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Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses

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dc.contributor.author Nieuwenhuijsen, Mark J.
dc.contributor.author Martinez Murciano, David
dc.contributor.author Grellier, James
dc.contributor.author Bennett, James
dc.contributor.author Best, Nicky
dc.contributor.author Iszatt, Nina
dc.contributor.author Vrijheid, Martine
dc.contributor.author Toledano, Mireille B.
dc.date.accessioned 2019-07-10T07:23:47Z
dc.date.available 2019-07-10T07:23:47Z
dc.date.issued 2009
dc.identifier.citation Nieuwenhuijsen MJ, Martinez D, Grellier J, Bennett J, Best N, Iszatt N et al. Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses. Environ Health Perspect. 2009 Oct;117(10):1486-93. DOI: 10.1289/ehp.0900677
dc.identifier.issn 1552-9924
dc.identifier.uri http://hdl.handle.net/10230/41973
dc.description.abstract OBJECTIVES: The aim of this study was to review epidemiologic evidence, provide summary risk estimates of the association between exposure to chlorination disinfection by-products (DBPs) and congenital anomalies, and provide recommendations for future studies. DATA SOURCES AND EXTRACTION: We included all published epidemiologic studies that evaluated a relationship between an index of DBP exposure (treatment, water source, DBP measurements, and both DBP measurements and personal characteristics) and risk of congenital anomalies. When three or more studies examined the same exposure index and congenital anomaly, we conducted a meta-analysis to obtain a summary risk estimate comparing the highest exposure group with the lowest exposure group. When five or more studies examined total trihalomethane (TTHM) exposure and a specific congenital anomaly, we conducted a meta-analysis to obtain exposure-response risk estimates per 10 microg/L TTHM. DATA SYNTHESIS: For all congenital anomalies combined, the meta-analysis gave a statistically significant excess risk for high versus low exposure to water chlorination or TTHM [17%; 95% confidence interval (CI), 3-34] based on a small number of studies. The meta-analysis also suggested a statistically significant excess risk for ventricular septal defects (58%; 95% CI, 21-107), but this was based on only three studies, and there was little evidence of an exposure-response relationship. We observed no statistically significant relationships in the other meta-analyses. We found little evidence for publication bias, except for urinary tract defects and cleft lip and palate. CONCLUSION: Although some individual studies have suggested an association between chlorination disinfection by-products and congenital anomalies, meta-analyses of all currently available studies demonstrate little evidence of such an association.
dc.description.sponsorship This work was conducted without specific allocated funding, but contributions were made by researchers working on the Integrated Assessment of Health Risks of Environmental Stressors in Europe (INTARESE) project, cofunded by the European Commission under the Sixth Framework Programme (2002–2006), and the Health Impacts of Long-term Exposure to Disinfection By-products in Drinking Water in Europe (HIWATE) project, which is a 3.5-year Specific Targeted Research Project funded under the European Union Sixth Framework Programme for Research and Technological Development by the Research Directorate–Biotechnology, Agriculture and Food Research Unit (contract Food-CT-2006-036224)
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher National Institute of Environmental Health Sciences (NIEHS)
dc.relation.ispartof Environmental Health Perspectives. 2009 Oct;117(10):1486-93
dc.rights Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, "Reproduced with permission from Environmental Health Perspectives"); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright
dc.subject.other Malformacions
dc.subject.other Desinfecció i desinfectants
dc.subject.other Halogenació
dc.subject.other Aigua -- Contaminació -- Toxicologia
dc.title Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1289/ehp.0900677
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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