Pinchoff Jessie, Monseur Brent, Desai Sapna, Koons Katelyn, Alvero Ruben, Hindin Michelle J
Population Council, One Dag Hammarskjold Plaza #3, New York, NY, 10017, USA.
Stanford University School of Medicine, 1195 W Fremont, Sunnyvale, CA, 94087, USA.
Int J Hyg Environ Health. 2022 Jan;239:113883. doi: 10.1016/j.ijheh.2021.113883. Epub 2021 Nov 24.
Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes.
We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10 μg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n = 599 districts). A spatial integration approach was used to merge these estimates with the third India District-Level Health Survey (DLHS-3) conducted in 2007-08 (n = 643,944 women of reproductive age). Maps of district level arsenic levels and rates of each of the three outcomes were created to visualize the patterns across India. To adjust for significant spatial autocorrelation, spatial error models were fit.
District-level analysis showed that the average level of stillbirth was 4.3%, recurrent pregnancy loss was 3.3%, and infertility was 8.1%. The average district-level probability of groundwater arsenic levels exceeding 10 μg/L was 42%. After adjustment for sociodemographic factors, and accounting for spatial dependence, at the district level, for each percentage point increase in predicted arsenic levels exceeding 10 μg/L increased, the rates of stillbirths was 4.5% higher (95% confidence interval (CI) 2.4-6.6, p < 0.0001), the rates of RPL are 4.2% higher (95% CI 2.5-5.9, p < 0.0001), and the rates of infertility are 4.4% higher (95% CI 1.2-7.7, p=<0.0001).).
While arsenic exposure has been implicated with a range of adverse health outcomes, this is one of the first population-level studies to document an association between arsenic and three adverse reproductive pregnancy outcomes. The high levels of spatial correlation suggest that further and targeted efforts to mitigate arsenic in groundwater are needed.
通过饮用水接触地下水中的砷在某些地区很常见，如印度的部分地区，会导致一系列负面健康影响，可能包括不良生殖健康后果。
我们对印度死产、复发性流产和不孕的自我报告率与地下水中砷水平进行了生态分析。我们使用了一个网格化的、模拟的地下水中砷超过10μg/L（世界卫生组织饮用水限值）概率的数据集，来计算地区层面（n = 599个地区）的平均概率。采用空间整合方法将这些估计值与2007 - 2008年进行的第三次印度地区级健康调查（DLHS - 3，n = 643,944名育龄妇女）的数据合并。绘制了地区层面砷水平和三种结局各自发生率的地图，以直观呈现印度各地的模式。为了校正显著的空间自相关性，拟合了空间误差模型。
地区层面分析显示，死产平均水平为4.3%，复发性流产为3.3%，不孕为8.1%。地区层面地下水中砷水平超过10μg/L的平均概率为42%。在调整社会人口学因素并考虑空间依赖性后，在地区层面，预测的砷水平超过10μg/L每增加一个百分点，死产率升高4.5%（95%置信区间（CI）2.4 - 6.6；p < 0.0001），复发性流产率升高4.2%（95% CI 2.5 - 5.9；p < 0.0001），不孕率升高4.4%（95% CI 1.2 - 7.7；p = 0.0001）。
虽然砷暴露与一系列不良健康后果有关，但这是首批记录砷与三种不良生殖妊娠结局之间关联的人群层面研究之一。高度的空间相关性表明需要进一步有针对性地努力减轻地下水中的砷含量。
