title: Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy.
abstract: 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.
authors.affiliation: Dipartimento di Scienze Igienistiche, Microbiologiche e Biostatistiche, Università degli Studi di Modena e Reggio Emilia, Via Campi 287. 41100 Modena, Italy. g.aggazzotti@unimore.it
authors.forename: Gabriella
authors.initials: G
authors.lastname: Aggazzotti
authors.forename: Elena
authors.initials: E
authors.lastname: Righi
authors.forename: Guglielmina
authors.initials: G
authors.lastname: Fantuzzi
authors.forename: Barbara
authors.initials: B
authors.lastname: Biasotti
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Ravera
authors.forename: Stefano
authors.initials: S
authors.lastname: Kanitz
authors.forename: Fabio
authors.initials: F
authors.lastname: Barbone
authors.forename: Giuliano
authors.initials: G
authors.lastname: Sansebastiano
authors.forename: Mario Alberto
authors.initials: MA
authors.lastname: Battaglia
authors.forename: Valerio
authors.initials: V
authors.lastname: Leoni
authors.forename: Leila
authors.initials: L
authors.lastname: Fabiani
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sciacca
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D017606:Chlorine Compounds / Q000506:poisoning*; D004305:Dose-Response Relationship, Drug; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019570:Inhalation Exposure; D007558:Italy / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D022882:Trihalomethanes / Q000506:poisoning; D018508:Water Purification
chemical_list: D017606:Chlorine Compounds; D022882:Trihalomethanes