Maternal exposure to nitrosamines in drinking water during pregnancy and birth outcomes in a Chinese cohort

Luo, Qiong; Yu, Miao; Liu, Chong; Bei, Er; Zhang, Jinfeng; Zhang, Linghua; Deng, Yan-Ling; Qiu, Yu; Lu, Wen-Qing; Wright, J. Michael; Chen, Chao; Zeng, Qiang

doi:10.1016/j.chemosphere.2023.137776

Cited by 5 publications

(3 citation statements)

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“…These studies examined total daily nitrate intake at levels comparable to and above the acceptable total daily intake of 0.84 mg/kg (of nitrate nitrogen) [17]. There are no epidemiological studies on CA and PTB that have used biomarkers for NOC, but an exposureresponse association between exogenous exposure to NOC in drinking water during pregnancy and PTB has been reported in one study [21]. The evidence that NOC increases the risk of CA stems mainly from animal studies [22,23] leading to difficulties when extrapolating conclusions to human populations due to the differences in fetal developmental trajectory across species.…”

Section: N-nitroso Compounds (Noc)mentioning

confidence: 99%

“…The mechanisms by which NOC may increase the risk of CA and PTB are not fully understood. The genotoxicity of NOC is likely to play a role, resulting in DNA damage and adverse fetal growth and development [21]. NOC, and in particular N-nitrosamines, have also been shown to induce oxidative stress, leading to impaired placental function and premature senescence in fetal membranes [21,26].…”

Section: N-nitroso Compounds (Noc)mentioning

confidence: 99%

“…The genotoxicity of NOC is likely to play a role, resulting in DNA damage and adverse fetal growth and development [21]. NOC, and in particular N-nitrosamines, have also been shown to induce oxidative stress, leading to impaired placental function and premature senescence in fetal membranes [21,26]. A diet rich in antioxidants may mitigate this mechanism by reducing NOC formation and oxidative stress, while nitrosatable compounds in the diet (e.g., red meat, nitrosatable drugs) are likely to amplify it [24].…”

Section: N-nitroso Compounds (Noc)mentioning

confidence: 99%

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Nitrate in drinking water and pregnancy outcomes: A narrative review of epidemiological evidence and proposed biological mechanisms

Royal,

‘t Mannetje,

Hales

et al. 2024

PLOS Water

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There is emerging evidence of an association between nitrate contamination in drinking water and adverse pregnancy outcomes. Few studies have discussed the evidence in the context of plausible biological mechanisms. We performed a narrative review of the current evidence investigating associations between nitrate in drinking water and the risk of adverse pregnancy outcomes with a focus on congenital anomalies (CA) and preterm birth (PTB). We also reviewed evidence and discuss several biological mechanisms that may explain the observed associations. We reviewed cohort and case-control epidemiological studies assessing associations between maternal nitrate exposure and adverse pregnancy outcomes published until January 2023. Three plausible mechanisms may explain how maternal exposure to nitrate may impact pregnancy outcomes, which include the formation of N-nitroso compounds (NOC), thyroid dysfunction and oxidative stress. For CA, seven studies were included (two cohort and five case-control studies). The strongest associations observed in epidemiological studies were for neural tube defects. Inconsistent positive and negative associations were observed for anomalies of the limb, eye, ear, face and neck. Of the four PTB studies (all cohort studies), three of the largest cohort studies observed associations between PTB with nitrate levels >5 mg/L while one small cohort study did not. Emerging epidemiological evidence has observed a potential increased risk of adverse pregnancy outcomes with elevated maternal nitrate exposure in drinking water. There are also plausible biological mechanisms to support this association. However, the current evidence lacks homogeneity and additional longitudinal evidence with robust exposure asssessments is required. Given the increasing concentrations of nitrate contamination in drinking water in many countries, and the adverse effects observed at concentrations below the current regulatory standard, a further precautionary approach should be adopted until futher evidence emerges.

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