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Abstract
Previous research has suggested that exposure to elevated levels of drinking water disinfection by-products (DBPs) may cause pregnancy loss. In 2000-2004, the authors conducted a study in three US locations of varying DBP levels and evaluated 2,409 women in early pregnancy to assess their tap water DBP concentrations, water use, other risk factors, and pregnancy outcome. Tap water concentrations were measured in the distribution system weekly or biweekly. The authors considered DBP concentration and ingested amount and, for trihalomethanes only, bathing/showering and integrated exposure that included ingestion. On the basis of 258 pregnancy losses, they did not find an increased risk of pregnancy loss in relation to trihalomethane, haloacetic acid, or total organic halide concentrations; ingested amounts; or total exposure. In contrast to a previous study, pregnancy loss was not associated with high personal trihalomethane exposure (> or =75 micro g/liter and > or =5 glasses of water/day) (odds ratio = 1.1, 95% confidence interval: 0.7, 1.7). Sporadic elevations in risk were found across DBPs, most notably for ingested total organic halide (odds ratio = 1.5, 95% confidence interval: 1.0, 2.2 for the highest exposure quintile). These results provide some assurance that drinking water DBPs in the range commonly encountered in the United States do not affect fetal survival.
Highlights
Previous research has suggested that exposure to elevated levels of drinking water disinfection by-products (DBPs) may cause pregnancy loss
No association was found between consumption of large amounts of cold tap water or receiving tap water with high levels of THMs and pregnancy loss [16], women who consumed five or more glasses of cold tap water per day containing 75 lg/liter of THM4 were at increased risk of pregnancy loss
After confirming that THM and haloacetic acid (HAA) levels were spatially uniform throughout the distribution system at the chlorinated and brominated DBP sites by collecting samples from throughout the distribution system and finding minimal differences, a single location was chosen for sample collection and measurement to reflect concentrations throughout the system
Summary
Previous research has suggested that exposure to elevated levels of drinking water disinfection by-products (DBPs) may cause pregnancy loss. No association was found between consumption of large amounts of cold tap water or receiving tap water with high levels of THMs and pregnancy loss [16], women who consumed five or more glasses of cold tap water per day containing 75 lg/liter of THM4 were at increased risk of pregnancy loss (odds ratio 1⁄4 1.8, 95 percent confidence interval: 1.1, 3.0). Women who consumed five or more glasses per day of cold tap water containing at least 18 lg/liter of one of the THM species, bromodichloromethane, showed a more pronounced increased risk (odds ratio 1⁄4 3.0, 95 percent confidence interval: 1.4, 6.6) Limitations of these studies include uncertainty regarding dates of pregnancy onset and loss and limited exposure information, but the results strongly encouraged continued evaluation of the potential link between DBPs and pregnancy loss. We conducted the most extensive study to date to evaluate whether exposure to DBPs in drinking water is associated with an increased risk of pregnancy loss
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