title: Maternal dioxin exposure and pregnancy outcomes over 30 years of follow-up in Seveso.
abstract: Animal evidence suggests an association between exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and adverse pregnancy outcomes. Epidemiologic studies report inconsistent results, but are limited by narrow range of exposure, small sample size, and lack of a biologic measure of highest lifetime exposure. On July 10, 1976, a chemical explosion in Seveso, Italy resulted in the highest known residential exposure to TCDD. In 1996, we initiated the Seveso Women's Health Study (SWHS), a retrospective cohort of TCDD exposure and reproductive health. Individual-level TCDD was measured in serum collected soon after the explosion. After 20years of follow-up, we found no association between maternal TCDD in 1976 serum or estimated at pregnancy and spontaneous abortion (SAB), fetal growth, or gestational length. Here, we present an updated analysis of TCDD exposure and adverse pregnancy outcomes from a subsequent follow-up of the SWHS cohort in 2008-2009. SWHS women had 1211 post-explosion pregnancies through the 2008-2009 follow-up. We found no association between TCDD estimated at pregnancy and SAB, fetal growth, or gestational length. However, we found a non-significant inverse association between maternal 1976 serum TCDD and birthweight (adjusted β=-22.8, 95% CI: -80.1, 34.6). The association was stronger among first post-explosion births, but remained non-significant (adjusted β=-47.7, 95% CI: -107.3, 11.9). SWHS is the first study to be able to consider two potentially relevant measures of TCDD exposure: highest lifetime dose and in utero. Our results, although non-significant, suggest that highest dose may be more relevant in epidemiologic studies of TCDD and pregnancy outcomes.
authors.affiliation: Center for Environmental Research and Children's Health, School of Public Health, University of California at Berkeley, Berkeley, CA, United States. Electronic address: amelia.wesselink@berkeley.edu.
authors.forename: Amelia
authors.initials: A
authors.lastname: Wesselink
authors.affiliation: Center for Environmental Research and Children's Health, School of Public Health, University of California at Berkeley, Berkeley, CA, United States. Electronic address: mwarner@berkeley.edu.
authors.forename: Marcella
authors.initials: M
authors.lastname: Warner
authors.affiliation: School of Public Health, University of Albany, The State University of New York, Albany, NY, United States. Electronic address: samplerx@earthlink.net.
authors.forename: Steven
authors.initials: S
authors.lastname: Samuels
authors.affiliation: University of Milano-Bicocca School of Medicine, Hospital of Desio, Desio-Milano, Italy. Electronic address: alizaparigi@alice.it.
authors.forename: Aliza
authors.initials: A
authors.lastname: Parigi
authors.affiliation: University of Milano-Bicocca School of Medicine, Hospital of Desio, Desio-Milano, Italy. Electronic address: brambilla@uds.unimib.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Brambilla
authors.affiliation: University of Milano-Bicocca School of Medicine, Hospital of Desio, Desio-Milano, Italy. Electronic address: mocarelli@uds.unimib.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mocarelli
authors.affiliation: Center for Environmental Research and Children's Health, School of Public Health, University of California at Berkeley, Berkeley, CA, United States. Electronic address: eskenazi@berkeley.edu.
authors.forename: Brenda
authors.initials: B
authors.lastname: Eskenazi
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D018811:Maternal Exposure; D000072317:Polychlorinated Dibenzodioxins / Q000097:blood / Q000633:toxicity*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D016387:Women's Health
chemical_list: D000072317:Polychlorinated Dibenzodioxins
keywords: 2,3,7,8-tetrachlorodibenzo-p-dioxin; Birthweight; Dioxin; Fetal growth; IQR; OR; PCB; PCDD; PCDF; Pregnancy outcomes; Preterm; SAB; SGA; SWHS; Seveso; Seveso Women's Health Study; TCDD; TEQ; interquartile range; odds ratio; parts-per-trillion; polychlorinated biphenyl; polychlorinated dibenzodioxin; polychlorinated dibenzofuran; ppt; small-for-gestational age; spontaneous abortion; toxic equivalent