Abstract
BackgroundPrenatal drinking water exposure to tetrachloroethylene (PCE) has been previously related to intrauterine growth restriction and stillbirth. Pathophysiologic and epidemiologic evidence linking these outcomes to certain other pregnancy complications, including placental abruption, preeclampsia, and small-for-gestational-age (SGA) (i.e., ischemic placental diseases), suggests that PCE exposure may also be associated with these events. We examined whether prenatal exposure to PCE-contaminated drinking water was associated with overall or individual ischemic placental diseases.MethodsUsing a retrospective cohort design, we compared 1,091 PCE-exposed and 1,019 unexposed pregnancies from 1,766 Cape Cod, Massachusetts women. Exposure between 1969 and 1990 was estimated using water distribution system modeling software. Data on birth weight and gestational age were obtained from birth certificates; mothers self-reported pregnancy complications.ResultsOf 2,110 eligible pregnancies, 9% (N = 196) were complicated by ≥1 ischemic placental disease. PCE exposure was not associated with overall ischemic placental disease (for PCE ≥ sample median vs. no exposure, risk ratio (RR): 0.90; 95% confidence interval (CI): 0.65, 1.24), preeclampsia (RR: 0.36; 95% CI: 0.12-1.07), or SGA (RR: 0.98; 95% CI: 0.66-1.45). However, pregnancies with PCE exposure ≥ the sample median had 2.38-times the risk of stillbirth ≥27 weeks gestation (95% CI: 1.01, 5.59), and 1.35-times of the risk of placental abruption (95% CI: 0.68, 2.67) relative to unexposed pregnancies.ConclusionsPrenatal PCE exposure was not associated with overall ischemic placental disease, but may increase risk of stillbirth.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-72) contains supplementary material, which is available to authorized users.
Highlights
Prenatal drinking water exposure to tetrachloroethylene (PCE) has been previously related to intrauterine growth restriction and stillbirth
We examined the association between prenatal PCE exposure and ischemic placental disease in a population-based retrospective cohort of 1,766 women
We examined associations of prenatal PCE with placental abruption, preeclampsia, and stillbirth in the restricted sample used for the composite outcome
Summary
Prenatal drinking water exposure to tetrachloroethylene (PCE) has been previously related to intrauterine growth restriction and stillbirth. Prenatal drinking water exposure to PCE has been previously linked to stillbirth [2] and intrauterine growth restriction [2,4], and investigation of related disorders, including placental abruption and preeclampsia, appears warranted. These four outcomes, sometimes termed ischemic placental diseases or placental dysfunction disorders [5,6,7], represent a heterogeneous group of disorders affecting placental function and fetal growth which are thought to have a common etiologic pathway at the level of placental vascular development [8]. Ischemic placental diseases may share common risk factors [9,10,11,12,13], making knowledge of risk factors for one ischemic placental disease potentially informative for identifying novel risk factors for related disorders.
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