistic human exposures, remains understudied.

OBJECTIVES

We evaluated the effect of gestational exposure to human-relevant body burden of PFHxS on fetal and placental development and explored mechanisms of action combining alternative splicing (AS) and gene expression (GE) analyses.

METHODS

Pregnant ICR mice were exposed to 0, 0.03, and 0.3 μ g / kg / day  from gestational day 7 to day 17 via oral gavage. Upon euthanasia, PFHxS distribution was measured using liquid chromatography-tandem mass spectrometry. Maternal and fetal phenotypes were recorded, and histopathology was examined for placenta impairment. Multiomics was adopted by combining AS and GE analyses to unveil disruptions in mRNA quality and quantity. The key metabolite transporters were validated by quantitative real-time PCR (qRT-PCR) for quantification and three-dimensional (3D) structural simulation by AlphaFold2. Targeted metabolomics based on liquid chromatography-tandem mass spectrometry was used to detect amino acid and amides levels in the placenta.

RESULTS

Pups developmentally exposed to PFHxS exhibited signs of intrauterine growth restriction (IUGR), characterized by smaller fetal weight and body length (p < 0.01 ) compared to control mice. PFHxS concentration in maternal plasma was 5.01 ± 0.54  ng / mL . PFHxS trans-placenta distribution suggested dose-dependent transfer through placental barrier. Histopathology of placenta of exposed dams showed placental dysplasia, manifested with an attenuated labyrinthine layer area and deescalated blood sinus counts and placental vascular development index marker CD34. Combined GE and AS analyses pinpointed differences in genes associated with key biological processes of placental development, proliferation, metabolism, and transport in placenta of exposed dams compared to that of control dams. Further detection of placental key transporter gene expression, protein structure simulation, and amino acid and amide metabolites levels suggested that PFHxS exposure during pregnancy led to impairment of placental amino acid transportation.

DISCUSSION

The findings from this study suggest that exposure to human-relevant very-low-dose PFHxS during pregnancy in mice caused IUGR, likely via downregulating of placental amino acid transporters, thereby impairing placental amino acid transportation, resulting in impairment of placental development. Our findings confirm epidemiological findings and call for future attention on the health risk of this persistent yet ubiquitous chemical in the early developmental stage and provide a new approach for understanding gene expression from both quantitative and qualitative omics approaches in toxicological studies. https://doi.org/10.1289/EHP13217.

Disinfection by-product precursors introduced by sandstorm events: Composition, formation characteristics and potential risks

Sandstorms, a natural meteorological event, occur repeatedly during the dry season and can accumulate large amounts of natural/anthropogenic pollutants during the deposition process, potentially introducing disinfection by-product (DBP) precursors into surface waters. In this study, the characteristics of sandstorm-derived dissolved organic matter (DOM) and its DBP formation potential were elucidated. Overall, sandstorm-derived DOM mainly consisted of low-molecular-weight, low-aromaticity, high-nitrogen organic matter, with a dissolved organic carbon (DOC) release yield of 14.4 mg-DOC/g. The halogenated DBP formation potential (calculated as total organic halogen) of sandstorm-derived DOM was comparable to that of surface water, while the normalized DBP-associated toxicity was 1.96 times higher. Similar to DOM introduced by other depositional pathways, sandstorm-derived DOM also had higher yields of highly cytotoxic DBPs (haloacetaldehydes [HALs], haloacetonitriles [HANs] and halonitromethanes [HNMs]). The average atmospheric deposition flux for DOM during the sandstorm event (50.4 ± 2.1 kg km-2 day-1) was 6.95 times higher than that of dry deposition, indicating a higher probability of contaminant input. Simultaneously, the estimation revealed that the sandstorm will increase the formation potential of toxicity forcing agents, such as HALs, HANs and HNMs, in surface water by 3.87%, 2.39% and 9.04%, respectively. Considering the high frequency of sandstorm events and the sorption of other organic pollutants by sand and dust, the impact of sandstorms on surface water quality should be of concern.

Impacts of hydraulic fracturing wastewater from oil and gas industries on drinking water: Quantification of 69 disinfection by-products and calculated toxicity

Oil and gas production generates large amounts of brine wastewater called "produced water" with various geogenic and synthetic contaminants. These brines are generally used in hydraulic fracturing operations to stimulate production. They are characterized by elevated halide levels, particularly geogenic bromide and iodide. Such salt concentrations in produced water may be as high as thousands of mg/L of bromide and tens of mg/L of iodide. Large volumes of produced water are stored, transported, reused in production operations, and ultimately disposed of by deep well injection into saline aquifers. Improper disposal may potentially contaminate shallow freshwater aquifers and impact drinking water sources. Because conventional produced water treatment typically does not remove halides, produced water contamination of groundwater aquifers may cause the formation of brominated and iodinated disinfection by-products (I-DBPs) at municipal water treatment plants. These compounds are of interest because of their higher toxicity relative to their chlorinated counterparts. This study reports a comprehensive analysis of 69 regulated and priority unregulated DBPs in simulated drinking waters fortified with 1 % (v/v) oil and gas wastewater. Impacted waters produced 1.3×-5× higher levels of total DBPs compared to river water after chlorination and chloramination. Individual DBP levels ranged from (<0.1-122 μg/L). Overall, chlorinated waters formed highest levels, including trihalomethanes that would exceed the U.S. EPA regulatory limit of 80 μg/L. Chloraminated waters had more I-DBP formation and highest levels of haloacetamides (23 μg/L) in impacted water. Calculated cytotoxicity and genotoxicity were higher for impacted waters treated with chlorine and chloramine than corresponding treated river waters. Chloraminated impacted waters had the highest calculated cytotoxicity, likely due to higher levels of more toxic I-DBPs and haloacetamides. These findings demonstrate that oil and gas wastewater if discharged to surface waters could adversely impact downstream drinking water supplies and potentially affect public health.

Inactivation of fungal spores by performic acid in water: Comparisons with peracetic acid

Performic acid (PFA) has received increasing attention in water disinfection due to its high disinfection efficiency and fewer formation of disinfection by-products. However, the inactivation of fungal spores by PFA has not been investigated. In this study, the results showed that the log-linear regression plus tail model adequately described the inactivation kinetic of fungal spores with PFA. The k values of A. niger and A. flavus with PFA were 0.36 min^-1 and 0.07 min^-1, respectively. Compared to peracetic acid, PFA was more efficient in inactivating fungal spores and caused more serious damage on cell membrane. Compared to neutral and alkaline conditions, acidic environments demonstrated a greater inactivation efficiency for PFA. The increase of PFA dosage and temperature had a promoting effect on the inactivation efficiency of fungal spores. PFA could kill the fungal spores by damaging cell membrane and penetration of cell membranes. In real water, the inactivation efficiency declined as a result of the existence of background substances such as dissolved organic matter. Moreover, the regrowth potential of fungal spores in R2A medium were severely inhibited after inactivation. This study provides some information for PFA to control fungi pollution and explores the mechanism of PFA inactivation.

