Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research Article
  • Published:

Exposure assessment in epidemiologic studies of adverse pregnancy outcomes and disinfection byproducts

Journal of Exposure Science & Environmental Epidemiology volume 14, pages 466–472 (2004)Cite this article

Abstract

A major challenge in studies that examine the association between disinfection byproducts in drinking water and pregnancy outcomes is the accurate representation of a subject's exposure. We used household water samples and questionnaire information on water-use behavior to examine several aspects of exposure assessment: (i) the distribution and correlation of specific disinfection byproducts, (ii) spatial distribution system and temporal variation in byproduct levels, and (iii) the contribution of individual water-use behavior. The level of specific trihalomethanes (THMs) and haloacetic acids (HAAs) was determined for 360 household water samples in Eastern Ontario and Nova Scotia. Subjects were interviewed regarding tap water ingestion and showering and bathing practices. In both provinces, total THMs correlated highly with chloroform (correlation coefficient (r) >0.95) and less so with total HAAs (r=0.74 in Nova Scotia and r=0.52 in Ontario). The correlation between total THMs and bromodichloromethane was high in Nova Scotia (r=0.63), but low in Ontario (r=0.26). The correlation was between THM level in individual household samples, and the mean THM level during the same time period from several distribution system samples was 0.63, while a higher correlation in THM level was observed for samples taken at the same location 1 year apart (r=0.87). A correlation of 0.73 was found between household THM level and a total exposure measure incorporating ingestion, showering, and bathing behaviors. These results point to the importance of: measurement of different classes of byproducts; household rather than distribution system sampling; and, incorporation of subject behaviors in exposure assessment in epidemiologic studies of disinfection byproducts and adverse pregnancy outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Arbuckle T.E., Hrudey S.E., Krasner S.W., Nuckols J.R., Richardson S.D., Singer P., Mendola P., Dodds L., Weisel C., Ashley D.L., Froese K.L., Pegram R.A., Schultz I.R., Reif J., Bachand A.M., Benoit F.M., Lynberg M., Poole C., and Waller K. Assessing exposure in epidemiologic studies to disinfection byproducts in drinking water: report from an international workshop. Environ Health Perspect 2002: 110(Suppl 1): 53–60.

    Article  CAS  Google Scholar 

  • Aschengrau A., Zierler S., and Cohen A. Quality of community drinking water and the occurrence of late adverse pregnancy outcomes. Archi Environ Health 1993: 48: 105–113.

    Article  CAS  Google Scholar 

  • Backer L.C., Ashley D.A., Bonin M.A., Cardinali F.L., Kieszak S.M., and Wooten J.V. Household exposures to drinking water disinfection byproducts: whole blood trihalomethane levels. J Expos Anal Environ Epidemiol 2000: 10: 321–326.

    Article  CAS  Google Scholar 

  • Bove F.J., Fulcomer M.C., Klotz J.B., Esmart J., Dufficy E.M., and Savrin J.E. Public drinking water contamination and birth outcomes. Am J Epidemiol 1995: 141(9): 850–862.

    Article  CAS  Google Scholar 

  • Bove F.J., Shim Y., and Zeitz P. Drinking water contaminants and adverse pregnancy outcomes: a review. Environ Health Perspect 2002: 110(Suppl 1): 61–74.

    Article  Google Scholar 

  • Consumer Reports. Fit to drink?, January 1990 pp 27–43.

  • Dodds L., King W.D., Allen A.C., Armson B.A., Fell D., and Nimrod C. Trihalomethanes in public water supplies and risk of stillbirth. Epidemiology 2004 (in press).

  • Dodds L., King W., Woolcott C., and Pole J. Trihalomethanes in public water supplies and adverse birth outcomes. Epidemiology 1999: 10(3): 233–237.

    Article  CAS  Google Scholar 

  • Environmental Protection Agency (EPA). EPA panel report and recommendations for conducting epidemiological research on possible reproductive and developmental effects of exposure to disinfected drinking water, Research Triangle Park, NC, 1998.

  • Gallagher M.D., Nuckols J.R., Stallones L., and Savitz D.A. Exposure to trihalomethanes and adverse pregnancy outcomes. Epidemiology 1998: 9: 484–489.

    Article  CAS  Google Scholar 

  • Jaakkola J.J.K., Magnus P., Skrondal A., Hwang B.-F., Becher G., and Dybing E. Foetal growth and duration of gestation relative to water chlorination. Occup Environ Med 2001: 58: 437–442.

    Article  CAS  Google Scholar 

  • Kallen B.A.J., and Robert E. Drinking water chlorination and delivery outcome—a registry-based study in Sweden. Reprod Toxicol 2000: 14: 303–309.

    Article  CAS  Google Scholar 

  • Kanitz S., Franco Y., Patrone V., Caltabellotta M., Raffo E., Riggi C., Timitilli D., and Ravera G. Association between drinking water disinfection and somatic parameters at birth. Environ Health Perspect 1996: 104(5): 516–520.

    Article  CAS  Google Scholar 

  • Kelsey J.L., Whittemore A.S., Evans A.S., and Thompson W.D. Methods in Observational Epidemiology. Oxford University Press, New York, 1996.

    Google Scholar 

  • Kerger B.D., Schmidt C.E., and Paustenbach D.J. Assessment of airborne exposure to trihalomethanes from tap water in residential showers and baths. Risk Anal 2000: 20: 637–651.

    Article  CAS  Google Scholar 

  • Klotz J.B., and Pyrch L.A. Neural tube defects and drinking water disinfection byproducts. Epidemiology 1999: 10: 383–390.

    Article  CAS  Google Scholar 

  • Kramer M.D., Lynch C.F., Isacson P., and Hanson J.W. The association of waterborne chloroform with intrauterine growth retardation. Epidemiology 1992: 3: 407–413.

