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

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.

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

2018 ◽  
Vol 16 (2) ◽  
pp. 181-196 ◽  
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.

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

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.

EXPOSURE TO CHLORITE AND CHLORATE IN DRINKING WATER AND ADVERSE PREGNANCY OUTCOMES IN ITALY

Epidemiology ◽  
2003 ◽  
Vol 14 (Supplement) ◽  
pp. S24
Author(s):  
G Aggazzotti ◽  
L Fabiani ◽  
M Triassi ◽  
S Sciacca ◽  
G Ravera ◽  
...  
Keyword(s):  
Drinking Water ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

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

2004 ◽  
Vol 2 (4) ◽  
pp. 233-247 ◽  
Author(s):  
Gabriella Aggazzotti ◽  
Elena Righi ◽  
Guglielmina Fantuzzi ◽  
Barbara Biasotti ◽  
Gianbattista Ravera ◽  
...  
Keyword(s):  
Drinking Water ◽  
Pregnancy Outcomes ◽  
Inhalation Exposure ◽  
Preterm Births ◽  
Adverse Pregnancy Outcomes ◽  
High Exposure ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Incident Cases ◽  
By Products

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.

scholarly journals Exposure assessment in epidemiologic studies of adverse pregnancy outcomes and disinfection byproducts

2004 ◽  
Vol 14 (6) ◽  
pp. 466-472 ◽  
Author(s):  
Will D King ◽  
Linda Dodds ◽  
B Anthony Armson ◽  
Alexander C Allen ◽  
Deshayne B Fell ◽  
...  
Keyword(s):  
Exposure Assessment ◽  
Pregnancy Outcomes ◽  
Epidemiologic Studies ◽  
Disinfection Byproducts ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

scholarly journals Maternal urinary levels of trichloroacetic acid and association with adverse pregnancy outcomes

2019 ◽  
Vol 17 (6) ◽  
pp. 884-895 ◽  
Author(s):  
Funanani Mashau ◽  
Esper Jacobeth Ncube ◽  
Kuku Voyi
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Premature Birth ◽  
Trichloroacetic Acid ◽  
Adverse Pregnancy Outcomes ◽  
Potential Health ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract The current study aimed to determine the association between trichloroacetic acid (TCAA) levels and adverse pregnancy outcomes among third-trimester pregnant women who were exposed to chlorinated drinking water. A total of 205 pregnant women who participated in the disinfection by-products exposure and adverse pregnancy outcome study in South Africa were randomly asked to participate in this study by providing their morning urine sample voids. Samples were analysed for urinary creatinine and TCAA. Furthermore, participants gave individual data using a structured questionnaire. The mean (median) concentration of creatinine-adjusted urinary TCAA was 2.34 (1.95) μg/g creatinine. Elevated levels of creatinine-adjusted TCAA concentrations showed an increased risk of premature birth, small for gestational age (SGA) and low birth weight. There was no significant statistical correlation observed between creatinine-adjusted TCAA concentrations and the total volume of cold water ingested among the study population. No statistically significant association was observed between creatinine-adjusted urinary TCAA and premature birth, SGA and low birth weight newborns among the study subjects. However, the urinary TCAA concentrations identified in this study suggest potential health risks towards women and foetus. Therefore, further studies are warranted to prevent further adverse pregnancy outcomes.

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