title: Risk of congenital anomalies in relation to the uptake of trihalomethane from drinking water during pregnancy.
abstract: OBJECTIVE
  Congenital anomalies have been inconsistently associated with maternal crude estimated exposure to drinking water trihalomethane (THM). We investigated the relationship between individual THM uptake during the first trimester of pregnancy and congenital anomalies.
  
  
  METHODS
  We estimated maternal THM uptake for 3074 live births using residential tap water concentrations, drinking water ingestion, showering and bathing, and uptake factors of THM in the blood. Multiple logistic regression was used to investigate the association of THM exposure with congenital anomalies.
  
  
  RESULTS
  We observed no statistically significant relationships between congenital anomalies and the total THM internal dose. We found little indication of a dose-response relationship for brominated THM and congenital heart anomalies. The relationship was statistically significant for bromodichloromethane (BDCM) (OR=2.16, 95% CI 1.05 to 4.46, highest vs lowest tertile) during the first month of pregnancy. During the first trimester of pregnancy, the probability of developing heart anomalies increased for every 0.1 μg/d increase in the BDCM and for every 0.01 μg/d increase in the internal dibromochloromethane (DBCM) dose (OR 1.70, 95% CI 1.09 to 2.66, and OR 1.25, 95% CI 1.01 to 1.54, respectively). A dose-response relationship was evident for musculoskeletal anomalies and DBCM exposure during the first and second months of pregnancy, while BDCM exposure tended to increase the risk of urogenital anomalies.
  
  
  CONCLUSIONS
  This study shows some evidence for an association between the internal dose of THM and the risk of congenital anomalies. In particular, increased prenatal exposure to brominated THM might increase the risk of congenital heart and musculoskeletal anomalies.
authors: Department of Environmental Sciences, Faculty of Natural Sciences, Vytauto DidŽiojo universitetas, Kaunas, Lithuania. r.grazuleviciene@gmf.vdu.lt
authors: Regina
authors: R
authors: Grazuleviciene
authors: Violeta
authors: V
authors: Kapustinskiene
authors: Jone
authors: J
authors: Vencloviene
authors: Jurate
authors: J
authors: Buinauskiene
authors: Mark J
authors: MJ
authors: Nieuwenhuijsen
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000097:blood / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000139:chemically induced; D006801:Humans; D016015:Logistic Models; D018811:Maternal Exposure / Q000009:adverse effects*; D009139:Musculoskeletal Abnormalities / Q000097:blood / Q000139:chemically induced; D016017:Odds Ratio; D011247:Pregnancy / Q000097:blood; D011264:Pregnancy Trimesters; D011297:Prenatal Exposure Delayed Effects; D022882:Trihalomethanes / Q000097:blood / Q000633:toxicity*; D014564:Urogenital Abnormalities / Q000097:blood / Q000139:chemically induced; D014874:Water Pollutants, Chemical / Q000097:blood / Q000633:toxicity; D014881:Water Supply
chemical_list: D060766:Drinking Water; D022882:Trihalomethanes; D014874:Water Pollutants, Chemical; C025191:bromodichloromethane
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