Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy

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 µg l−1), while chlorite and chlorate concentrations were relatively high (median: 216.5 µg l−1 for chlorites and 76.5 µg l−1 for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels ≥200 µg 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 (≥30 µg l−1), or chlorite or chlorate (≥200 µg 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.

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Drinking water disinfection by-products exposure and health effects on pregnancy outcomes: a systematic review

Journal of Water and Health ◽

10.2166/wh.2018.167 ◽

2018 ◽

Vol 16 (2) ◽

pp. 181-196 ◽

Cited By ~ 5

Author(s):

Funanani Mashau ◽

Esper Jacobeth Ncube ◽

Kuku Voyi

Keyword(s):

Drinking Water ◽

Exposure Assessment ◽

Pregnancy Outcomes ◽

Assessment Method ◽

Maternal Exposure ◽

Adverse Pregnancy Outcomes ◽

Water Disinfection ◽

Increased Risk ◽

Adverse Pregnancy ◽

By Products

Abstract Epidemiological studies have found that maternal exposure to disinfection by-products (DBPs) may lead to adverse pregnancy outcomes although the findings tend to be inconsistent. The objective of this study was to systematically review the evidence in associated with drinking water DBP exposure in relation to adverse pregnancy outcomes. Peer-reviewed articles were identified using electronic databases searched for studies published in the English language. Studies selected for review were evaluated for exposure assessment, confounders, and analyses risks of bias in the selection, outcomes assessment, and attrition. A comprehensive search and screening yielded a total of 32 studies, of which 12 (38%) reported a statistical association between maternal exposure to DBPs and adverse pregnancy outcomes. A maternal exposure to trihalomethanes (THMs) shows an increased risk of small for gestational age (SGA) and slightly increased risk of pregnancy loss. Risks of bias were low among the studies included in the review. Evidence on association relating to adverse pregnancy outcomes to DBP exposure is still less significant. There is a need for future robust research in this field, with the use of urinary trichloroacetic acid (TCAA) biomarkers as a direct exposure assessment method for this field.

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Increased risk of adverse pregnancy outcomes for women with migraines: A nationwide population-based study

Cephalalgia ◽

10.1111/j.1468-2982.2009.01935.x ◽

2009 ◽

Vol 30 (4) ◽

pp. 433-438 ◽

Cited By ~ 43

Author(s):

H-M Chen ◽

S-F Chen ◽

Y-H Chen ◽

H-C Lin

Keyword(s):

Pregnancy Outcomes ◽

Low Birthweight ◽

Preterm Births ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Multivariate Logistic Regression ◽

Population Based Study ◽

Increased Risk ◽

Preterm Babies ◽

Adverse Pregnancy

Using a 3-year nationwide population-based database, this study aims to examine the risk of adverse pregnancy outcomes in women with migraines, including low birthweight (LBW), preterm birth, infants born small for gestational age, Caesarean section (CS) and pre-eclampsia. We identified a total of 4911 women with migraines who gave birth from 2001 to 2003, together with 24 555 matched women as a comparison cohort. Multivariate logistic regression analyses showed that after adjusting for potential confounders, the odds ratios were 1.16 [95% confidence intervals (CI) = 1.03–1.31, P = 0.014] for LBW, 1.24 (95% CI = 1.13–1.39, P < 0.001) for preterm births, 1.16 (95% CI = 1.07–1.24, P < 0.001) for CS and 1.34 (95% CI = 1.02–1.77, P = 0.027) for pre-eclampsia for women with migraines compared with unaffected mothers. We conclude that women with migraines were at increased risk of having LBW, preterm babies, pre-eclampsia and delivery by CS, compared with unaffected mothers.

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The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1723778 ◽

2021 ◽

Author(s):

Shamil D. Cooray ◽

Jacqueline A. Boyle ◽

Georgia Soldatos ◽

Shakila Thangaratinam ◽

Helena J. Teede

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Therapeutic Interventions ◽

Clinical Prediction Model ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Individual ◽

Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

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Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217754 ◽

2022 ◽

pp. jech-2021-217754

Author(s):

Lixin Li ◽

Yanpeng Wu ◽

Yao Yang ◽

Ying Wu ◽

Yan Zhuang ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Maternal Education ◽

Rural China ◽

Education Level ◽

Adverse Pregnancy Outcomes ◽

Secondary Outcome ◽

Health Examination ◽

Educational Inequalities ◽

Increased Risk ◽

Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

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Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

American Journal of Perinatology ◽

10.1055/s-0038-1670634 ◽

2018 ◽

Vol 36 (05) ◽

pp. 517-521 ◽

Cited By ~ 3

Author(s):

Whitney Bender ◽

Adi Hirshberg ◽

Lisa Levine

Keyword(s):

Body Mass Index ◽

Preterm Birth ◽

Body Mass ◽

Pregnancy Outcomes ◽

Subsequent Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

History Of ◽

Index Changes ◽

Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

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Association between exposure to drinking water disinfection byproducts and adverse pregnancy outcomes in South Africa

Journal of Water and Health ◽

10.2166/wh.2020.214 ◽

2020 ◽

Author(s):

Funanani Mashau ◽

Esper Jacobeth Ncube ◽

Kuku Voyi

Keyword(s):

Drinking Water ◽

Pregnancy Outcomes ◽

Premature Birth ◽

Disinfection Byproducts ◽

Maternal Exposure ◽

Adverse Pregnancy Outcomes ◽

Water Disinfection ◽

Regulatory Data ◽

Adverse Pregnancy ◽

The Individual

Abstract Currently, there is contradictory evidence for the risk of adverse pregnancy outcomes associated with maternal exposure to disinfection byproducts (DBPs). We examine the association between maternal exposure to trihalomethanes (THMs) in drinking water and adverse pregnancy outcomes, including premature birth, low birth weight (LBW) and small for gestational age (SGA). In total, 1,167 women older than 18 years were enrolled at public antenatal venues in two geographical districts. For each district, we measured the levels of residential drinking water DBPs (measured in THMs) through regulatory data and routine water sampling. We estimated the individual uptake of water of each woman by combining individual water use and uptake factors. Increased daily internal dose of total THMs during the third trimester of pregnancy significantly increased the risk of delivering premature infants (AOR 3.13, 95% CI 1.36–7.17). The risk of premature birth was also positiviely associated with exposure to total THMs during the whole pregnancy (AOR 2.89, 95% CI 1.25–6.68). The risk of delivering an SGA and LBW infant was not associated with maternal exposure to THMs. Our findings suggest that exposure to THMs is associated with certain negative pregnancy outcomes. The levels of THMs in water should be routinely monitored.

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Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201212 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1487

Author(s):

Shaina Chamotra ◽

Kushla Pathania ◽

S. K. Verma ◽

Ankit Chaudhary

Keyword(s):

Pregnancy Outcomes ◽

Homocysteine Level ◽

Perinatal Outcomes ◽

Normal Subjects ◽

Adverse Pregnancy Outcomes ◽

Intrauterine Death ◽

Increased Risk ◽

Causal Pathway ◽

Mother And Child ◽

Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

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