Flint, Michigan had elevated water lead (Pb) levels during the 2014–15 Flint Water Crisis (FWC) and reports claim the exposures caused excess fetal deaths.
To model the likelihood of excess fetal deaths occurring from FWC lead exposure and compare results to Vital Records.
We used an established bio-kinetic model to predict relative blood lead trends in pregnant women from characteristic exposure to 90th percentile water lead levels (WLLs), and another established model to then estimate characteristic miscarriage (<20 gestation weeks) odds ratios (OR) in Flint (2011–17). For comparison, we made similar predictions for exposures during (1) Washington DC’s worst water lead crisis year (2001), (2) Flint “Resident Zero” home with anomalously high WLLs, and (3) 19th century lead-based abortifacients. Data on stillbirths (≥20 gestation weeks) and total fertility rates were obtained from the State of Michigan.
The models predicted that pregnant women drinking water with representative 90th percentile WLLs had a miscarriage OR during the worst FWC period (June–August 2014) of 1.21 (95% CI = 1.02,1.60), versus 1.66 (95% CI = 1.07, 3.56) during a time of high water lead 3 years before the FWC and 1.00 (95% CI = 1.00, 1.01) post-FWC. The corresponding predicted OR in late-2001 for Washington D.C. when higher fetal death rates were statistically associated with very high WLLs was 3.01 (95% CI = 1.16, 16.23). No apparent differences were revealed in overall and race-specific stillbirth rates before, during, or after the FWC. Total fertility rates dropped 6.8% during the FWC (April 2014–October 2015 versus April 2012–October 2013), but this is now revealed to be within the normal annual variation (−9.4% to +15%) observed post-FWC when residents were protected from water lead exposure.
Neither model simulations nor Vital Records data are consistent with the hypothesis that there was an uptick in fetal deaths or decreased fertility attributable to water lead exposure during the FWC.
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Schwake DO, Garner E, Strom OR, Pruden A, Edwards MA. Legionella DNA markers in tap water coincident with a spike in Legionnaires’ disease in Flint. Mi Environ Sci Technol Lett. 2016;3:311–5.
Pieper KJ, Tang M, Edwards MA. Flint water crisis caused by interrupted corrosion control: investigating “ground zero” home. Environ Sci Technol. 2017;51:2007–14.
Pieper KJ, Martin R, Tang M, Walters L, Parks J, Roy S, Devine C, Edwards MA. Evaluating water lead levels during the Flint water crisis. Environ Sci Technol. 2018;52:8124–32. https://doi.org/10.1021/acs.est.8b00791.
Rhoads WJ, Garner E, Ji P, Zhu N, Parks J, Schwake DO, Pruden A, Edwards MA. Distribution system operational deficiencies coincide with reported Legionnaires’ disease clusters in Flint, Michigan. Environ Sci Technol. 2017;51:11986–95. https://doi.org/10.1021/acs.est.7b01589.
Edwards M. Lead testing results for water sampled by residents. Flint Water Study. http://flintwaterstudy.org/information-for-flint-residents/results-for-citizen-testing-for-lead-300-kits/ Published September 2015. Accessed 12 Sep 2020.
Fonger R. Virginia Tech professor says Flint’s tests for lead in water can’t be trusted. MLive. http://www.mlive.com/news/flint/index.ssf/2015/09/virginia_tech_researcher_says.html Published September 2015. Accessed 12 Sep 2020.
Hanna-Attisha M, LaChance J, Sadler RC, Champney Schnepp A. Elevated blood lead levels in children associated with the Flint drinking water crisis: a spatial analysis of risk and public health response. Am J public health. 2016;106:283–90. https://doi.org/10.2105/AJPH.2015.303003.
Roy S, Tang M, Edwards MA. Lead release to potable water during the Flint, Michigan water crisis as revealed by routine biosolids monitoring data. Water Res. 2019;160:475–83. https://doi.org/10.1016/j.watres.2019.05.091.
