title: Congenital anomalies, labor/delivery complications, maternal risk factors and their relationship with perfluorooctanoic acid (PFOA)-contaminated public drinking water.
abstract: BACKGROUND
  We have previously examined the associations between perfluorooctanoic acid (PFOA) exposure, birth weight and gestational age in individuals exposed to PFOA-contaminated residential drinking water from the Little Hocking Water Association (LHWA). In this investigation, we expand the scope of our analysis to examine the associations between PFOA, congenital anomalies, labor and delivery complications and maternal risk factors.
  
  
  OBJECTIVE
  To compare the likelihood of congenital anomalies, labor and delivery complications and maternal risk factors in neonates and their mothers residing in zip codes with public water service provided completely, partially or not at all by the LHWA.
  
  
  METHODS
  Logistic regression analyses were performed on singleton neonatal birth outcome data supplied by the Ohio Department of Health to examine the associations between LHWA water service category and the outcomes of interest. When possible, models were adjusted for maternal age, preterm birth, neonatal sex, race, maternal education, alcohol use, tobacco use and diabetic status.
  
  
  RESULTS
  Increased PFOA exposure, as assessed by water service category, was not associated with an overall increase in the likelihood of congenital anomalies or any specific diagnosis (adjusted OR: 1.4, 95% CI: 0.34-3.3). The overall likelihood of labor and delivery complications was significantly lower among mothers with water service provided by the LHWA, as compared to mothers not serviced by the LHWA (adjusted OR: 0.65, 95% CI: 0.46-0.92). A significant increase in the likelihood of anemia (crude OR: 11, 95% CI: 1.8-64) and dysfunctional labor (crude OR: 5.3, 95% CI: 1.2-24) was noted for mothers residing within zip codes serviced by the LHWA, but the number of reported cases was very small.
  
  
  CONCLUSIONS
  At the levels measured in the LHWA, we conclude that PFOA is not associated with increased risk of congenital anomalies, most labor and delivery complications and maternal risk factors. Additional research is required to assess the observed associations between PFOA, anemia and dysfunctional labor.
authors.affiliation: Center of Excellence in Environmental Toxicology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Nolan
authors.forename: John M
authors.initials: JM
authors.lastname: Nolan
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Nancy V
authors.initials: NV
authors.lastname: Rodway
authors.forename: Edward A
authors.initials: EA
authors.lastname: Emmett
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D002210:Caprylates / Q000633:toxicity*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D005466:Fluorocarbons / Q000633:toxicity*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D007744:Obstetric Labor Complications / Q000139:chemically induced*; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D014874:Water Pollutants, Chemical / Q000633:toxicity*; D014877:Water Pollution, Chemical / Q000032:analysis; D014881:Water Supply / Q000032:analysis*
chemical_list: D002210:Caprylates; D005466:Fluorocarbons; D014874:Water Pollutants, Chemical; C023036:perfluorooctanoic acid