Developmental toxicity of perfluorohexane sulfonate at human relevant dose during pregnancy via disruption in placental lipid homeostasis

Perfluorohexyl sulfonate (PFHxS) is the third most abundant per- and polyfluoroalkyl substances and its developmental toxicity remains very poorly understood. Here, pregnant mice exposed to PFHxS at human relevant dose showed increased fetal death incidence in the high-dose PFHxS-H group (P < 0.01). Body distribution analyses suggested that PFHxS crossed the placental barrier reaching the fetus in a dose-dependent manner. Histopathological data demonstrated impairment in the placenta with reduced blood sinus volume, placental labyrinth area as well as thickness of labyrinthine layer. Further lipidomic and transcriptomic data together showed that PFHxS exposure caused significant disruption in placental lipid homeostasis, including total lipid accumulation in the placenta, and dysregulation in phospholipid and glycerol lipid metabolism. Gene expression analyses uncovered elevation in key placental fatty acid transporters including fabp2, whereas protein expression showed transporter specific disruptions following exposure. Together, gestational exposure to human relevant level of PFHxS may increase the incidence of fetal deaths and caused placental dysplasia via disruption in lipid metabolism homeostasis. These findings raise the concern regarding the highly prevalent and persistent chemical towards early sensitive developing stages and provide basis for further understanding of its effects on lipid metabolism and underlying mechanisms.

Toxicological aspect of water treated by chlorine-based advanced oxidation processes: A review

As well established in the literature, residual toxicity is an important parameter for evaluating the sanitary and environmental safety of water treatment processes, and this parameter becomes even more crucial when chlorine-based processes are applied for water treatment. Eliminating initial toxicity or preventing its increase after water treatment remains a huge challenge mainly due to the formation of highly toxic disinfection by-products (DBPs) that stem from the degradation of organic contaminants or the interaction of the chlorine-based oxidants with different matrix components. In this review, we present a comprehensive discussion regarding the toxicological aspects of water treated using chlorine-based advanced oxidation processes (AOPs) and the recent findings related to the factors influencing toxicity, and provide directions for future research in the area. The review begins by shedding light on the advances made in the application of free chlorine AOPs and the findings from studies conducted using electrochemical technologies based on free chlorine generation. We then delve into the insights and contributions brought to the fore regarding the application of NH₂Cl- and ClO₂-based treatment processes. Finally, we broaden our discussion by evaluating the toxicological assays and predictive models employed in the study of residual toxicity and provide an overview of the findings reported to date on this subject matter, while giving useful insights and directions for future research on the topic.

Impacts of disinfection byproduct exposures on male reproductive health: Current evidence, possible mechanisms and future needs

Disinfection byproducts (DBPs) are a class of ubiquitous chemicals in drinking water and inevitably result in widespread human exposures. Potentially adverse health effects of DBP exposures, including reproductive and developmental outcomes, have been increasing public concerns. Several reviews have focused on the adverse pregnancy outcomes of DBPs. This review summarized current evidence on male reproduction health upon exposure to DBPs from toxicological and epidemiological literature. Based on existing experimental studies, there are sufficient evidence showing that haloacetic acids (HAAs) are male reproductive toxicants, including reduced epididymal weight, decreased semen parameters and sperm protein 22, and declined testosterone levels. However, epidemiological evidence remains insufficient to support a link of DBP exposures with adverse male reproductive outcomes, despite that blood and urinary DBP biomarkers are associated with decreased semen quality. Eight potential mechanisms, including germ/somatic cell dysfunction, oxidative stress, genotoxicity, inflammation, endocrine hormones, folate metabolism, epigenetic alterations, and gut microbiota, are likely involved in male reproductive toxicity of DBPs. We also identified knowledge gaps in toxicological and epidemiological studies to enhance future needs.

Maternal exposure to nitrosamines in drinking water during pregnancy and birth outcomes in a Chinese cohort

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.

Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment

INTRODUCTION

The relevance of ecosystems to physiotherapy has traditionally been overlooked, despite its potential for health impacts relevant to conditions often managed by physiotherapists.

PURPOSE

The purpose of this article is to introduce the concept of ecosystem services to physiotherapists, and to discuss how understanding ecosystem services may improve patient care, and population and planetary health.

DISCUSSION AND CONCLUSION

Physiotherapists with an understanding of ecosystem services may improve patient care by value-adding to management through patient education, empathy, advocacy, and broader population health approaches. Physiotherapists are also well placed to promote the conservation and restoration of ecosystem through participation, advocacy, and the development of public health measures, to the benefit of global sustainability and population health. Further research is required into how physiotherapists currently use nature-based interventions, and the barriers and enablers to their use. To be adequately prepared to meet the challenges that climate change and environmental degradation pose to patient care, population health and health systems, both current and future physiotherapists need to take a broader view of their practice. By including consideration of the potential role of the environment and green space exposure in particular on their patient's health, physiotherapists can ultimately contribute more to population and planetary health.

Anthracite Releases Aromatic Carbons and Reacts with Chlorine to Form Disinfection Byproducts in Drinking Water Production

Anthracite is globally used as a filter material for water purification. Herein, it was found that up to 15 disinfection byproducts (DBPs) were formed in the chlorination of anthracite-filtered pure water, while the levels of DBPs were below the detection limit in the chlorination of zeolite-, quartz sand-, and porcelain sandstone-filtered pure water. In new-anthracite-filtered water, the levels of dissolved organic carbon (DOC), dissolved organic nitrogen (DON), and ammonia nitrogen (NH₃-N) ranged from 266.3 to 305.4 μg/L, 37 to 61 μg/L, and 8.6 to 17.1 μg/L, respectively. In aged anthracite (collected from a filter at a DWTP after one year of operation) filtered water, the levels of the above substances ranged from 475.1 to 597.5 μg/L, 62.1 to 125.6 μg/L, and 14 to 28.9 μg/L, respectively. Anthracite would release dissolved substances into filtered water, and aged anthracite releases more substances than new anthracite. The released organics were partly (around 5%) composed by the μg/L level of toxic and carcinogenic aromatic carbons including pyridine, paraxylene, benzene, naphthalene, and phenanthrene, while over 95% of the released organics could not be identified. Organic carbon may be torn off from the carbon skeleton structure of anthracite due to hydrodynamic force in the water filtration process.

