Examining the association between safe drinking water act violations and adverse birth outcomes in Virginia

In 1974, the United States established the Safe Drinking Water Act (SDWA) to protect consumers from potential exposure to drinking water contaminants associated with health risks. Each contaminant is assigned a health-based standard meant to reflect the maximum level at which an adverse human health outcome is unlikely; measurements beyond that level have greater potential to result in adverse health outcomes. Although there is extensive research on human health implications following water contaminant exposure, few studies have specifically examined associations between fetal health and municipal drinking water violations. Therefore, the objective of this study is to assess whether SDWA drinking water violations are associated with fetal health outcomes, including preterm birth (PTB), low birth weight (LBW), and term-low birth weight (tLBW), in the Commonwealth of Virginia. Singleton births (n = 665,984) occurring between 2007 and 2015 in Virginia were geocoded and assigned to a corresponding estimated water service area. Health-based (HB) and monitoring and reporting (MR) violations for 12 contaminants were acquired from the US EPA Safe Drinking Water Information System, with exposure defined at the approximate service area level to limit exposure misclassification. A logistic regression model for each birth outcome assessed potential relationships with SDWA violations. When examining the association between individual MR violations and birth outcomes, Nitrate-Nitrite (OR = 1.10; 95% CI = 1.02, 1.18, P = 0.01) was positively associated with PTB and the total coliform rule was negatively associated with tLBW (OR = 0.93; 95% CI = 0.87, 1.00, P = 0.04). These findings indicate that a lack of regular monitoring and reporting by water providers (resulting in monitoring and reporting violations) may be concealing health-based violations as these health concerns cannot be revealed without testing, suggesting a need for additional technical, managerial, and financial support to enable often-underfunded water systems to adhere to monitoring and reporting requirements meant to protect public health.