Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy

Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ec...

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Bibliographic Details
Published in:Journal of water and health 2004-12, Vol.2 (4), p.233-247
Main Authors: Aggazzotti, Gabriella, Righi, Elena, Fantuzzi, Guglielmina, Biasotti, Barbara, Ravera, Gianbattista, Kanitz, Stefano, Barbone, Fabio, Sansebastiano, Giuliano, Battaglia, Mario Alberto, Leoni, Valerio, Fabiani, Leila, Triassi, Maria, Sciacca, Salvatore
Format: Article
Language:English
Subjects:
Adult
By-products
Byproducts
Case-Control Studies
Chlorate
Chlorates
Chlorination
Chlorine
Chlorine Compounds - poisoning
Chlorine dioxide
Chlorite
Chlorites
Dose-Response Relationship, Drug
Drinking water
Ecological monitoring
Environmental Exposure
Epidemiology
Exposure
Female
Gestational age
Habits
Health risk assessment
Humans
Infant, Low Birth Weight
Infant, Newborn
Inhalation
Inhalation Exposure
Italy - epidemiology
Male
Odds Ratio
Pregnancy
Pregnancy Outcome
Premature Birth - epidemiology
Premature Birth - etiology
Ratios
Respiration
Risk Assessment
Towns
Trihalomethanes
Trihalomethanes - poisoning
Water analysis
Water Purification
Water sampling
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Summary:Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th-37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers' personal habits during pregnancy and by water sampling directly at mothers' homes. Levels of trihalomethanes (THMs) were low (median: 1.10 microg l(-1)), while chlorite and chlorate concentrations were relatively high (median: 216.5 microg l(-1) for chlorites and 76.5 microg l(-1) for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels > or =200 microg l(-1) combined with low and high levels of inhalation exposure are considered, suggested a dose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91-2.54 and 1.70, 95%CI: 0.97-3.0, respectively). A weak association with high exposure levels of either THMs (> or =30 microg l(-1)), or chlorite or chlorate (> or =200 microg l(-1)) was also found (adjusted-OR: 1.38, 95%CI: 0.92-2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.
ISSN:1477-8920
1996-7829
DOI:10.2166/wh.2004.0021