Exposures to volatile organic compounds, serum vitamin D, and kidney function: association and interaction assessment in the US adult population

The relationships of exposures to volatile organic compounds (VOCs) with vitamin D and kidney function remain unclear. Our analyses included 6070 adults from 2003 to 2010 survey cycles of the National Health and Nutrition Examination Survey to explore associations of six VOCs with serum vitamin D, albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). The results suggested that dibromochloromethane was positively associated with ACR, and chloroform was inversely associated with ACR. U-shaped associations of toluene, m-/p-xylene, bromodichloromethane, and 1,4-dichlorobenzene with ACR were observed. Toluene, m-/p-xylene, and 1,4-dichlorobenzene were associated with eGFR in U-shaped manners, while bromodichloromethane and chloroform were inversely associated with eGFR. Elevation in 1,4-dichlorobenzene was associated with decrease in vitamin D, while chloroform and m-/p-xylene were in U-shaped associations with vitamin D. VOCs mixture was U-shaped associated with ACR, inversely associated with eGFR, and inversely associated with vitamin D. Vitamin D was in a U-shaped association with ACR. Vitamin D significantly interacted with VOCs on the two kidney parameters. In the US adult population, exposures to VOCs were associated with kidney function and serum vitamin D level decline, and the serum vitamin D may have interaction effects with VOCs exposures on kidney function.

A censorious review on the role of natural lignocellulosic fiber waste as a low-cost adsorbent for removal of diverse textile industrial pollutants

BACKGROUND

Textile industries produce fabricated colored products using toxic dyes and other harsh chemicals. It is the responsibility of the textile industries to treat and eliminate these hazardous pollutants. However, due to the growing population demand, the treatment of these hazardous effluents is ineffective and imposes the treatment cost over the end users. The release of partially treated effluents in the environment may cause a severe threat to the ecology and its biota. The critical objective is to treat textile effluents efficiently using agricultural natural fiber waste. Generation of agricultural lignocellulosic fibrous waste increases every year due to growing population demand. Its use in the modern world is limited due to synthetic products. An alternative has enumerated to avoid wastage of fibrous resources and its clean disposal.

OBJECTIVE

The main objective of this review paper discussed the feasibility of lignocellulosic fibers and other lignocellulosic materials as natural low-cost adsorbent.

METHODS

The literature study was performed using Web of Science and Scopus indexed journals. The main factors considered to increase the adsorption ability, including the types of lignocellulosic surface modification techniques were searched with utmost importance for quality results. Intending to summarize the literature survey and provide persuasive content, systematic review process was considered for this novel article.

RESULTS

Out of 230 valuable publications, 159 published articles were considered for the present study until March 2022. The articles surplus with factors affecting adsorption (pH, adsorption dosage, surface area, temperature, initial concentration, contact time, physical and chemical properties of pollutants) and surface modification techniques (physical, chemical, and biological) were considered for this manuscript.

CONCLUSION

Overall, the physical and chemical modification methods are widely used instead of biological methods due to various factors as discussed briefly. Furthermore, the finding of this article supports the fact that the fibrous by-product resources are wasted in various occasions due to the modern lifestyle. Even though there is evidential possibility to implement the low-cost adsorbents, the industries limit their application prospects due to existing technology and financial compromises.

Halocyclopentadienes: An Emerging Class of Toxic DBPs in Chlor(am)inated Drinking Water

Although >700 disinfection by-products (DBPs) have been identified to date, most DBPs in drinking water are still unknown. Identifying unknown DBPs is an important step for improving drinking water quality because known DBPs do not fully account for the adverse health effects noted in epidemiologic studies. Using gas chromatography high-resolution mass spectrometry, six chloro- and bromo-halocyclopentadienes (HCPDs) were identified in chlorinated and chloraminated drinking water via non-target analysis; five HCPDs are reported for the first time as new alicyclic DBPs. Formation pathways were also proposed. Simulated disinfection experiments with Suwannee River natural organic matter (NOM) confirm that NOM is a precursor for these new DBPs. Further, HCPDs are more abundant in chlorinated drinking water (real and simulated) when compared to chloraminated drinking water due to the higher reactivity of chlorine. Of these new DBPs, 1,2,3,4,5,5-hexachloro-1,3-cyclopentadiene is approximately 100,000× more toxic (in vivo) than regulated trihalomethanes (THMs) and haloacetic acids (HAAs) and 20-2000× more toxic than halobenzoquinones, halophenols, and halogenated pyridinols using the available median lethal dose (LD50) and concentration for 50% of maximal effective concentration (EC50) of DBPs to aquatic organisms. The predicted bioconcentration factors of these HCPDs range from 384 to 3980, which are 2-3 orders of magnitude higher than those for regulated and priority DBPs (including THMs, HAAs, halobenzoquinones, haloacetonitriles, haloacetamides, halonitromethanes, haloacetaldehydes, iodo-THMs, and iodo-HAAs). Thus, HCPDs are an important emerging class of DBPs that should be studied to better understand their impact on drinking water quality and long-term human health exposure.

How well does XAD resin extraction recover halogenated disinfection byproducts for comprehensive identification and toxicity testing?

Halogenated disinfection byproducts (DBPs) are an unintended consequence of drinking water disinfection, and can have significant toxicity. XAD resins are commonly used to extract and enrich trace levels of DBPs for comprehensive, nontarget identification of DBPs and also for in vitro toxicity studies. However, XAD resin recoveries for complete classes of halogenated DBPs have not been evaluated, particularly for low, environmentally relevant levels (ng/L to low µg/L). Thus, it is not known whether levels of DBPs or the toxicity of drinking water might be underestimated. In this study, DAX-8/XAD-2 layered resins were evaluated, considering both adsorption and elution from the resins, for extracting 66 DBPs from water. Results demonstrate that among the 7 classes of DBPs investigated, trihalomethanes (THMs), including iodo-THMs, were the most efficiently adsorbed, with recovery of most THMs ranging from 50%-96%, followed by halonitromethanes (40%-90%). The adsorption ability of XAD resins for haloacetonitriles, haloacetamides, and haloacetaldehydes was highly dependent on the individual species. The adsorption capacity of XAD resins for haloacetic acids was lower (5%-48%), even after adjusting to pH 1 before extraction. Recovery efficiency for most DBPs was comparable with their adsorption, as most were eluted effectively from XAD resins by ethyl acetate. DBP polarity and molecular weight were the two most important factors that determine their recovery. Recovery of trichloromethane, iodoacetic acid, chloro- and iodo-acetonitrile, and chloroacetamide were among the lowest, which could lead to underestimation of toxicity, particularly for iodoacetic acid and iodo-acetonitrile, which are highly toxic.

