title: Salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension in coastal Bangladesh: a case-control study.
abstract: BACKGROUND
  Hypertensive disorders in pregnancy are among the leading causes of maternal and perinatal death in low-income countries, but the aetiology remains unclear. We investigated the relationship between salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension in a coastal community.
  
  
  METHODS
  A population-based case-control study was conducted in Dacope, Bangladesh among 202 pregnant women with (pre)eclampsia or gestational hypertension, enrolled from the community served by the Upazilla Health Complex, Dacope and 1,006 matched controls from the same area. Epidemiological and clinical data were obtained from all participants. Urinary sodium and sodium levels in drinking water were measured. Logistic regression was used to calculate odds ratios, and 95% confidence intervals.
  
  
  RESULTS
  Drinking water sources had exceptionally high sodium levels (mean 516.6 mg/L, S.D 524.2). Women consuming tube-well (groundwater) were at a higher disease risk than rainwater users (p<0.001). Adjusted risks for (pre)eclampsia and gestational hypertension considered together increased in a dose-response manner for increasing sodium concentrations (300.01-600 mg/L, 600.1-900 mg/L, >900.01 mg/L, compared to <300 mg/L) in drinking water (ORs 3.30 [95% CI 2.00-5.51], 4.40 [2.70-7.25] and 5.48 [3.30-9.11] (p-trend<0.001). Significant associations were seen for both (pre)eclampsia and gestational hypertension separately.
  
  
  CONCLUSIONS
  Salinity in drinking water is associated with increased risk of (pre)eclampsia and gestational hypertension in this population. Given that coastal populations in countries such as Bangladesh are confronted with high salinity exposure, which is predicted to further increase as a result of sea level rise and other environmental influences, it is imperative to develop and evaluate affordable approaches to providing water with low salt content.
authors.affiliation: MRC-HPA Centre for Environment and Health and Dept. of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Grantham Institute for Climate Change, Imperial College London, London, United Kingdom.
authors.forename: Aneire Ehmar
authors.initials: AE
authors.lastname: Khan
authors.affiliation: MRC-HPA Centre for Environment and Health and Dept. of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Pauline Franka Denise
authors.initials: PF
authors.lastname: Scheelbeek
authors.affiliation: Dhaka Children's Hospital, Dhaka, Bangladesh.
authors.forename: Asma Begum
authors.initials: AB
authors.lastname: Shilpi
authors.affiliation: MRC-HPA Centre for Environment and Health and Dept. of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.affiliation: Upazilla Health Complex Dacope, Khulna, Bangladesh.
authors.forename: Sontosh Kumar
authors.initials: SK
authors.lastname: Mojumder
authors.affiliation: Bangladesh Center for Advanced Studies, Dhaka, Bangladesh.
authors.forename: Atiq
authors.initials: A
authors.lastname: Rahman
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Haines
authors.affiliation: MRC-HPA Centre for Environment and Health and Dept. of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Grantham Institute for Climate Change, Imperial College London, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D001459:Bangladesh; D001794:Blood Pressure; D016022:Case-Control Studies; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors; D012964:Sodium / Q000032:analysis* / Q000652:urine; D055815:Young Adult
chemical_list: D060766:Drinking Water; D012964:Sodium