Roy S, Edwards MA. Preventing another lead (Pb) in drinking water crisis: Lessons from the Washington DC and Flint MI contamination events. Curr Opin Environ Sci Health. 2019;7:34–44. https://doi.org/10.1016/j.coesh.2018.10.002.
Roy S, Edwards MA. Efficacy of corrosion control and pipe replacement in reducing citywide lead exposure during the Flint, MI water system recovery. Environ Sci Water Res Technol. 2020. https://doi.org/10.1039/D0EW00583E
Fonger R. Two studies come to different conclusions on how Flint water affected stillbirths. MLive. https://www.mlive.com/news/flint/2019/08/two-studies-come-to-different-conclusions-on-how-flint-water-affected-stillbirths.html Published August 2019. Accessed 12 Sep 2020.
Gómez HF, Borgialli DA, Sharman M, Weber AT, Scolpino AJ, Oleske JM, Bogden JD. Blood lead levels in females of childbearing age in Flint, Michigan, and the water crisis. Obstet Gynecol. 2019;134:628–35.
Grossman D, Slutsky DJ. The effect of an increase in lead in the water system on fertility and birth outcomes: The case of Flint, Michigan. https://researchrepository.wvu.edu/cgi/viewcontent.cgi?article=1017&context=econ_working-papers Published September 2017. Accessed 12 Sep 2020.
The Economist. The water crisis in Flint, Michigan has had terrible consequences for residents’ health. https://www.economist.com/graphic-detail/2017/09/27/the-water-crisis-in-flint-michigan-has-had-terrible-consequences-for-residents-health Published September 2017. Accessed 12 Sep 2020.
Wang R, Chen X, Li X. Something in the pipe: Flint water crisis and health at birth. https://www.econstor.eu/bitstream/10419/196614/1/dp12115.pdf Published January 2019. Accessed 12 Sep 2020.
Wells K. So, the state says Flint water crisis did NOT hurt pregnancy outcomes. Now what? Michigan Radio. https://www.michiganradio.org/post/so-state-says-flint-water-crisis-did-not-hurt-pregnancy-outcomes-now-what Published October 2017. 12 Accessed Sep 2020.
Schaefer J. Flint wonders: What’s true in all those water studies? Conflicting results causing stress. Detroit Free Press. https://www.freep.com/story/news/2017/10/15/flint-water-crisis-studies/761752001/ Published October 2017. Accessed 12 Sep 2020.
Centers for Disease Control and Prevention. Fetal Deaths: National Vital Statistics System. https://www.cdc.gov/nchs/nvss/fetal_death.htm Published April 2020. Accessed 12 Sep 2020.
Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res Part A: Clin Mol Teratol. 2012;94:417–23.
Hurt KJ, Guile MW, Bienstock JL, Fox HE, Wallach EE. The Johns Hopkins manual of gynecology and obstetrics. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
Goldenberg RL, Kirby R, Culhane JF. Stillbirth: a review. J Matern-fetal neonatal Med. 2004;16:79–94. https://doi.org/10.1080/jmf.188.8.131.52.
MacDorman MF, Reddy UM, Silver RM. Trends in stillbirth by gestational age in the United States, 2006–2012. Obstet Gynecol. 2015;126:1146–1150.
Edwards M. Fetal death and reduced birth rates associated with exposure to lead-contaminated drinking water. Environ Sci Technol. 2014;48:739–46.
Troesken W. The great lead water pipe disaster. Cambridge, MA: Mit Press; 2006.
Ingraham C. Flint’s lead-poisoned water had a ‘horrifyingly large’ effect on fetal deaths, study finds. The Washington Post. https://www.washingtonpost.com/news/wonk/wp/2017/09/21/flints-lead-poisoned-water-had-a-horrifyingly-large-effect-on-fetal-deaths-study-finds/ Published September 2017. Accessed 12 Sep 2020.