Feel the Burn: Disinfection Byproduct Formation and Cytotoxicity during Chlorine Burn Events

Nitrification and biofilm growth within distribution systems remain major issues for drinking water treatment plants utilizing chloramine disinfection. Many chloraminated plants periodically switch to chlorine disinfection for several weeks to mitigate these issues, known as "chlorine burns". The evaluation of disinfection byproduct (DBP) formation during chlorine burns beyond regulated DBPs is scarce. Here, we quantified an extensive suite of 80 regulated and emerging, unregulated DBPs from 10 DBP classes in drinking water from two U.S. drinking water plants during chlorine burn and chloramination treatments. Total organic halogen (TOX), including total organic chlorine, total organic bromine, and total organic iodine, was also quantified, and mammalian cell cytotoxicity of whole water mixtures was assessed in chlorine burn waters for the first time. TOX and most DBPs increased in concentration during chlorine burns, and one emerging DBP, trichloroacetaldehyde, reached 99 μg/L. THMs and HAAs reached concentrations of 249 and 271 μg/L, respectively. Two highly cytotoxic nitrogenous DBP classes, haloacetamides and haloacetonitriles, increased during chlorine burns, reaching up to 14.2 and 19.3 μg/L, respectively. Cytotoxicity did not always increase from chloramine treatment to chlorine burn, but a 100% increase in cytotoxicity was observed for one plant. These data highlight that consumer DBP exposure during chlorine burns can be substantial.

Potential risks and approaches to reduce the toxicity of disinfection by-product - A review

Water contamination through anthropogenic and industrial activities has led to the emergence and necessity of disinfection methods. Chlorine and bromine gases, often used to disinfect water, resulted in the by-product formation by reacting with organic matter. The Disinfectant by-products (DBP) led to the formation of Trihaloaceticacid (TAA), Trihalomethane (THM), and other minor components. The release of chemicals has also led to the outbreak of diseases like infertility, asthma, stillbirth, and types of cancer. There are new approaches that are found to be useful to compensate for the generation of toxic by-products and involve membrane technologies, namely reverse osmosis, ultrafiltration, and nanofiltration. This review mainly focuses on the toxicology effects of DBPs and various approaches to mitigate the same. The health hazards caused by different DBPs and the various treatment techniques available for the removal are discussed. In addition, a critical comparison of the different removal techniques was discussed.

Health Effect of N-Nitroso Diethylamine in Treated Water on Gut Microbiota Using a Simulated Human Intestinal Microbiota System

Chlorination disinfection byproducts (CDBPs) can exert adverse human health effects. Many toxicology-based studies confirmed the health hazards of CDBPs, but little research has been done on gut microbiome. We explored the effect of CDBPs on intestinal microbiota in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME). The results showed that CDBPs slightly inhibited the production of short-chain fatty acids, and the abundance of Actinobacteria decreased in the transverse colon and descending colon. The abundance of Proteobacteria increased in the ascending colon and descending colon, while it decreased in the transverse colon. The abundance of Firmicutes decreased in both the ascending colon and descending colon. In particular, the abundance of Lachnospiraceae members, Bilophila, Oscillospira, Parabacteroides, Desulfovibrio, and Roseburia increased in the ascending colon, while the abundance of Sutterella, Bacteroides, Escherichia, Phascolarctobacterium, Clostridium, Citrobacter, and Klebsiella increased in the descending colon. The Shannon index differed significantly in both the ascending colon and descending colon before and after exposure. Overall, we demonstrate the feasibility of applying the SHIME model to studying the effects of intestinal toxicity on health of chlorinated by-products. The findings of this study improve our understanding of the health impact of CDBPs on the intestinal microbiota and better control of CDBPs in treated water is recommended.

Total organic halogen in two drinking water supply systems: Occurrence, variations, and relationship with trihalomethanes

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 (r_s = 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.

Health effects of exposure to chlorination by-products in swimming pools

Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.

Are Disinfection Byproducts (DBPs) Formed in My Cup of Tea? Regulated, Priority, and Unknown DBPs

Globally, tea is the second most consumed nonalcoholic beverage next to drinking water and is an important pathway of disinfection byproduct (DBP) exposure. When boiled tap water is used to brew tea, residual chlorine can produce DBPs by the reaction of chlorine with tea compounds. In this study, 60 regulated and priority DBPs were measured in Twinings green tea, Earl Grey tea, and Lipton tea that was brewed using tap water or simulated tap water (nanopure water with chlorine). In many cases, measured DBP levels in tea were lower than in the tap water itself due to volatilization and sorption onto tea leaves. DBPs formed by the reaction of residual chlorine with tea precursors contributed ∼12% of total DBPs in real tap water brewed tea, with the remaining 88% introduced by the tap water itself. Of that 12%, dichloroacetic acid, trichloroacetic acid, and chloroform were the only contributing DBPs. Total organic halogen in tea nearly doubled relative to tap water, with 96% of the halogenated DBPs unknown. Much of this unknown total organic halogen (TOX) may be high-molecular-weight haloaromatic compounds, formed by the reaction of chlorine with polyphenols present in tea leaves. The identification of 15 haloaromatic DBPs using gas chromatography-high-resolution mass spectrometry indicates that this may be the case. Further studies on the identity and formation of these aromatic DBPs should be conducted since haloaromatic DBPs can have significant toxicity.

Associations of public water system trihalomethane exposure during pregnancy with spontaneous preterm birth and the cervicovaginal microbial-immune state

BACKGROUND

Water total trihalomethanes (TTHMs) are disinfectant byproducts found in municipal water supplies. TTHM exposure has been linked to cancer and may be associated with adverse reproductive outcomes. A non-optimal cervicovaginal microbiota and low cervicovaginal beta-defensin-2 levels are associated with increased risk of spontaneous preterm birth. Whether TTHM exposure increases the risk of spontaneous preterm birth or alters the cervicovaginal microbial or immune state is unknown.

OBJECTIVE

Investigate associations of water TTHM levels with spontaneous preterm birth, a non-optimal cervicovaginal microbiota, and beta-defensin-2 levels in a completed, diverse, urban pregnancy cohort. We hypothesized that higher TTHM levels would be associated with spontaneous preterm birth, a non-optimal cervicovaginal microbiota, and lower beta-defensin-2 levels.

