Maternal exposure to water disinfection by-products during gestation and risk of hypospadias

Luben, Thomas J.; Nuckols, John R.; Mosley, Bridget S.; Hobbs, Charlotte A.; Reif, John S.

doi:10.1136/oem.2007.034256

Cited by 28 publications

(27 citation statements)

References 42 publications

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“…We used data provided by the utilities to evaluate the accuracy of the method. We confirmed service to 81–86% of all residences using PWS; these percentages are consistent with other studies (Luben et al 2004, 2008; Nuckols et al 2004a). Verification for 10% of residences served by PWS was not requested, primarily because of incomplete addresses.…”

Section: Methodssupporting

confidence: 93%

Estimating Water Supply Arsenic Levels in the New England Bladder Cancer Study

Nuckols

Freeman

Lubin

et al. 2011

Environ Health Perspect

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Background: Ingestion of inorganic arsenic in drinking water is recognized as a cause of bladder cancer when levels are relatively high (≥ 150 µg/L). The epidemiologic evidence is less clear at the low-to-moderate concentrations typically observed in the United States. Accurate retrospective exposure assessment over a long time period is a major challenge in conducting epidemiologic studies of environmental factors and diseases with long latency, such as cancer.Objective: We estimated arsenic concentrations in the water supplies of 2,611 participants in a population-based case–control study in northern New England.Methods: Estimates covered the lifetimes of most study participants and were based on a combination of arsenic measurements at the homes of the participants and statistical modeling of arsenic concentrations in the water supply of both past and current homes. We assigned a residential water supply arsenic concentration for 165,138 (95%) of the total 173,361 lifetime exposure years (EYs) and a workplace water supply arsenic level for 85,195 EYs (86% of reported occupational years).Results: Three methods accounted for 93% of the residential estimates of arsenic concentration: direct measurement of water samples (27%; median, 0.3 µg/L; range, 0.1–11.5), statistical models of water utility measurement data (49%; median, 0.4 µg/L; range, 0.3–3.3), and statistical models of arsenic concentrations in wells using aquifers in New England (17%; median, 1.6 µg/L; range, 0.6–22.4).Conclusions: We used a different validation procedure for each of the three methods, and found our estimated levels to be comparable with available measured concentrations. This methodology allowed us to calculate potential drinking water exposure over long periods.

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Section: Methodssupporting

confidence: 93%

Estimating Water Supply Arsenic Levels in the New England Bladder Cancer Study

Nuckols

Freeman

Lubin

et al. 2011

Environ Health Perspect

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“…A third of these studies were conducted in the United States (Aschengrau et al 1993; Bove et al 1995; Klotz and Pyrch 1999; Luben et al 2008; Shaw et al 2003), followed by Sweden (Cedergren et al 2002; Källen and Robert 2000), England and Wales (Iszatt N, Nieuwenhuijsen MJ, Toledano MB, Nelson P, Elliott P, unpublished data; Nieuwenhuijsen et al 2008), Canada (Dodds et al 1999; Dodds and King 2001), Norway (Hwang et al 2002; Magnus et al 1999), Australia (Chisholm et al 2008), and Taiwan (Hwang et al 2008). Five were case–control studies [Aschengrau et al 1993; Iszatt N, Nieuwenhuijsen MJ, Toledano MB, Nelson P, Elliott P, unpublished data; Klotz and Pyrch 1999; Luben et al 2008; Shaw et al 2003 (includes two studies)], whereas the rest were cross-sectional, population-based studies, generally using registry data, which limited the opportunity to adjust for potential confounders. Most included live births, fetal deaths, and terminations.…”

Section: Resultsmentioning

confidence: 99%

Chlorination Disinfection By-Products in Drinking Water and Congenital Anomalies: Review and Meta-Analyses

Nieuwenhuijsen

Martínez

Grellier

et al. 2009

Environ Health Perspect

142

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ObjectivesThe 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 extractionWe 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 μg/L TTHM.Data synthesisFor 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.ConclusionAlthough 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.

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“…A long list of suspicious substances have been discussed, including pharmaceutical compounds, herbicides, fungicides, insecticides and industrial by-products and end-products, such as diethylstilbestrol, vinclozolin, linuron, bisphenol A, butyl benzyl phthalate, polychlorinated biphenyls, phthalates, and dioxin (Sultan et al, 2001;Sohoni et al, 1998;Sonnenschein et al, 1998;Kalfa et al, 2009). Women in the intermediate tertiles who are exposed to water disinfection by-products have a higher risk of having an infant with hypospadias (Luben et al, 2008). More pesticides were detected in newborns with cryptorchidism or hypospadias, or both, than in boys without malformations (Fernandez et al, 2007).…”

Section: Discussionmentioning

confidence: 99%