Exposure to Trihalomethanes and Adverse Pregnancy Outcomes

Gallagher, M. J.; Nuckols, John R.; Stallones, Lorann; Savitz, D. A.

doi:10.1097/00001648-199809000-00003

Cited by 196 publications

(119 citation statements)

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“…Study results on (term) low birth weight (LBW) have been mixed, with some studies reporting statistically significant associations (Bove et al 1995;Gallagher et al 1998;Källen & Robert 2000;Lewis et al 2006) and others not (Kramer et al 1992;Savitz et al 1995;Kanitz et al 1996;Dodds et al 1999;Yang et al 2000aYang et al , 2007Jaakkola et al 2001;Wright et al 2003;Yang 2004;Toledano et al 2005). Hinckley et al (2005) found no association with THMs, but did for some specific HAAs.…”

Section: (B) Reproductive Outcomesmentioning

confidence: 99%

The epidemiology and possible mechanisms of disinfection by-products in drinking water

Nieuwenhuijsen

Grellier

Smith

et al. 2009

Phil. Trans. R. Soc. A.

127

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This paper summarizes the epidemiological evidence for adverse health effects associated with disinfection by-products (DBPs) in drinking water and describes the potential mechanism of action.There appears to be good epidemiological evidence for a relationship between exposure to DBPs, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers including colorectal cancer is inconclusive and inconsistent. There appears to be some evidence for an association between exposure to DBPs, specifically THMs, and little for gestational age/intrauterine growth retardation and, to a lesser extent, pre-term delivery, but evidence for relationships with other outcomes such as low birth weight, stillbirth, congenital anomalies and semen quality is inconclusive and inconsistent. Major limitations in exposure assessment, small sample sizes and potential biases may account for the inconclusive and inconsistent results in epidemiological studies. Moreover, most studies have focused on total THMs as the exposure metric, whereas other DBPs appear to be more toxic than the THMs, albeit generally occurring at lower levels in the water.The mechanisms through which DBPs may cause adverse health effects including cancer and adverse reproductive effects have not been well investigated. Several mechanisms have been suggested, including genotoxicity, oxidative stress, disruption of folate metabolism, disruption of the synthesis and/or secretion of placental syncytiotrophoblast-derived chorionic gonadotropin and lowering of testosterone levels, but further work is required in this area.

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Section: (B) Reproductive Outcomesmentioning

confidence: 99%

The epidemiology and possible mechanisms of disinfection by-products in drinking water

Nieuwenhuijsen

Grellier

Smith

et al. 2009

Phil. Trans. R. Soc. A.

127

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“…A common approach has used information on birth certificates to identify maternal residence and exposure to some potential confounders ( Bove et al, 1995;Gallagher et al, 1998;Dodds et al, 1999 ). Exposure assessment has typically been based on the concentration of total trihalomethanes in the study subject's municipal water source.…”

Section: Introductionmentioning

confidence: 99%

Exposure to tap water during pregnancy

Zender

Bachand

Reif

2001

J Expo Sci Environ Epidemiol

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Studies of disinfection byproducts ( DBPs ) in drinking water and risk of adverse reproductive outcome have usually relied on approximate measures of exposure. Individual differences in consumption of bottled or filtered water, variability in tap water consumption at home and at work, dermal and inhalation exposure to volatile contaminants, and changes in residency during pregnancy may lead to exposure misclassification. We characterized exposures to tap water and other risk factors among 71 pregnant and 43 non -pregnant women attending public health clinics. Nearly all residences had a municipal water source, but 25% of women drank filtered or bottled water. Fifty percent of the women in our sample reported working outside the home where, on average, one third of their daily water intake took place. Pregnant women consumed more water than non -pregnant women ( 3.4 vs. 3.0 total l / day ) , especially cold tap water at home ( 1.8 vs. 1.3 l / day, 95% CI for the difference = 0.1, 0.9 ) . Patterns of showering were similar for both groups of women, but pregnant women were more likely to bathe and to bathe more frequently. The prevalence of smoking was lower among pregnant women ( 22.5% vs. 32.6% ) , as was the consumption of alcohol ( 4.2% vs. 53.5%, 95% CI for the difference = À 64.9, À 33.7 ) . Thirty -two percent of women had moved during their current pregnancy. The data reaffirm the importance of collecting individual -level data for water consumption and exposure to potential confounders to avoid misclassification bias. This study is the first to target women of low socio -economic status ( SES ) and therefore of particular interest in studies of adverse reproductive outcomes for which this group is at increased risk.

