Righi E, Fantuzzi G, Montanari M, Bargellini A, Predieri G, Aggazzotti G
Dipartimento di Scienze Igienistiche, Microbiologiche e Biostatistiche, Università degli Studi di Modena e Reggio Emilia, Italy.
Ann Ig. 2003 Sep-Oct;15(5):649-62.
Chlorination By Products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, such as small term birth (STB) and preterm delivery. Up to date epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level: in this study the exposure is evaluated at the individual level. A case control study with incident cases was performed in Modena between October 1999-September 2000. 332 subjects were enrolled: 93 preterm births (26th-37th week of pregnancy), 73 STB (from 38th week, and weight less than the lowest 10th percentile) and 166 controls. Exposure was assessed both by applying a questionnaire on personal habits and by personal water sampling directly at subjects' home. THMs were analysed in all samples, chlorite and chlorate in water samples treated with chlorine dioxide. Subjects usually drinking tap water were few (5.2%): most of them were living in areas supplied by water treated with chlorine dioxide (87%). Levels of THMs were low (mean: 0.73 microgram/l), while chlorite and chlorate concentrations were relatively high (mean: 217.8 microgram/l for chlorites and 95.2 microgram/l for chlorates). Preterm birth did not show any significant association with CBPs, while STB appeared significantly associated, after adjusting for many potential confounders, with CBPs induced by chlorine dioxide treatment, especially with levels of chlorate higher than 200 microgram/l (OR: 4.7; 95%CI: 1.15-19.72). The association between STB and chlorate must be investigated further as the number of water utilities applying chlorine dioxide as disinfection treatment is increasing.
饮用水中的氯化副产物（CBPs）与不良妊娠结局风险增加有关，如足月前出生（STB）和早产。由于通常不准确的暴露评估（往往是在生态层面），现有流行病学证据的说服力被削弱：在本研究中，暴露评估是在个体层面进行的。1999年10月至2000年9月期间在摩德纳进行了一项针对新发病例的病例对照研究。共纳入332名受试者：93例早产（妊娠第26 - 37周）、73例足月前出生（从第38周起，体重低于最低第10百分位数）和166名对照。通过询问个人习惯问卷以及直接在受试者家中采集个人水样来评估暴露情况。对所有样本分析了三卤甲烷，对用二氧化氯处理的水样分析了亚氯酸盐和氯酸盐。通常饮用自来水的受试者很少（5.2%）：他们大多生活在由二氧化氯处理水供应的地区（87%）。三卤甲烷水平较低（均值：0.73微克/升），而亚氯酸盐和氯酸盐浓度相对较高（亚氯酸盐均值：217.8微克/升，氯酸盐均值：95.2微克/升）。早产与氯化副产物未显示出任何显著关联，而在调整了许多潜在混杂因素后，足月前出生与二氧化氯处理诱导的氯化副产物显著相关，尤其是氯酸盐水平高于200微克/升时（比值比：4.7；95%置信区间：1.15 - 19.72）。随着使用二氧化氯作为消毒处理的自来水公司数量不断增加，足月前出生与氯酸盐之间的关联必须进一步研究。