DESIGN

Methods: This was a secondary analysis of participants (n = 474) in the Motherhood & Microbiome (M&M) study (n = 2000), who lived in Philadelphia and had cervicovaginal samples analyzed for cervicovaginal microbiota composition and beta-defensin-2 levels. The microbiota was classified into community state types (CSTs). CST IV (non-optimal microbiota) is characterized by a paucity of Lactobacillus species and wide array of anaerobes. Municipal water TTHM levels were obtained from 16 sites monthly across the city of Philadelphia to establish mean residential water supply levels for each participant for the first four months of pregnancy (prior to vaginal swab collection at 16-20 weeks' gestation). Associations of water TTHM levels with spontaneous preterm birth and a non-optimal cervicovaginal microbiota birth were analyzed using multivariable logistic regression. Multivariable linear regression was used to model associations of water TTHM levels with log-transformed cervicovaginal beta-defensin-2 levels. Since water TTHM levels vary by season and beta-defensin-2 levels have been shown to differ by race, stratified models by warm (April-September) and cold (October-March) seasons as well as by self-identified race were utilized.

RESULTS

Participants' water supply TTHM levels (mean μg/L [SD]) were higher in the warm (53.5 [9.4]) than cold (33.4 [7.5]) season (p < 0.0001). TTHM levels were non-significantly higher among Black participants than non-Black participants (44.8 [13.5] vs. 41.8 [11.8], p = 0.07). No associations were detected between TTHM with spontaneous preterm birth (per SD increment of TTHM, aOR 0.94, 95%CI: 0.66, 1.34) or with CST IV (aOR 0.94, 95%CI: 0.86, 1.16). Counter to our hypothesis, we observed positive associations of water TTHM with log-transformed cervicovaginal beta-defensin-2 levels in unadjusted models (β 0.20 [95%CI: 0.02, 0.39]) per SD increment of TTHM), but the association was null after adjustment for season. However, in models adjusted for covariates including season and stratified by race, TTHM was significantly associated with lower beta-defensin-2 levels among non-Black participants (β -0.75 [95%CI: -1.43, -0.08]) but not among Black participants (β 0.17 [95%CI: -0.15, 0.49]), interaction p = 0.013).

CONCLUSION

We did not detect associations of water TTHM levels with spontaneous preterm birth or the structure of the cervicovaginal microbiota. However, the finding of a significant interaction between TTHM and race on beta-defensin-2 levels suggest that environmental exposures may contribute to differences in reproductive tract innate immune function by race. Future studies to delineate environmental contributions to the cervicovaginal microbial-immune state, a potentially important biologic underpinning for preterm birth, are warranted.

Use of trihalomethanes as a surrogate for haloacetonitrile exposure introduces misclassification bias

Epidemiologists have used trihalomethanes (THMs) as a surrogate for overall disinfection byproduct (DBP) exposure based on the assumption that THM concentrations are proportional to concentrations of other DBP classes. Toxicological evidence indicates THMs are less potent toxins than unregulated classes like haloacetonitriles (HANs). If THMs are not proportional to the DBPs driving toxicity, the use of THMs to measure exposure may introduce non-trivial exposure misclassification bias in epidemiologic studies. This study developed statistical models to evaluate the covariance and proportionality of HAN and THM concentrations in a dataset featuring over 9500 measurements from 248 public water systems. THMs only explain ∼30% of the variance in HANs, whether the data is pooled in a classic linear regression or hierarchically grouped by water system in a multilevel linear regression. The 95% prediction interval on HANs for the median THM concentration exceeds the interquartile range of HANs. Mean HAN:THM ratios range from ∼2.4% to ∼80% across water systems, and varied with source water category, season, disinfectant sequence and distribution system location. The HAN:THM ratio was 265% higher in groundwater systems than in surface water systems and declined by ∼40% between finished effluent and maximum residence times in surface water systems with chlorine-chlorine disinfection. A maximum likelihood approach was used to estimate the misclassification bias that may result from using THMs to construct risk-ratios, assuming that HANs represent the "true" DBP exposure risk. The results indicate an odds ratio of ∼2 estimated with THM concentrations could correspond to a true odds ratio of 4-5. These findings demonstrate the need for epidemiologic studies to evaluate exposure by measuring DBPs that are likely to drive toxicity.

Meta-analysis of small for gestational age births and disinfection byproduct exposures

BACKGROUND

Some epidemiological studies show associations between disinfection byproducts (DBPs) and adverse developmental outcomes.

OBJECTIVES

We undertook a meta-analysis of epidemiological studies on maternal exposure to trihalomethanes (THMs) and haloacetic acids (HAAs) and risk of small for gestational age (SGA) birth.

METHODS

We identified forty-five publications including two reports and five theses via a 2020 literature search. Nineteen study populations from 16 publications met the inclusion criteria and were systematically evaluated. Effect measures were pooled using random effects meta-analytic methods along with cumulative, sub-group and meta-regression analyses to examine between-study heterogeneity and variation in risk across different DBP measures.

RESULTS

We detected a small increased risk for SGA with exposure to the sum of four (i.e., THM4) THM4 (odds ratio (OR) = 1.07; 95%CI: 1.03, 1.11), chloroform (OR = 1.05; 95%CI: 1.01, 1.08), bromodichloromethane (OR = 1.08; 95%CI: 1.05, 1.11) and the sum of the brominated THM4 (OR = 1.05; 95%CI: 1.02, 1.09). Larger ORs were detected for the sum of five haloacetic acids (i.e., HAA5) (OR = 1.12; 95%CI: 1.01, 1.25), dichloroacetic acid (OR = 1.25; 95%CI: 1.01, 1.41) and trichloroacetic acid (OR = 1.21; 95%CI: 1.07, 1.37). We detected larger SGA risks for several THM4 among the prospective cohort and case-control studies compared to retrospective cohorts and for the SGA3/5% (vs. SGA10%) studies. The THM4 meta-regression showed associations between SGA and the total quality score based on categorical or continuous measures. For example, an OR of 1.03 (95%CI: 1.01, 1.06) was detected for each 10-point increase in the study quality score based on our systematic review.

CONCLUSIONS

We detected a small increased risk of SGA based on 18 THM4 study populations that was comparable to a previous meta-analysis of eight THM4 study populations. We also found increased risks for other THM4 and HAA measures not previously examined; these results were robust after accounting for outliers, publication bias, type of SGA classification, different exposure windows, and other factors.