Grossman DS, Slusky DJ. The impact of the Flint water crisis on fertility. Demography. 2019;56:2005–31.
Edwards M. COMMENTARY: MDEQ Mistakes and Deception Created the Flint Water Crisis. Flint Water Study http://flintwaterstudy.org/2015/09/commentary-mdeq-mistakes-deception-flint-water-crisis/ Published September 2015. Accessed 12 Sep 2020.
O’Flaherty EJ. A physiologically based kinetic model for lead in children and adults. Environ Health Perspect. 1998;106:1495–503.
Pounds JG, Leggett RW. The ICRP age-specific biokinetic model for lead: validations, empirical comparisons, and explorations. Environ Health Perspect. 1998;106:1505–11.
United States Environmental Protection Agency. Lead at Superfund Sites: Software and Users’ Manuals. https://www.epa.gov/superfund/lead-superfund-sites-software-and-users-manuals. Published June 2009. Accessed 12 Sep 2020.
Khoury GA, Diamond GL. Risks to children from exposure to lead in air during remedial or removal activities at Superfund sites: a case study of the RSR lead smelter Superfund site. J Exposure Sci Environ Epidemiol. 2003;13:51–65.
Pizzol M, Thomsen M, Andersen MS. Long-term human exposure to lead from different media and intake pathways. Sci Total Environ. 2010;408:5478–88.
Borja-Aburto VH, Hertz-Picciotto I, Lopez MR, Farias P, Rios C, Blanco J. Blood lead levels measured prospectively and risk of spontaneous abortion. Am J Epidemiol. 1999;150:590–7.
Edwards M, Triantafyllidou S, Best D. Elevated blood lead in young children due to lead-contaminated drinking water: Washington, DC, 2001–2004. Environ Sci Technol 2009;43:1618–23.
McLaren, A. Birth Control in Nineteenth-Century England. New York, NY: Holmes & Meier Publishers, Inc., 1978. p.242–246.
U.S. Environmental Protection Agency. Exposure Factors Handbook Chapter 3 (Update, Ingestion of Water and Other Select Liquids. http://ofmpub.epa.gov/eims/eimscomm.getfile?p_download_id=538153 Published February 2019. Accessed 12 Sep 2020.
FlintWaterStudy.org. Lead Results from Tap Water Sampling in Flint, MI during the Flint Water Crisis—Citizen Science Rounds 1-5. http://flintwaterstudy.org/2017/09/complete-dataset-lead-results-from-tap-water-sampling-in-flint-mi-rounds-1-5/ Published 2017. Accessed 23 Mar 2021.
Ettinger, AS, Egan, KB, Homa, DM, Brown, MJ. Blood lead levels in US women of childbearing age, 1976–2016. Environmental Health Perspect. 2020;128:017012.
Centers for Disease Control and Prevention. NHANES Questionnaires, Datasets, and Related Documentation. https://wwwn.cdc.gov/nchs/nhanes/default.aspx Published August 2020. Accessed 23 March 2021.
US Environmental Protection Agency. Guidance Manual for the IEUBK Model for Lead in Children (OSWER 9285.7-15-1). USEPA Office of Solid Waste and Emergency Response, Washington, DC, USA, 1994.
Vork K, Carlisle J, Brown JP. Estimating Workplace Air and Worker Blood Lead Concentration using an Updated Physiologically-based Pharmacokinetic (PBPK) Model: Office of Environmental Health Hazard Assessment. California Environmental Protection Agency. 2013. https://oehha.ca.gov/media/downloads/air/document/pbpk2013.pdf Published 2013. Accessed March 8, 2021.
Centers for Disease Control and Prevention. Stillbirth Data and Statistics. https://www.cdc.gov/ncbddd/stillbirth/data.html Published August 2020. Accessed 12 Sep 2020.
US Census Bureau. QuickFacts: Flint city, Michigan. US Census. https://www.census.gov/quickfacts/fact/table/flintcitymichigan,detroitcitymichigan, MI US/PST045219 Published 2019. Accessed 21 June 2020.
