Tardiff Robert G, Carson M Leigh, Ginevan Michael E
The Sapphire Group, Inc., Bethesda, MD, USA.
Regul Toxicol Pharmacol. 2006 Jul;45(2):185-205. doi: 10.1016/j.yrtph.2006.03.001. Epub 2006 Apr 19.
Disinfection by-products (DBP) are produced when water is treated with chemical disinfectants. Some toxicological and epidemiological studies suggest an association between DBP exposure and adverse reproductive and developmental effects. In a previous critical review, [Graves, C.G., Matanoski, G.M., Tardiff, R.G., 2001. Weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products: a critical review. Regul. Toxicol. Pharmacol. 34, (2) 103-124] evaluated the weight of evidence for this exposure and these effects. This investigation updates the previous evaluation and considers all toxicological and epidemiological evidence since the earlier review and reassesses the weight-of-evidence for all of the data on the various effects, outcome by outcome. The updated toxicity weight of evidence found little indication of previously unreported reproductive or developmental toxicity. In particular, the recently published findings of an exceptionally well conducted cohort study of broad scope found no impact of chlorination by-products on the highly controversial outcome of spontaneous abortion, unlike predecessor studies of more limited methodology, leading the authors to recommend no further epidemiologic pursuit for this hypothesis since the cohort was scrutinized very closely and dispelled any concern of such an association. The updated epidemiologic weight of evidence demonstrated that no association with DBP exposure exists for over a dozen outcomes including low and very low birth weight, preterm delivery, some specific congenital anomalies, and neonatal death. The analysis found inconsistent or very weak results for all congenital anomalies/birth defects, all central nervous system anomalies, neural tube defects, and spontaneous abortion. As in the previous article, the updated weight of evidence suggested a positive association with DBP exposure and some measure of growth retardation such as intrauterine growth retardation, small for gestational age, term low birth weight, and small body length or head circumference. Exposure assessment in most epidemiological studies remains inadequate to definitively demonstrate any association of small magnitude.
当用水处理化学消毒剂时会产生消毒副产物（DBP）。一些毒理学和流行病学研究表明，接触DBP与不良生殖和发育影响之间存在关联。在之前的一项重要综述中，[格雷夫斯，C.G.，马塔诺斯基，G.M.，塔尔迪夫，R.G.，2001年。不良生殖和发育影响与接触消毒副产物之间关联的证据权重：一项重要综述。《监管毒理学与药理学》34卷，（2）103 - 124页]评估了这种接触与这些影响之间的证据权重。本次调查更新了之前的评估，并考虑了自早期综述以来的所有毒理学和流行病学证据，逐个结果地重新评估了关于各种影响的所有数据的证据权重。更新后的毒性证据权重几乎没有表明存在先前未报告的生殖或发育毒性。特别是，最近发表的一项范围广泛且实施得非常好的队列研究结果发现，与方法更有限的先前研究不同，氯化副产物对极具争议的自然流产结果没有影响，这使得作者建议不再对这一假设进行进一步的流行病学研究，因为该队列经过了非常仔细的审查，消除了对这种关联的任何担忧。更新后的流行病学证据权重表明，对于包括低出生体重和极低出生体重、早产、一些特定先天性异常以及新生儿死亡在内的十几种结果，不存在与DBP接触的关联。分析发现，对于所有先天性异常/出生缺陷、所有中枢神经系统异常、神经管缺陷和自然流产，结果不一致或非常微弱。与上一篇文章一样，更新后的证据权重表明与DBP接触以及某种程度的生长迟缓呈正相关，如宫内生长迟缓、小于胎龄、足月低出生体重以及小身长或小头围。大多数流行病学研究中的暴露评估仍然不足以明确证明任何微小关联。
