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Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects

Kaufman, John, A., MPH; Wright, J., Michael, ScD; Evans, Amanda, MSPH; Rivera-Núñez, Zorimar, PhD; Meyer, Amy, BS; Narotsky, Michael, G., PhD

Journal of Occupational and Environmental Medicine: February 2018 - Volume 60 - Issue 2 - p 109–119
doi: 10.1097/JOM.0000000000001191
Original Articles

Objective: The aim of this study was to examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (ie, DBP9).

Methods: We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case–control study of 366 CFD cases in Massachusetts towns with complete 1999 to 2004 THM and HAA data.

Results: We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95% CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform.

Conclusion: This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects and DBPs beyond THM4.

Association of Schools and Programs of Public Health, hosted by U.S. Environmental Protection Agency, National Center for Environmental Assessment, Office of Research and Development, Cincinnati, Ohio (Mr Kaufman); National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Cincinnati, Ohio (Dr Wright); Campbell University, School of Osteopathic Medicine, Lillington, North Carolina (Ms Evans); Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (Dr Rivera-Núñez); Independent Researcher, New York, New York (Ms Meyer); and National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina (Dr Narotsky).

Address correspondence to: John A. Kaufman, MPH, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati, OH 45268 (kaufman.john.a@gmail.com).

This research was supported by Cooperative Agreement Number X3-83555301 from the U.S. Environmental Protection Agency (USEPA) and the Association of Schools and Programs of Public Health (ASPPH). The views expressed in this manuscript are those of the authors and do not necessarily reflect the views or policies of the US EPA or ASPPH.

A.E. was supported through the Oak Ridge Institute of Science and Education Research Participation Program (agreement no. DW8992376701) sponsored by the U.S. EPA. J.A.K. was supported by cooperative agreement no. X3-83555301 from the U.S. EPA and the Association of Schools and Programs of Public Health (ASPPH). Z.R.-N. was supported through The National Academies, Research Associateship Programs sponsored by the U.S. EPA.

Authors Kaufman, Wright, Evans, Rivera-Núñez, Meyer, and Narotsky have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

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Copyright © 2018 by the American College of Occupational and Environmental Medicine