Reduction of bromate by zero valent iron (ZVI) enhances formation of brominated disinfection by-products during chlorination

Bromate (BrO₃^-) is a predominant undesired toxic disinfection by-product (DBP) during ozonation of bromide-containing waters. The reduction of BrO₃^- by zero valent iron (ZVI) and its effect on formation of organic halogenated DBPs during chlorination were investigated in this study. The presence of ZVI could reduce BrO₃^- to bromide (Br^-), and Br^- formed could be transformed to free bromine (HOBr/OBr^-) during chlorination, further leading to organic brominated (Br-) DBPs formation. Formation of DBPs during chlorination, including trihalomethanes (THMs) and haloacetonitriles (HANs) was detected under different conditions. The results showed that when ZVI dosage increased from 0 to 1 g L^-1, the formation of Br-DBPs (e.g., TBM and DBCM) was significantly improved, while the formation of Cl-DBPs (e.g., TCM, TCAN and DCAN) reduced. Higher ZVI dosage exhibited inhibitory effect on Br-DBPs formation due to the competition between ZVI and free chlorine (HOCl/OCl^-). The bromine substitution factor (BSF) of THMs significantly decreased from 0.61 ± 0.06 to 0.22 ± 0.02, as the pH was raised from 5.0 to 9.0. Besides, the increase of initial BrO₃^- concentration significantly improved the formation of Br-DBPs and decreased the formation of Cl-DBPs, leading to an obvious rise on the BSF of THMs. As the initial concentration of HOCl increased, all THMs and HANs gradually increased. Moreover, the analysis based on the cytotoxicity index (CTI) of the determined DBPs showed that reduction of BrO₃^- by ZVI during chlorination had certain risks in real water sources, which should be paid attention to in the application.

Photocatalytic Oxidation of Natural Organic Matter in Water

Increased concentrations of natural organic matter (NOM), a complex mixture of organic substances found in most surface waters, have recently emerged as a substantial environmental issue. NOM has a significant variety of molecular and chemical properties, which in combination with its varying concentrations both geographically and seasonally, introduce the opportunity for an array of interactions with the environment. Due to an observable increase in amounts of NOM in water treatment supply sources, an improved effort to remove naturally-occurring organics from drinking water supplies, as well as from municipal wastewater effluents, is required to continue the development of highly efficient and versatile water treatment technologies. Photocatalysis has received increasing interest from around the world, especially during the last decade, as several investigated processes have been regularly reported to be amongst the best performing water treatment technologies to remove NOM from drinking water supplies and mitigate the formation of disinfection by products. Consequently, this overview highlights recent research and developments on the application of photocatalysis to degrade NOM by means of TiO2-based heterogeneous and homogeneous photocatalysts. Analytical techniques to quantify NOM in water and hybrid photocatalytic processes are also reviewed and discussed.

Differential Cytotoxicity of Haloaromatic Disinfection Byproducts and Lead Co-exposures against Human Intestinal and Neuronal Cells

Disinfecting drinking water with chlorine inadvertently generates disinfection byproducts (DBPs) which can cause potential adverse health effects to humans. Haloaromatic DBPs are a group of emerging DBPs recently identified, suspected to be substantially more toxic than haloaliphatic DBPs but have not been extensively studied. Simultaneously, service pipelines made of lead materials are widely used in water distribution systems and become a source of dissolved lead (Pb) in tap water. In this study, we investigated the cytotoxicity of nine haloaromatic DBPs and lead ion (Pb²⁺), both separately as well as in combination, to human epithelial colorectal adenocarcinoma (Caco-2) and neuroblastoma (SH-SY5Y) cells. Results show that the cytotoxicity of the DBPs against Caco-2 cells followed the descending rank order of 2,4,6-triiodophenol ≅ 2,5-dibromohydroquinone > 2,4,6-tribromophenol > 3,5-dibromo-4-hydroxybenzaldehyde ≅ 2,4,6-trichlorophenol > 4-chlorophenol ≅ 3,5-dibromo-4-hydroxybenzoic acid > 2,6-dichlorophenol >5-chlorosalicylic acid, and the cytotoxicity of the DBPs against SH-SY5Y cells followed a similar rank order, 2,4,6-triiodophenol ≅ 2,5-dibromohydroquinone > 2,4,6-tribromophenol > 3,5-dibromo-4-hydroxybenzaldehyde ≅ 2,4,6-trichlorophenol > 4-chlorophenol > 3,5-dibromo-4-hydroxybenzoic acid > 2,6-dichlorophenol ≅ 5-chlorosalicylic acid. Lead in water did not change the toxicity of 3,5-dibromo-4-hydroxybenzoic acid (to either cell-type) or the toxicity of 4-chlorophenol (to the neuronal cell-type); but Pb²⁺ exhibited different degrees of synergistic effects with other tested DBPs. The synergism resulted in different rank orders of cytotoxicity against both intestinal and neuronal cells. These data indicate that future prioritization and regulation of emerging haloaromatic DBPs in drinking water should be considered in terms of their own toxicity and combinatorial effects with lead in water.

Characteristics of low and high SUVA precursors: Relationships among molecular weight, fluorescence, and chemical composition with DBP formation

Disinfection by-products (DBPs) formed upon water treatment is an emerging issue worldwide. While monitoring of DBP precursors can easily be achieved for high specific UV absorbance (SUVA) organic (>6 L/mg·m), low and extremely low SUVA precursors (<2 L/mg·m) are difficult to monitor or even to predict their DBP formation behaviour. This study investigated the relationships among NOM characteristics, such as molecular weight (MW), fluorescence, and chemical composition, with DBP formation resulting from the chlorination of relatively high and low SUVA precursors. High SUVA precursors were formed by C-rich substances (82-85% of total mass) corresponding with high C/N and C/O (>100 and >5, respectively). Such precursors exhibited the fluorescence of long-wavelength humic-like signal and occurred at a high MW range (>30 kDa). By contrast, low SUVA precursors were either N-rich and/or O-rich substances, associated with much lower carbon content (40-70%). Low SUVA, N-rich precursors particularly also occurred at a high MW region (>100 kDa) and produced a strong protein-like fluorescence signal. When SUVA values of O-rich precursors were extremely low (<1 L/mg·m) they were accompanyied by short-wavelength humic-like fluorescence. During DBP tests, high SUVA produced only high yields of carbonaceous DBPs (e.g trichloromethane, haloacetic acids, haloketones), whereas low SUVA N-rich precursors yielded high levels of both C and NDBPs (e.g. haloacetonenitrile, chloropicrin). By contrast, extremely low SUVA precursors produced significantly low levels of both C and NDBPs (total < 30 μg/mgC). Furthermore, 19 of 20 regression models of DBP formation using log-transformed MW gave R² = 0.50-0.97. The strong regressions and correlations of NOM characteristics with DBPs in this study provide a better understanding of the influence of precursors characteristics on DBP monitoring, especially for low SUVA NOM.

