Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3 East, Boston, MA, 02118, USA.
Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921B, Boston, MA, 02118, USA.
Environ Health. 2018 Jul 3;17(1):58. doi: 10.1186/s12940-018-0402-1.
Residents of Massachusetts and Rhode Island were exposed to tetrachloroethylene (PCE)-contaminated drinking water from 1968 through the early 1990s when the solvent was used to apply a vinyl liner to drinking water mains to address taste and odor problems. Few studies have examined the risk of fetal death among women exposed to solvent-contaminated drinking water. Two previous investigations found moderate increases in the risk of stillbirth among highly exposed women; however, these results were based on a small number of cases. The present case-control study was undertaken to examine further this association with a large number of stillbirths.
Cases were comprised of stillborn infants delivered between 1968 and 1995 to mothers who resided in 28 Massachusetts and Rhode Island cities and towns with some affected water mains (N = 296). Cases were included if the cause of death was placental abruption and/or placental insufficiency. Controls were randomly selected live-born infants who were delivered in the same time period and geographic area (N = 783). Data on confounding variables were gathered from vital records and questionnaires. PCE exposure was estimated using a leaching and transport model integrated into water system software.
Mothers with any PCE exposure had a 1.7-fold increase in the adjusted odds of placenta-related stillbirth (95% CI: 1.2-2.4). The adjusted odds ratio (OR) increased as a woman's exposure level increased: in comparison to unexposed mothers, ORs were 1.5 (95% CI: 1.0-2.3) for low exposure (> 0-median), 1.7 (95% CI: 1.1-2.5) for moderate exposure (>median-90th percentile) and 1.9 (95% CI: 1.1-3.2) for high exposure (>90th percentile) (p value for trend = 0.02). A similar pattern was observed when PCE exposure was dichotomized at 40 μg/L, the suggested action guideline for remediation (OR = 1.5, 95% CI: 1.1-2.2 and OR = 2.6, 95% CI: 1.4-4.8, respectively, for PCE exposure <=40 μg/L and > 40 μg/L) (p value for trend = .003).
We observed a linear dose-dependent increase in the odds of stillbirth due to placental abruption and placental insufficiency with prenatal exposure to PCE contaminated drinking water. Because PCE remains a common drinking water contaminant, these findings highlight the importance of considering pregnant women when monitoring, regulating and remediating drinking water supplies.
1968 年至 1990 年初，马萨诸塞州和罗得岛州的居民饮用水受到四氯乙烯（PCE）污染，当时该溶剂被用于饮用水总管上涂乙烯基衬里，以解决味道和气味问题。很少有研究调查接触溶剂污染饮用水的妇女的胎儿死亡风险。两项先前的调查发现，高暴露组的死产风险略有增加；然而，这些结果是基于少数病例得出的。本病例对照研究旨在通过大量死产进一步研究这种关联。
病例由 1968 年至 1995 年期间母亲居住在马萨诸塞州和罗得岛州 28 个城镇（有部分受影响的水管）分娩的死产婴儿组成（n=296）。如果死因是胎盘早剥和/或胎盘功能不全，则将病例包括在内。对照组为同期和同一地理区域分娩的活产婴儿（n=783）。通过生命记录和问卷调查收集混杂变量数据。使用集成到水系统软件中的浸出和传输模型来估计 PCE 暴露量。
接触任何 PCE 的母亲发生胎盘相关死产的调整后比值比（OR）增加 1.7 倍（95%CI：1.2-2.4）。随着女性暴露水平的增加，调整后的 OR 也随之增加：与未暴露的母亲相比，低暴露（>0-中位数）的 OR 为 1.5（95%CI：1.0-2.3），中度暴露（中位数-90 百分位）的 OR 为 1.7（95%CI：1.1-2.5），高暴露（>90 百分位）的 OR 为 1.9（95%CI：1.1-3.2）（趋势检验 p 值=0.02）。当将 PCE 暴露量在 40μg/L 处分为二分类时（40μg/L 是修复的建议行动指南），也观察到了类似的模式（OR=1.5，95%CI：1.1-2.2 和 OR=2.6，95%CI：1.4-4.8，分别为 PCE 暴露量<=40μg/L 和>40μg/L）（趋势检验 p 值=0.003）。
我们观察到，产前接触受 PCE 污染的饮用水与胎盘早剥和胎盘功能不全导致的死产风险呈线性剂量依赖性增加。由于 PCE 仍然是一种常见的饮用水污染物，这些发现强调了在监测、监管和修复饮用水供应时考虑孕妇的重要性。
