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The Effect of Water Disinfection By-products on Pregnancy Outcomes in Two Southeastern US Communities

Horton, Bethany Jablonski BS; Luben, Thomas J. PhD; Herring, Amy H. ScD; Savitz, David A. PhD; Singer, Philip C. PhD; Weinberg, Howard S. DSc; Hartmann, Katherine E. MD, PhD

Journal of Occupational and Environmental Medicine: October 2011 - Volume 53 - Issue 10 - p 1172–1178
doi: 10.1097/JOM.0b013e31822b8334
Original Articles

Objective: To determine if exposure to disinfection by-products (DBPs) during gestation increases the risk of adverse birth outcomes, specifically term small for gestational age (SGA) birth, preterm birth (PTB), and very PTB (<32 weeks’ gestation).

Methods: We used weekly measurements total trihalomethanes (TTHMs), five haloacetic acids (HAA5), and total organic halides (TOX) collected from two distribution systems to evaluate the associations between DBP concentrations and term SGA, PTB, and very PTB using logistic regression.

Results: We found no associations between DBPs and term-SGA. In the site with higher concentrations of bromine-containing DBPs, we found an association between TOX and PTB; this association was larger, though less precise, for very PTB.

Conclusions: Our results do not support an association between TTHMs or HAA5 and the birth outcomes investigated, but an association was found between increased TOX and PTB.

Supplemental Digital Content is available in the text.

From the Departments of Biostatistics (Ms Horton and Dr Herring) and Environmental Sciences and Engineering (Drs Singer and Weinberg), University of North Carolina Gillings School of Global Public Health, Chapel Hill; Carolina Population Center (Dr Herring), Chapel Hill; National Center for Environmental Assessments, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park (Dr Luben), NC; Departments of Community Health and Obstetrics and Gynecology (Dr Savitz), Brown University, Providence, RI; and Department of Obstetrics and Gynecology (Dr Hartmann), Vanderbilt University, Nashville, Tenn.

Address correspondence to: Bethany Horton, BS, 3101 McGavran-Greenberg Hall, CB 7420, Chapel Hill, NC 27599. E-mail:

This study was funded jointly by the AWWA Research Foundation (AwwaRF: Project 2579) and the US Environmental Protection Agency (USEPA) under Cooperative Agreement Nos. CR825625-01, CR827268-01, and CR828216-01, the Center for Environmental Health and Susceptibility (CEHS) at the University of North Carolina at Chapel Hill (P30E510126), US EPA STAR award RD-83184301-0, and NIH/NIEHS T32ES007018.

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©2011The American College of Occupational and Environmental Medicine