A review on the 40th anniversary of the first regulation of drinking water disinfection by-products

Water disinfection, primarily by chlorination, is one of the greatest achievements of public health. However, more than half a century after its introduction, studies in the 1970s reported that (a) chlorine interacted with organic matter in the water to form disinfection by-products (DBPs); (b) two DBPs, chloroform and bromoform, both trihalomethanes (THMs), were rodent carcinogens; (c) three brominated THMs were mutagenic; in six studies chlorinated drinking waters in the United States and Canada were mutagenic; and (d) in one epidemiological study there was an association between bladder cancer mortality and THM exposure. This led the U.S. Environmental Protection Agency to issue its first DBP regulation in 1979. Forty years later, >600 DBPs have been characterized, 20/22 have been shown to be rodent carcinogens, >100 have been shown to be genotoxic, and 1000s of water samples have been found to be mutagenic. Data support a hypothesis that long-term dermal/inhalation exposure to certain levels of the three brominated THMs, as well as oral exposure to the haloacetic acids, combined with a specific genotype may increase the risk for bladder cancer for a small but significant population group. Improved water-treatment methods and stricter regulations have likely reduced such risks over the years, and further reductions in potential risk are anticipated with the application of advanced water-treatment methods and wider application of drinking water regulations. This 40-year research effort is a remarkable example of sustained cooperation between academic and government scientists, along with public/private water companies, to find answers to a pressing public health question.

Exposure to Drinking Water Chlorination by-Products and Fetal Growth and Prematurity: A Nationwide Register-Based Prospective Study

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.

Melatonin supplementation revives diabetic induced biochemical, histological and hematological impairments in rats

Diabetes is very common all over the world, but still not curable and controlled; it causes alteration in all over body. It needs serious concern for the scientific community to find out some control measures. The current work was planned to explore the possible defensive effect of melatonin against the diabetes induced changes in whole blood profile. For this study albino rats were treated with streptozotocin [(STZ) (15 mg/kg for 6 days)] to induce diabetes. Induction was confirmed by blood glucose and serum sugar assessment. Total 36 rats were randomly selected for the experimental purpose and were divided into two major groups. Major group-1 consisting eighteen (18) and were further sub-divided into three (3) different groups viz. group-I served as normal control, group-II served as melatonin treated, group-III served as glibenclamide treated. Major group-2 consisting eighteen (18) rats were given streptozotocin (STZ) injection (15 mg/kg) for 6 days. After confirmation of diabetes by measuring blood glucose level, animals having blood glucose level above 250 mg/dl) confirmed as diabetic. Eighteen (18) Diabetic rats were three subdivided into following sub-groups and were given different therapeutic treatments, Viz group-IV served as Diabetic control, group-V treated with melatonin, group-VI treated with glibenclamide, respectively. Diabetic rats demonstrated inflection in all hematological variables. Diabetic animals revealed considerable reduction in RBCs count, HB content and its associated indices (HCT, RDW, MCV, MCH and MCHC). Decrease in WBCs and its related indices (polymorphs and lymphocytes). Platelet count showed significant increase, but platelet distribution width (PDW %) was found decreased. However administration of melatonin restored all the alterations in hematological parameters. Therefore, it can be concluded that melatonin will be better therapeutic molecule to revive hematological alterations during diabetes.

Different cytotoxicity of disinfection by-product haloacetamides on two exposure pathway-related cell lines: Human gastric epithelial cell line GES-1 and immortalized human keratinocyte cell line HaCaT

Humans are exposed to disinfection by-products (DBPs) mainly through drinking water ingestion and dermal contact. As an emerging class of nitrogenous DBPs (N-DBPs), haloacetamides (HAcAms) have been found to have significantly higher cytotoxicity than regulated DBPs. In this study, we investigated the cytotoxicity of HAcAms on two exposure pathway-related cell lines: human gastric epithelial GES-1 cells and immortalized keratinocytes HaCaT. Our results showed that the ranking order of cytotoxicity of 13 HAcAms was different between HaCaT and GES-1 cells. In addition, the 50% inhibitive concentration in HaCaT was 1.01-3.29 times that in GES-1. Further comparison among GES-1, HaCaT and CHO cell lines confirmed that different cell lines exhibited different sensitivity to the same compound. Importantly, HAcAms showed 5.83-7.13 × 10⁴ times higher toxicity than the well-clarified DBP chloroform, clearly demonstrating the increased toxicity of HAcAms. Finally, using a novel high-content screening (HCS) analysis, we found that 39.29% of chlorinated HAcAms, 42.86% of brominated HAcAms and 16.07% of iodinated HAcAms significantly affected at least one of the cell-health parameters, such as nuclear size, membrane permeability, mitochondrial membrane potential, or cytochrome c release, in GES-1 or HaCaT cells. Thus, brominated HAcAms appear to have stronger effects under the sublethal exposure dose, possibly causing cytotoxicity via apoptosis. Together, our study provides new insights to the toxicity of HAcAms and a comprehensive toxicology dataset for health risk assessment.

Urinary Biomarker of Prenatal Exposure to Disinfection Byproducts, Maternal Genetic Polymorphisms in CYP2E1 and GSTZ1, and Birth Outcomes

The effects of disinfection byproducts (DBPs) on adverse birth outcomes remain unsettled. Maternal genetic variants in relation to DBP metabolism may modify this effect. Pregnant women during late pregnancy (n = 1306) were included from a Chinese cohort. Maternal urinary trichloroacetic acid (TCAA) was measured as a biomarker of DBP exposure. Maternal genotyping was conducted in cytochrome P450 2E1 (CYP2E1; rs2031920, rs3813867, and rs915906) and glutathione S-transferase zeta-1 (GSTZ1; rs7975). The associations between maternal urinary TCAA and birth outcomes and statistical interactions between maternal exposure and genetic polymorphisms were estimated. We found that maternal urinary TCAA levels were associated with decreased birth weight (P for trend = 0.003) and ponderal index (P for trend = 0.004). Interaction analyses showed that maternal urinary TCAA in association with decreased birth weight was observed only among subjects with CYP2E1 rs3813867 GC/CC versus GG (P_int = 0.07) and associations with decreased birth length, ponderal index, and gestational age were observed only among subjects with GSTZ1 rs7975 GA/AA versus GG (P_int = 0.07, 0.02, and 0.02, respectively). Our results suggested that prenatal DBP exposure was negatively associated with birth weight and ponderal index, and maternal genetic polymorphisms in CYP2E1 and GSTZ1 might modify these associations.

Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects

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.

