Environmental and Urinary Markers of Prenatal Exposure to Drinking Water Disinfection By-Products, Fetal Growth, and Duration of Gestation in the PELAGIE Birth Cohort (Brittany, France, 2002–2006)

Abstract

Although prenatal exposure to water disinfection by-products does not appear to affect the duration of gestation, its impact on fetal growth remains an open question. The authors studied the associations between prenatal exposure to disinfection by-products and fetal growth restriction (FGR) and preterm birth in the PELAGIE cohort, a French birth cohort comprising 3,421 pregnant women recruited between 2002 and 2006. Exposure was assessed by estimating levels of trihalomethanes (THMs) in tap water during pregnancy and maternal water use and by measuring maternal urinary levels of trichloroacetic acid (TCAA) during early pregnancy in a nested case-control design that compared 174 FGR cases, 114 preterm births, and 399 controls. Higher uptake of THMs (especially brominated THMs) was associated with a higher risk of FGR. Women with TCAA detected in their urine (>0.01 mg/L) had a higher risk of FGR than those with TCAA levels below the detection limit (adjusted odds ratio = 1.8, 95% confidence interval: 0.9, 3.7) and had an odds ratio for preterm birth below 1 (adjusted odds ratio = 0.8, 95% confidence interval: 0.3, 2.6). Results from this prospective study, the first to use a biomarker of disinfection by-product exposure, suggest that prenatal exposure affects fetal growth, but the causal agent or agents remain to be identified.

Occurrence and Toxicity of Disinfection Byproducts in European Drinking Waters in Relation with the HIWATE Epidemiology Study

“…It should be noted, however, that the drinking water samples for the epidemiologic analyses and the current analytical chemical and toxicological evaluations were not collected at the same time. Existing epidemiological studies on birth outcomes including those in the HIWATE project, have evaluated a limited number of DBPs (usually only THMs) through environmental analyses of drinking water or, in the case of the French study [52] through an evaluation of biomarkers of haloacetic acid metabolites in urine. The analyses of water toxicity presented in this paper were limited in number due to their complexity, but they provide an overall evaluation of differences of toxicity in different geographic areas.…”

Association of Brominated Trihalomethane and Haloacetic Acid Exposure With Fetal Growth and Preterm Delivery in Massachusetts

“…27,30,48 Nonetheless, given the potential number of DBPs present in drinking water, the delineation of which surrogate DBP mixture to target remains elusive. More studies are needed to address this surrogacy issue by quantifying associations between individual DBPs or specific DBP mixtures (eg, DBP9 or a TOX exposure metric not attributable to THMs and HAAs as reported by Horton et al 9 ).…”

Prenatal pesticide exposure and otitis media during early childhood in the PELAGIE mother–child cohort

“…This study has been previously described 13 21. Briefly, 3421 women were recruited from April 2002 through February 2006 in the Brittany region (France) during a routine prenatal visit before they had completed their 19th week of gestation.…”