背景:孕妇在饮用水中接受消毒副产品(DBPs)与后代神经管缺陷(NTDs)之间的关系尚无定论,部分受到暴露错误分类的限制。
方法:来自全国出生缺陷预防研究的饮用水源和消费的产妇访谈报告与2000年至2005年期间分娩的NTD病例儿童和对照儿童的公共供水系统监测数据中的DBP浓度相关联。分析的DBPs是总的三卤甲烷,五种最常见的卤代乙酸组合,和个体物种。估计了所有NTDs组合和选定亚型的关联(脊柱裂,无脑),母亲在公共供水系统中对DBPs的感知暴露,并且每天平均对DBPs的感知摄入占个人水平的消耗和过滤信息。应用混合效应逻辑回归模型,将产妇种族/种族和分娩时的教育程度作为固定效应,将研究地点作为随机截距。
结果:总体而言,111例和649例对照儿童符合分析条件。对于所有NTD的总和,产妇在公共供水系统中暴露于DBP的调整后的优势比在0.8-1.5之间,脊柱裂0.6-2.0,无脑畸形为0.7-1.9;产妇每日平均摄入DBPs的范围分别为0.7-1.1、0.5-1.5和0.6-1.8。观察到几个积极的估计(≥1.2),但所有的置信区间都包括null。
结论:使用来自大型,US,以人口为基础,病例对照研究,我们观察到孕妇在饮用水中接受总DBP和单个DBP物种与NTDs和亚型之间的统计学无显著关联.
BACKGROUND: Associations between maternal periconceptional exposure to disinfection by-products (DBPs) in drinking water and neural tube defects (NTDs) in offspring are inconclusive, limited in part by exposure misclassification.
METHODS: Maternal interview reports of drinking water sources and consumption from the National Birth Defects Prevention Study were linked with DBP concentrations in public water system monitoring data for case children with an NTD and control children delivered during 2000-2005. DBPs analyzed were total
trihalomethanes, the five most common haloacetic acids combined, and individual species. Associations were estimated for all NTDs combined and selected subtypes (spina bifida, anencephaly) with maternal periconceptional exposure to DBPs in public water systems and with average daily periconceptional ingestion of DBPs accounting for individual-level consumption and filtration information. Mixed effects logistic regression models with maternal race/ethnicity and educational attainment at delivery as fixed effects and study site as a random intercept were applied.
RESULTS: Overall, 111 case and 649 control children were eligible for analyses. Adjusted odds ratios for maternal exposure to DBPs in public water systems ranged from 0.8-1.5 for all NTDs combined, 0.6-2.0 for spina bifida, and 0.7-1.9 for anencephaly; respective ranges for average daily maternal ingestion of DBPs were 0.7-1.1, 0.5-1.5, and 0.6-1.8. Several positive estimates (≥1.2) were observed, but all confidence intervals included the null.
CONCLUSIONS: Using community- and individual-level data from a large, US, population-based, case-control study, we observed statistically nonsignificant associations between maternal periconceptional exposure to total and individual DBP species in drinking water and NTDs and subtypes.