Zierler S, Theodore M, Cohen A, Rothman K J
Department of Community Health, Brown University, Providence, Rhode Island 02912.
Int J Epidemiol. 1988 Sep;17(3):589-94. doi: 10.1093/ije/17.3.589.
We undertook a case-control study to investigate the association between chemicals in maternal drinking water consumed during pregnancy and congenital heart disease in the offspring. Two hundred and seventy affected children and 665 healthy children were enrolled in the study. Information on contaminant levels in maternal drinking water was available from records of routine water analysis of samples taken from public taps in the communities where the mothers resided during pregnancy. Mothers provided information during a telephone interview on their health, pregnancy management, and demographic characteristics. Nine inorganic metals were analysed for detection of an association with congenital heart disease. The chemical exposures of particular interest were arsenic, lead, mercury and selenium. None of the chemicals was associated materially with an increase in the frequency of congenital heart disease overall. Arsenic exposure at any detectable level was associated with a threefold increase in occurrence of coarctation of the aorta (prevalence odds ratio = 3.4, 95% confidence interval = 1.3-8.9). Detectable traces of selenium in drinking water were associated with a lower frequency of any congenital heart disease than was observed among children exposed to drinking water not containing detectable levels of selenium (prevalence odds ratio = 0.62, 95% confidence limits = 0.40-0.97). A dose-response effect was observed over four levels of selenium exposure. Non-differential errors in the measurement and classification of exposure to contaminants routinely monitored in drinking water could account for lack of positive findings. In addition, most of the contaminant levels were below the maximum levels set by the Environmental Protection Agency, so that lack of evidence of effect may have been due to the low exposure levels in this population.
我们开展了一项病例对照研究，以调查孕期母亲饮用水中的化学物质与后代先天性心脏病之间的关联。该研究纳入了270名患病儿童和665名健康儿童。母亲孕期居住社区公共水龙头采集的水样常规水质分析记录提供了母亲饮用水中污染物水平的信息。母亲们在电话访谈中提供了有关她们的健康状况、孕期管理和人口统计学特征的信息。分析了九种无机金属，以检测其与先天性心脏病的关联。特别关注的化学暴露物质为砷、铅、汞和硒。总体而言，没有一种化学物质与先天性心脏病发病率的增加有实质性关联。任何可检测水平的砷暴露都与主动脉缩窄发生率增加两倍相关（患病率比值比 = 3.4，95%置信区间 = 1.3 - 8.9）。饮用水中可检测到的痕量硒与任何先天性心脏病的发生率低于未接触到含可检测水平硒的饮用水的儿童（患病率比值比 = 0.62，95%置信限 = 0.40 - 0.97）。在四个硒暴露水平上观察到了剂量反应效应。饮用水中常规监测的污染物暴露测量和分类中的非差异误差可能导致未得出阳性结果。此外，大多数污染物水平低于美国环境保护局设定的最高水平，因此缺乏效应证据可能是由于该人群的低暴露水平。
