Experimental data suggest that chlorite and chlorate, the main disinfection by-products (DBPs) when chlorine dioxide is used, can be related to developmental toxicity, however no epidemiological evidence is available. This study is a part of the international project “HiWate” (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water), funded under the EU Sixth Framework Programme for Research and Technological Development (FP6), and had the aim to evaluate the risk of congenital anomalies related to chlorite and chlorate exposure during pregnancy.METHODS: A case-control study was carried out in a Northern Italy region (Emilia-Romagna). During the study period (2002-2005), newborns with different congenital anomalies (neural tube, cardiovascular, abdominal wall, cleft lip and palate, respiratory, genital organs and urinary tract defects) or chromosomal anomalies were extracted from the Regional Malformation Registry, while controls (newborns without malformations) were randomly selected from the Regional Birth Register. On the basis of each mother’s address the network supplying drinking water during the period of interest (first trimester of pregnancy) was identified: data on disinfection, water quality and DBPs were linked to each subject.RESULTS: Chlorite levels were available for 5494 subjects (mean value:427±184µg/l; range <200-1283µg/l); chlorate levels were available for 1178 women (mean value:283±78µg/l; range <200-1140µg/l). In comparison to subjects exposed to levels below 200µg/l, women exposed to chlorite level >700µg/l resulted, after adjusting for personal, reproductive and socio-economical confounders, at higher risk of newborns with renal defects (OR:3.3; 95%IC:1.4-8.1), abdominal wall defects (OR:6.9; 95%IC:1.7-28), cleft palate (OR:4.1; 95%IC:0.98-16.8); while women exposed to chlorate level >200µg/l resulted at higher risk of newborns with obstructive urinary defects (OR:2.9; 95%IC:1.1-7.6), spina bifida (OR:4.94; 95%IC:1.1-22).CONCLUSIONS: This was the first epidemiological study evaluating the relationship between chlorite and chlorate exposure and congenital anomalies and, despite of the ecological exposure assessment, significant increased risks were observed, mainly for urinary tract defects
CHLORATE AND CHLORITE EXPOSURE VIA DRINKING WATER DURING PREGNANCY AND THE RISK OF CONGENITAL ANOMALIES / Righi, Elena; Bechtold, PETRA ELISABETH; Mariosa, D; Mastroianni, Katia; Giacobazzi, Pierluigi; Predieri, Guerrino; Calzolari, E; Astolfi, G; Lauriola, P; Tortorici, D; Fantuzzi, Guglielmina; Aggazzotti, Gabriella. - In: EPIDEMIOLOGY. - ISSN 1044-3983. - STAMPA. - 22:1(2011), pp. S125-S125. (Intervento presentato al convegno Conference of International Society of Exposure Science & International Society for Environmental Epidemiology ISES-ISEE 2010 Technology, Environmental sustainability and Health tenutosi a Seoul, Korea nel 28 August -1 September 2010).
CHLORATE AND CHLORITE EXPOSURE VIA DRINKING WATER DURING PREGNANCY AND THE RISK OF CONGENITAL ANOMALIES
RIGHI, Elena;BECHTOLD, PETRA ELISABETH;MASTROIANNI, KATIA;GIACOBAZZI, Pierluigi;PREDIERI, Guerrino;FANTUZZI, Guglielmina;AGGAZZOTTI, Gabriella
2011
Abstract
Experimental data suggest that chlorite and chlorate, the main disinfection by-products (DBPs) when chlorine dioxide is used, can be related to developmental toxicity, however no epidemiological evidence is available. This study is a part of the international project “HiWate” (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water), funded under the EU Sixth Framework Programme for Research and Technological Development (FP6), and had the aim to evaluate the risk of congenital anomalies related to chlorite and chlorate exposure during pregnancy.METHODS: A case-control study was carried out in a Northern Italy region (Emilia-Romagna). During the study period (2002-2005), newborns with different congenital anomalies (neural tube, cardiovascular, abdominal wall, cleft lip and palate, respiratory, genital organs and urinary tract defects) or chromosomal anomalies were extracted from the Regional Malformation Registry, while controls (newborns without malformations) were randomly selected from the Regional Birth Register. On the basis of each mother’s address the network supplying drinking water during the period of interest (first trimester of pregnancy) was identified: data on disinfection, water quality and DBPs were linked to each subject.RESULTS: Chlorite levels were available for 5494 subjects (mean value:427±184µg/l; range <200-1283µg/l); chlorate levels were available for 1178 women (mean value:283±78µg/l; range <200-1140µg/l). In comparison to subjects exposed to levels below 200µg/l, women exposed to chlorite level >700µg/l resulted, after adjusting for personal, reproductive and socio-economical confounders, at higher risk of newborns with renal defects (OR:3.3; 95%IC:1.4-8.1), abdominal wall defects (OR:6.9; 95%IC:1.7-28), cleft palate (OR:4.1; 95%IC:0.98-16.8); while women exposed to chlorate level >200µg/l resulted at higher risk of newborns with obstructive urinary defects (OR:2.9; 95%IC:1.1-7.6), spina bifida (OR:4.94; 95%IC:1.1-22).CONCLUSIONS: This was the first epidemiological study evaluating the relationship between chlorite and chlorate exposure and congenital anomalies and, despite of the ecological exposure assessment, significant increased risks were observed, mainly for urinary tract defects
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