The potential reproductive effects of long-term, low-dose exposure to chloroform have received little attention despite the known, acute toxicity of high exposures and the widespread occurrence of low concentrations in drinking water. We studied the association of waterborne chloroform with low birthweight (<2,500 gm), prematurity (<37 weeks gestation), and intrauterine growth retardation (<5th percentile of weight for gestational age). Cases were not mutually exclusive, but each outcome was analyzed independently. Birth certificates from January 1, 1989, to June 30, 1990, were used to identify cases and randomly selected controls. All were live, singleton infants born to non-Hispanic, white women from Iowa towns with 1,000–5,000 inhabitants. Exposures to chloroform and other trihalomethanes were ecologic variables based on maternal residence and a 1987 municipal water survey. After adjustment for maternal age, parity, adequacy of prenatal care, marital status, education, and maternal smoking by multiple logistic regression, residence in municipalities where chloroform concentrations were ≥10 μg/liter was associated with an increased risk for intrauterine growth retardation (odds ratio = 1.8, 95% confidence interval = 1.1–2.9). The major limitations of this study involve the ascertainment and classification of exposures to trihalomethanes, including such issues as the imprecision of using aggregate municipal measures for classifying exposure at the level of the individual, the potential misclassification due to residential mobility, and the fluctuation of trihalomethane levels. (Epidemiology 1992;3:407–413)
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