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“…Although toxicology experiments with individual DPBs are necessary to establish plausible mechanisms of toxic action, epidemiologic studies of human populations are necessary to establish whether actual DPB exposures from drinking water pose a human health risk. Such studies have historically been focused on cancer outcomes, but more recently a number of studies have addressed the possibility of adverse reproductive outcomes (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

mentioning

confidence: 99%

Trichloroacetic acid as a biomarker of exposure to disinfection by-products in drinking water: a human exposure trial in Adelaide, Australia.

Froese

Sinclair

Hrudey

2002

Environ Health Perspect

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The question of whether disinfection byproducts (DPBs) in drinking water pose any health risk to humans has been an ongoing issue since the discovery of DPBs in 1974. Although toxicology experiments with individual DPBs are necessary to establish plausible mechanisms of toxic action, epidemiologic studies of human populations are necessary to establish whether actual DPB exposures from drinking water pose a human health risk. Such studies have historically been focused on cancer outcomes, but more recently a number of studies have addressed the possibility of adverse reproductive outcomes (1-12).The ability of epidemiologic studies to address these health questions has been seriously limited by inadequate individual assessment of exposure to DPBs (13,14). A major prospect for improved exposure assessment for epidemiologic studies of adverse reproductive outcomes is to validate a biomarker of exposure to DPBs. Desirable characteristics of potential biomarkers of DPB exposure have been discussed by Froese et al. (15).To date, the only DPBs evaluated for use as biomarkers of exposure have been the trihalomethanes (THMs) and the haloacetic acids (HAAs). Weisel et al. (16) found that most background breath samples from a cohort of women who had participated in the Klotz and Pyrch (8) study were nondetectable for THMs in exhaled breath. Measurable levels of THMs were obtained in post-shower breath samples, and these breath values correlated with water levels of THMs. However, breath levels of THMs as a biomarker of exposure to DPBs do not persist for sufficient time to integrate exposure measurement over more than minutes to hours, at most. Likewise, measurable THM exposures are limited to inhalation and dermal exposure from showering or bathing. THM levels in breath will not reflect ingestion exposure because of rapid first-pass metabolism of ingested THMs in the liver. THMs in blood were demonstrated to be feasible for evaluating background THM exposure (17), but blood sampling is an invasive procedure.The potential of two HAAs, dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA), as DPB biomarkers in urine was examined with a cross-sectional study of a cohort of 49 women, who provided 42 valid samples (16,18). That study found that DCAA was rapidly metabolized and that urine levels showed no difference between low-exposure and high-exposure groups. However, TCAA did show higher excretion levels for higher-TCAA-exposure versus lower-TCAAexposure groups. TCAA excretion in urine did not correlate significantly with measured water concentrations of TCAA. A more detailed TCAA exposure calculation was done by accounting for the volume of water consumed, the proportion of heated water used (estimating a 39% reduction in TCAA from boiling), and the use of home water filters (estimating a 70% reduction for any filter type). With these adjustments, a significant correlation (R of 0.73, n = 42) was found between estimated TCAA ingestion (estimated as micrograms of TCAA consumed in the previous 48 hr) and measured TCAA...

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Exposure to Trihalomethanes and Adverse Pregnancy Outcomes

Cited by 196 publications

References 0 publications

The epidemiology and possible mechanisms of disinfection by-products in drinking water

The epidemiology and possible mechanisms of disinfection by-products in drinking water

Exposure to tap water during pregnancy

Trichloroacetic acid as a biomarker of exposure to disinfection by-products in drinking water: a human exposure trial in Adelaide, Australia.

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