    Article  CAS  Google Scholar 

  • Krasner S.W., McGuire M.J., Jacaugelo J.G., Patania N.L., Reagen K.M., and Aieta E.M. The occurrence of disinfection byproducts in US drinking water. J Am Water Works Assoc 1989: 81: 41–53.

    Article  CAS  Google Scholar 

  • Kuo H.W., Chiang T.F., Lo I.I., Lai J.S., Chan C.C., and Wand J.D. VOC concentration in Taiwan's household drinking water. Science of the Total Environ 1997: 208: 41–47.

    Article  CAS  Google Scholar 

  • Lynberg M., Nuckols J.R., Langlois P., Ashley D., Singer P., Mendola P., Wilkes C., Krapfl H., Miles E., Speight V., Lin B., Small L., Miles A., Bonin M., Zeitz P., Tadkod A., Henry J., and Forrester M.B. Assessing exposure to disinfection byproducts in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods. Environ Health Perspect 2001: 109(6): 597–604.

    Article  CAS  Google Scholar 

  • Mills C.J., Bull R.J., Cantor K., Reif J., Hrudey S., and an expert working group. Health risk of drinking water chlorination byproduct: report of an expert working group. Chronic Diseases Canada 1998: 19(3): 91–102.

    CAS  Google Scholar 

  • Nieuwenhuijsen M.J., Toledano M.B., Eaton N.E., Fawell J., and Elliott P. Chlorine disinfection byproducts in water and their association with adverse reproductive outcomes: a review. J Occup Environ Med 2000: 57: 73–85.

    Article  CAS  Google Scholar 

  • Oliver B.G., and Lawence J. Haloforms in drinking water: a study of precursors and precursor removal. J Am Water Works Assoc 1979: 7: 161–163.

    Article  Google Scholar 

  • Pourmogahaddas H., and Stevens A.A. Relationship between trihalomethanes and haloacetic acids with total organic halogen during chlorination. Water Res 1995: 29: 2059–2062.

    Article  Google Scholar 

  • Reif J.S., Hatch M.C., Bracken M., Holmes L., Schwetz B., and Singer P.C. Reproductive and developmental effects of disinfection byproducts in drinking water. Environ Health Perspect 1996: 104: 1056–1061.

    Article  CAS  Google Scholar 

  • Savitz D.A., Andrews K.W., and Pasore L.M. Drinking water and pregnancy outcome in Central North Carolina: source, amount, and trihalomethane levels. Environ Health Perspect 1995: 103: 592–596.

    Article  CAS  Google Scholar 

  • Shaw G.M., Malcoe L.H., Milea A., and Swan S.H. Chlorinated water exposures and congenital cardiac anomalies (letter to the editor). Epidemiology 1991: 2: 459–460.

    CAS  PubMed  Google Scholar 

  • Singer P.C. Formation and characterization of disinfection byproducts, In: Cruan G.F. (ed.) Safety of Water Disinfection: Balancing Microbial Risks. International Life Sciences Inst. Press, Washington DC, 1993 pp 201–219.

    Google Scholar 

  • Waller K., Swan S.H., DeLorenze G., and Hopkins B. Trihalomethanes in drinking water and spontaneous abortion. Epidemiology 1998: 9: 134–140.

    Article  CAS  Google Scholar 

  • Weisel C.P., and Jo W.K. Ingestion, inhalation and dermal exposures to chloroform and trichloroethene from tap water. Environ Health Perspect 1996: 104(1): 48–51.

    Article  CAS  Google Scholar 

  • Williams D.T., LeBel G.L., and Benoit F.M. Disinfection byproducts in Canadian drinking water. Chemosphere 1997: 34(2): 299–316.

    Article  CAS  Google Scholar 

  • Wu W.W., Benjamin M.M., and Korshin G.V. Effects of thermal treatment on halogenated disinfection byproducts in drinking water. Water Res 2001: 35(15): 3545–3550.

    Article  CAS  Google Scholar 

  • Yang C.Y., Cheng B.H., Tsai S.S., Wu T.N., Lin M.C., and Lin K.C. Association between chlorination of drinking water and adverse pregnancy outcome in Taiwan. Environ Health Perspect 2000: 108: 765–768.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This research was funded by the Toxic Substance Research Initiative, a research program managed jointly by Health Canada and Environment Canada, and by the Canadian Chlorine Coordinating Committee. LD and BAA are supported by a Clinical Research Scholar Award from Dalhousie University. We thank the study coordinators Adelia Trenchard and Celine Zakos. We are grateful for assistance from the Reproductive Care Program of Nova Scotia, the Perinatal Partnership Program of Eastern and Southeastern Ontario, and the Analytical Services Unit of Queen's University. We thank all the participating physicians and hospitals.

Author information

Authors and Affiliations

  1. Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada

    Will D King

  2. Departments of Obstetrics and Gynaecology and Pediatrics, Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada

    Linda Dodds, B Anthony Armson, Alexander C Allen & Deshayne B Fell

  3. Department of Obstetrics and Gynaecology, Ottawa University, Ottawa, Ontario, Canada

    Carl Nimrod

Authors
  1. Will D King
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Dodds
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Anthony Armson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander C Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deshayne B Fell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carl Nimrod
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Will D King.

Rights and permissions

Reprints and permissions

About this article

Cite this article

King, W., Dodds, L., Armson, B. et al. Exposure assessment in epidemiologic studies of adverse pregnancy outcomes and disinfection byproducts. J Expo Sci Environ Epidemiol 14, 466–472 (2004). https://doi.org/10.1038/sj.jea.7500345

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jea.7500345

Keywords

This article is cited by

Search

Advanced search

Quick links