Centers for Disease Control and Prevention. Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP, Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. https://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf Published 2010. Accessed 23 Mar 2021.
Hertz‐Picciotto I. The evidence that lead increases the risk for spontaneous abortion. Am J Ind Med. 2000;38:300–9.
Tallarida RJ, Murray RB. Area under a curve: trapezoidal and Simpson’s rules. In Manual of Pharmacologic Calculations. New York, NY: Springer; 1987. p. 77–81.
US Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. US Department of Health and Human Services. 2007. https://stacks.cdc.gov/view/cdc/37676. Accessed 6 July 2021.
Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CM. Impact Evaluation in Practice, second edition. Washington, DC: Inter-American Development Bank and World Bank; 2016.
Torres-Reyna O. Differences-in-Differences (using R). Princeton University. https://www.princeton.edu/~otorres/DID101R.pdf Published August 2015. Accessed 23 Mar 2021.
Bertrand M, Duflo E, Mullainathan S. How much should we trust differences-in-differences estimates?. The Quarterly journal of economics. 2004;119:249–75.
Tenny S, Hoffman MR. Odds ratio (OR). StatPearls [Internet]. Treasure Island (FL, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431098/ Published November 2019. Accessed 23 Mar 2021.
Ettinger AS, Wengrovitz AM. Guidelines for the identification and management of lead exposure in pregnant and lactating women. Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/11854 Published November 2010. Accessed 12 Sep 2020.
Vigeh M, Yokoyama K, Kitamura F, Afshinrokh M, Beygi A, Niroomanesh S. Early pregnancy blood lead and spontaneous abortion. Women health. 2010;50:756–66.
Rosinger AY, Herrick KA, Wutich AY, Yoder JS, Ogden CL. Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007–2014. Public health Nutr. 2018;21:1455–64.
Edwards M, Mantha A. Lead in Drinking Water – Health Risks to Flint Residents. Flint Water Study. http://flintwaterstudy.org/2015/09/lead-in-drinking-water-health-risks-to-flint-residents/ Published September 2015. Accessed 12 Sep 2020.
Michigan Department of Health and Human Services. Blood Lead Level Test Results for Selected Flint Zip Codes, Genesee County, and the State of Michigan: Executive Summary for November 2020 https://www.michigan.gov/documents/mdhhs/November_Monthly_Executive_Blood_Lead_Report_01.05.21_721106_7.pdf Published December 2020. Accessed 2 Apr 2021.
Hertz-Picciotto I, Swan SH, Neutra RR, Samuels SJ. Spontaneous abortions in relation to consumption of tap water: an application of methods from survival analysis to a pregnancy follow-up study. Am J Epidemiol. 1989;130:79–93.
Zender R, Bachand AM, Reif JS. Exposure to tap water during pregnancy. J Exposure Sci Environ Epidemiol. 2001;11:224–30.
Smith L. This mom helped uncover what was really going on with Flint’s water. Michigan Radio. https://www.michiganradio.org/post/mom-helped-uncover-what-was-really-going-flint-s-water Published December 2015. Accessed 12 Sep 2020.
Zahran S, McElmurry SP, Sadler RC. Four phases of the Flint water crisis: Evidence from blood lead levels in children. Environ Res. 2017;157:160–72.
Mantha A, Tang M, Pieper KJ, Parks JL, Edwards MA. Tracking reduction of water lead levels in two homes during the Flint Federal Emergency. Water Research X. 2020;100047. https://doi.org/10.1016/j.wroa.2020.100047
Olson ED, Fedinick KP. What’s in Your Water: Flint and Beyond. NRDC, June. 2016. https://www.nrdc.org/resources/whats-your-water-flint-and-beyond Published June 2016. Accessed 12 Sep 2020.
