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Water chlorination and birth defects: a systematic review and meta-analysis
Bing-Fang Hwang1, Jouni J K Jaakkola
1Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA.
Archives of Environmental Health
|August 6, 2003
Summary
Prenatal exposure to chlorination byproducts may increase the risk of certain birth defects, including neural tube and urinary system defects, according to a meta-analysis of epidemiological studies.
Area of Science:
- Environmental Health
- Epidemiology
- Reproductive Health
Background:
- Disinfection byproducts (DBPs) are formed during water chlorination.
- Concerns exist regarding potential adverse health effects of prenatal exposure to DBPs.
Purpose of the Study:
- To synthesize epidemiological evidence on the association between prenatal exposure to chlorination byproducts and birth defects.
- To quantify the risk of birth defects associated with DBPs through meta-analysis.
Main Methods:
- Systematic review and meta-analysis of studies identified through the Medline database (1966-2001).
- Calculation of summary odds ratios and confidence intervals using fixed-effects (Mantel-Haenszel) and random-effects (DerSimonian-Laird) models for 5 relevant studies.
Main Results:
- Evidence suggests an increased risk of any birth defect and specifically neural tube and urinary system defects with DBP exposure.
- Results for respiratory, cardiac, and oral cleft defects were heterogeneous and inconclusive.
Conclusions:
- Prenatal exposure to chlorination byproducts is associated with an increased risk of specific birth defects.
- Population susceptibility and exposure assessment methods may contribute to heterogeneity in findings.