Water depollution using metal-organic frameworks-catalyzed advanced oxidation processes: A review

This paper presents a review on the environmental applications of metal-organic frameworks (MOFs), which are inorganic-organic hybrid highly porous crystalline materials, prepared from metal ion/clusters and multidentate organic ligands. The emphases are made on the enhancement of the performance of advanced oxidation processes (AOPs) (photocatalysis, Fenton reaction methods, and sulfate radical (SO₄^-)-mediated oxidations) using MOFs materials. MOFs act as adsorption and light absorbers, leading to superior performance of photocatalytic processes. More recent examples of photocatalytic degradation of dyes are presented. Additionally, it is commonly shown that Fe-based MOFs exhibited excellent catalytic performance on the Fenton-based and SO₄^•--mediated oxidations of organic pollutants (e.g., dyes, phenol and pharmaceuticals). The significantly enhanced generation of reactive species such as OH and/or SO₄^- by both homogeneous and heterogeneous catalysis was proposed as the possible mechanism for water depollution. Based on the existing literature, the challenge and future perspectives in MOF-based AOPs are addressed.

Profiles, variability and predictors of concentrations of blood trihalomethanes and urinary haloacetic acids along pregnancy among 1760 Chinese women

Blood trihalomethanes (THMs) and urinary haloacetic acids (HAAs) are the leading candidate biomarkers for disinfection byproduct (DBP) exposure. However, no studies have assessed the exposure profiles, temporal variability, and potential predictors of these biomarkers during pregnancy. Here we collected blood (n = 4304) and urine samples (n = 4165) from 1760 Chinese pregnant women during early, mid-, and late pregnancy, which were separately analyzed for 4 THMs and 2 HAAs. We calculated the intraclass correlation coefficients (ICCs) to assess the variability of these biomarkers and estimated their correlations with sociodemographic, water-use behavioral, dietary and sample collection factors using mixed models. The median concentrations of TCM, BDCM, Br-THMs [sum of BDCM, dibromochloromethane (DBCM), bromoform (TBM)], total THMs (TTHMs, sum of TCM and Br-THMs), DCAA and TCAA in the water distribution system were 4.2 μg/L, 1.7 μg/L, 2.9 μg/L, 7.1 μg/L, 3.4 μg/L and 8.2 μg/L, respectively. Chloroform (TCM), bromodichloromethane (BDCM), dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) were detected in > 75% of the biospecimens. Repeated measurements of blood TCM, BDCM, Br-THMs and TTHMs and urinary DCAA and TCAA uniformly exhibited high variability (ICCs = 0.01-0.13); the use of a single measurement to classify gestational average exposure resulted in a high degree of exposure misclassification. The sampling season was a strong predictor of all analyzed DBPs. Additionally, we detected a positive association of blood TCM and BDCM with household income, urinary DCAA with age, and urinary TCAA with tap water usage, education level and amount of tap water consumed. Inverse associations were found between blood BDCM and vegetable consumption, and between blood Br-THM and TTHM and time interval since the last bathing/showering. Afternoon samples had lower DCAA concentrations than did early morning samples. Our results indicate that blood THM and urinary HAA concentrations vary greatly over the course of pregnancy and are affected by sampling season, time of day of blood/urine collection, sociodemographic factors, recent water-use activities and dietary intake.

Formation, Identification, and Occurrence of New Bromo- and Mixed Halo-Tyrosyl Dipeptides in Chloraminated Water

Dipeptides are widely present in surface water and serve as precursors to form disinfection byproducts (DBPs) during disinfection (e.g., chloramination). Bromide (Br^-) and iodide (I^-) are common in many source waters, enhancing Br- and I-DBP formation. Recently Cl-, I-, and Cl-I-dipeptides were identified after chloramination of tyrosyl dipeptides in the presence of I^- and were detected in authentic disinfected drinking water samples. However, the formation and occurrence of Br- and mixed halogen (Cl, Br, and/or I)-dipeptides in disinfected water have not been studied. Here we investigated the formation of halogenated dipeptides from three aromatic dipeptides, phenylalanylglycine (Phe-Gly), tyrosylalanine (Tyr-Ala), and tyrosylglycine (Tyr-Gly), under chloramination in the presence of Br^- and I^- at environmentally relevant levels ([Br^-] and [I^-], 0 and 0 μg L^-1, 6 and 30 μg L^-1, 30 and 30 μg L^-1, 150 and 30 μg L^-1, 300 and 30 μg L^-1, and 900 and 30 μg L^-1, respectively). For the first time, N-Br- and N,N-di-Br- as well as N-Br- N-Cl- and N-Br-3-I-tyrosyl dipeptides were identified using infusion electrospray quadrupole time-of-flight mass spectrometry. Tyrosyl dipeptides produced N-Cl-, 3-I-/3,5-di-I-, and N-Cl-3-I-tyrosyl dipeptides, while Phe-Gly formed only N-Cl-/ N, N-di-Cl-Phe-Gly. To determine halogenated dipeptides in authentic water samples, we developed a new method of solid phase extraction and high-performance liquid chromatography with quadrupole ion trap mass spectrometry using reaction monitoring. 3,5-Di-I-Tyr-Ala and N-Br-Tyr-Ala were detected in treated water but not in the corresponding raw water, warranting further investigation into the occurrence of halogenated peptides in other drinking water systems.

Characterization of Disinfection By-Products Levels at an Emergency Surface Water Treatment Plant in a Refugee Settlement in Northern Uganda

The reliance on chlorination in humanitarian operations has raised concerns among practitioners about possible health risks associated with disinfection by-products; however, to date, there has not been an evaluation of disinfection by-product (DBP) levels in an emergency water supply intervention. This study aimed to investigate DBP levels at a surface-water treatment plant serving a refugee settlement in northern Uganda using the colorimetric Hach THM Plus Method. The plant had two treatment processes: (1) Simultaneous clarification–chlorination (“rapid treatment”); and (2) pre-clarification and chlorination in separate tanks (“standard treatment”). For both standard (n = 17) and rapid (n = 3) treatment processes, DBP levels in unique parcels of water were tested at 30 min post-chlorination and after 24 h of storage (to simulate what refugees actually consume). DBP levels after 24 h did not exceed the World Health Organization (WHO) guideline limit of 300 ppb equivalent chloroform, either for standard treatment (mean: 85.1 ppb; 95% confidence interval (C.I.): 71.0–99.1 ppb; maximum: 133.7 ppb) or for rapid treatment (mean: 218.0 ppb; 95% C.I.: 151.2–284.8; maximum: 249.0 ppb). Observed DBPs levels do not appear to be problematic with respect to the general population, but may pose sub-chronic exposure risks to specifically vulnerable populations that warrant further investigation.

Environmental Contaminants Exposure and Preterm Birth: A Systematic Review

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.