Kiken S, Sinks T, Stringer W, Coleman M, Crandall M, Seitz T. Health Hazard Evaluation Report: (1990) USA Today/Gannett Co., Inc., Rosslyn, Virginia. National Institute for Occupational Safety and Health (NIOSH), April 1990. https://www.cdc.gov/niosh/hhe/reports/pdfs/1989-0069-2036.pdf
Michigan Department of Health and Human Services. 2017. Flint perinatal metrics analyses: Michigan Department of Health and Human Services. https://www.michigan.gov/documents/mdhhs/Flint_Perinatal_Metrics_Updated_10.4.17_603174_7.pdf Published October 2017. Accessed 12 Sep 2020.
Roy S. The Hand-in-Hand Spread of Mistrust and Misinformation in Flint. American Scientist. 2017;105:22. https://doi.org/10.1511/2017.124.22.
Flint Cares. From Crisis to Recovery: Household Resources. Flint Cares. http://flintcares.com/wp-content/uploads/2018/05/Crisis-to-Recovery-Booklet_Rev.pdf Published May 2018. Accessed 12 Sep 2020.
Roy S, Edwards M. Citizen Science During the Flint, Michigan Federal Water Emergency: Ethical Dilemmas and Lessons Learned. Citizen Science: Theory and Practice. 2019;4. https://doi.org/10.5334/cstp.154.
Morckel V, Rybarczyk G. The effects of the water crisis on population dynamics in the City of Flint. Mich Cities Health 2018;2:69–81.
Khazan O. The Trouble With America’s Water. The Atlantic. https://www.theatlantic.com/health/archive/2019/09/millions-american-homes-have-lead-water/597826/ Published September 2019. Accessed 12 Sep 2020.
Laitner B. Detroit passes Michigan’s stricter tests for lead contaminated water. Detroit Free Press. https://www.freep.com/story/news/local/michigan/detroit/2019/11/19/detroit-water-lead-levels-michigan/4236166002/ Published November 2019. Accessed 12 Sep 2020.
Facebook. Lead can cause… Environmental Defense Fund. https://www.facebook.com/EnvDefenseFund/posts/10157922009818164 Published February 2020. Accessed 12 Sep 2020.
Falconer R, Rummler O. Michigan to pay Flint water crisis victims $600 million. Axios. https://www.axios.com/michigan-flint-water-crisis-victims-600-million-pay-9f471b15-e24f-4f76-9895-a5af375243ac.html Published August 2020. Accessed 12 Sep 2020.
Nellany T, Phinney R, Schmidt Gordon S, Smith K, Weinstein J, Wood BA. Flint [Documentary]. United Kingdom: Montrose Pictures. https://www.imdb.com/title/tt5472822/
Alfonsi S. Early results from 174 Flint children exposed to lead during water crisis shows 80% of them will require special education services. CBS News 60 min https://www.cbsnews.com/news/flint-water-crisis-effect-on-children-60-minutes-2020-03-15/ Published March 2020. Accessed 12 Sep 2020.
Murdock R, Murray M, Simpson-Mersha I. ‘The money is not justice’: Flint mothers express relief, skepticism about water crisis settlement. MLive. https://www.mlive.com/news/flint/2020/08/the-money-is-not-justice-flint-mothers-express-relief-skepticism-about-water-crisis-settlement.html Published August 2020. Accessed 12 Sep 2020.
Sobeck J, Smith-Darden J, Hicks M, Kernsmith P, Kilgore PE, Treemore-Spears L, McElmurry S. Stress, Coping, Resilience and Trust during the Flint Water Crisis. Behav Med. 2020;46:202–16.
Robertson D. Flint Has Clean Water Now. Why Won’t People Drink It?. Politico. https://www.politico.com/news/magazine/2020/12/23/flint-water-crisis-2020-post-coronavirus-america-445459 Published December 2020. Accessed 2 Apr 2021.
Garcıa-Enguıdanos A, Calle ME, Valero J, Luna S, Domınguez-Rojas V. Risk factors in miscarriage: a review. Eur J Obstet Gynecol Reprod Biol. 2002;102:111–119.
Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. Bmj. 2013;346:346 https://doi.org/10.1136/bmj.f108.
Danagoulian S, Jenkins D. Rolling Back the Gains: Flint Water Switch Undermines Progress of Maternal Health in Pregnancy. Working Paper. http://papers.shooshandanagoulian.com/SecondDraft_Winter2020.pdf Published April 2020. Accessed 12 Sep 2020.
Abouk R, Adams S. Birth outcomes in Flint in the early stages of the water crisis. J Public Health Policy. 2018;39:68–85.
Hoyert DL, Gregory EC. Cause of fetal death: data from the fetal death report, 2014: Centers for Disease Control and Prevention. National vital statistics reports. 65:2017–1120 https://stacks.cdc.gov/view/cdc/42413
Maddaloni M, Ballew M, Diamond G, Follansbee M, Gefell D, Goodrum P, Johnson M, Koporec K, Khoury G, Luey J, Odin M, Troast R, Van Leeuwen P, Zaragoza L. Assessing lead risks at non-residential hazardous waste sites. Hum Ecol Risk Assess. 2005;11:967–1003.
Paneth N. Review of: Grossman DS, Slusky DJG: The Effect of an Increase in Lead in the Water System on Fertility and Birth Outcomes: The Case of Flint, Michigan. 2017. https://mediad.publicbroadcasting.net/p/michigan/files/review_of_grossman_and_slusky_paper.pdf?_ga=2.44376164.1108148605.1506794535-1282647051.1440964267 Published 2017. Accessed 12 Sep 2020.
Kirby RS. Re: Case-cohort analysis of agricultural pesticide applications near maternal residence and selected causes of fetal death. Am J Epidemiol. 2002;155:779–80.
We are grateful to Dr. Gary Diamond (Syracuse Research Corporation) for providing a user-friendly Excel version of the ICRP bio-kinetic model (v. R5CHELATE.3000), Drs. Sarah Lyon-Callo and Patricia McKane (Michigan Department of Health and Human Services) for stillbirth data and providing feedback on this manuscript under a Data User Agreement, Drs. David J. G. Slusky (University of Kansas) and Daniel S. Grossman (West Virginia University) for general fertility rate data and relevant discussions at the 2019 American College of Toxicology conference, and Virginia Tech’s Statistical Applications and Innovations Group for statistical advice on using the miscarriage model. We also acknowledge CrowdTangle, a public insights tool owned and operated by Facebook, which allowed us to search for news shares about fetal deaths in Flint on public Facebook pages and groups.
This study was partly funded and developed under grants awarded by the U.S. Environmental Protection Agency (No. 8399375 “Untapping the Crowd: Consumer Detection and Control of Lead in Drinking Water”) and Spring Point Partners LLC to Virginia Tech. This work has not been formally reviewed by USEPA or Spring Point Partners LLC. The findings, conclusions, and opinions in this report are those of the author(s) and do not necessarily represent the official position of the USEPA or Spring Point Partners LLC. USEPA or Spring Point Partners LLC do not endorse any products or commercial services mentioned in this publication. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
MAE and SR worked with Flint residents to expose the Flint Water Crisis, and their data, testimony and emails have been subpoenaed in several lawsuits. They are not party to any of these lawsuits. MAE has been subpoenaed as a fact witness in many of the lawsuits, but he has refused all financial compensation for time spent on those activities. Previously, MAE served as an uncompensated fact witness in lawsuits pertaining to the Washington DC lead in drinking water crisis, all of which have ended.
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Roy, S., Edwards, M.A. Are there excess fetal deaths attributable to waterborne lead exposure during the Flint Water Crisis? Evidence from bio-kinetic model predictions and Vital Records. J Expo Sci Environ Epidemiol 32, 17–26 (2022). https://doi.org/10.1038/s41370-021-00363-z