title: Drinking water contaminants and adverse pregnancy outcomes: a review.
abstract: Concern for exposures to drinking water contaminants and their effects on adverse birth outcomes has prompted several studies evaluating chlorination disinfection by-products and chlorinated solvents. Some of these contaminants are found to be teratogenic in animal studies. This review evaluates 14 studies on chlorination disinfection by-products such as trihalomethanes (THMs) and five studies on chlorinated solvents such as trichloroethylene (TCE). The adverse birth outcomes discussed in this review include small for gestational age (SGA), low birth weight, preterm birth, birth defects, spontaneous abortions, and fetal deaths. Because of heterogeneities across the studies in the characterization of birth outcomes, the assessment and categorization of exposures, and the levels and mixtures of contaminants, a qualitative review was conducted. Generally, the chief bias in these studies was exposure misclassification that most likely underestimated the risk, as well as distorted exposure-response relationships. The general lack of confounding bias by risk factors resulted from these factors not being associated with drinking water exposures. The studies of THMs and adverse birth outcomes provide moderate evidence for associations with SGA, neural tube defects (NTDs), and spontaneous abortions. Because fewer studies have been conducted for the chlorinated solvents than for THMs, the evidence for associations is less clear. Nevertheless, the findings of excess NTDs, oral clefts, cardiac defects, and choanal atresia in studies that evaluated TCE-contaminated drinking water deserve follow-up.
authors.affiliation: Division of Health Studies, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA. fbove@cdc.gov
authors.forename: Frank
authors.initials: F
authors.lastname: Bove
authors.forename: Youn
authors.initials: Y
authors.lastname: Shim
authors.forename: Perri
authors.initials: P
authors.lastname: Zeitz
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced*; D000328:Adult; D002869:Chromosome Aberrations; D000013:Congenital Abnormalities / Q000209:etiology*; D004195:Disease Models, Animal; D004202:Disinfectants / Q000009:adverse effects* / Q000737:chemistry; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D012997:Solvents / Q000009:adverse effects*; D014241:Trichloroethylene / Q000009:adverse effects*; D022882:Trihalomethanes / Q000009:adverse effects*; D014873:Water Pollutants / Q000009:adverse effects*; D014881:Water Supply
chemical_list: D004202:Disinfectants; D012997:Solvents; D022882:Trihalomethanes; D014873:Water Pollutants; D014241:Trichloroethylene