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

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 include...

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Autores: Nieuwenhuijsen, Mark J., Martinez Murciano, David, Grellier, James, Bennett, James, Best, Nicky, Iszatt, Nina, Vrijheid, Martine, Toledano, Mireille B.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2009
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/41973
Acceso en línea:http://hdl.handle.net/10230/41973
http://dx.doi.org/10.1289/ehp.0900677
Access Level:acceso abierto
Palabra clave:Malformacions
Desinfecció i desinfectants
Halogenació
Aigua -- Contaminació -- Toxicologia
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spelling Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analysesNieuwenhuijsen, Mark J.Martinez Murciano, DavidGrellier, JamesBennett, JamesBest, NickyIszatt, NinaVrijheid, MartineToledano, Mireille B.MalformacionsDesinfecció i desinfectantsHalogenacióAigua -- Contaminació -- ToxicologiaOBJECTIVES: 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.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)National Institute of Environmental Health Sciences (NIEHS)201920192009info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/41973http://dx.doi.org/10.1289/ehp.0900677reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésEnvironmental Health Perspectives. 2009 Oct;117(10):1486-93Publication 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 copyrightinfo:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/419732026-06-12T07:21:37Z
dc.title.none.fl_str_mv Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
title Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
spellingShingle Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
Nieuwenhuijsen, Mark J.
Malformacions
Desinfecció i desinfectants
Halogenació
Aigua -- Contaminació -- Toxicologia
title_short Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
title_full Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
title_fullStr Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
title_full_unstemmed Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
title_sort Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses
dc.creator.none.fl_str_mv Nieuwenhuijsen, Mark J.
Martinez Murciano, David
Grellier, James
Bennett, James
Best, Nicky
Iszatt, Nina
Vrijheid, Martine
Toledano, Mireille B.
author Nieuwenhuijsen, Mark J.
author_facet Nieuwenhuijsen, Mark J.
Martinez Murciano, David
Grellier, James
Bennett, James
Best, Nicky
Iszatt, Nina
Vrijheid, Martine
Toledano, Mireille B.
author_role author
author2 Martinez Murciano, David
Grellier, James
Bennett, James
Best, Nicky
Iszatt, Nina
Vrijheid, Martine
Toledano, Mireille B.
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malformacions
Desinfecció i desinfectants
Halogenació
Aigua -- Contaminació -- Toxicologia
topic Malformacions
Desinfecció i desinfectants
Halogenació
Aigua -- Contaminació -- Toxicologia
description 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.
publishDate 2009
dc.date.none.fl_str_mv 2009
2019
2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/41973
http://dx.doi.org/10.1289/ehp.0900677
url http://hdl.handle.net/10230/41973
http://dx.doi.org/10.1289/ehp.0900677
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Environmental Health Perspectives. 2009 Oct;117(10):1486-93
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv National Institute of Environmental Health Sciences (NIEHS)
publisher.none.fl_str_mv National Institute of Environmental Health Sciences (NIEHS)
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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