Nigra Anne E, Bloomquist Tessa R, Rajeev Tushara, Burjak Mohamad, Casey Joan A, Goin Dana E, Herbstman Julie B, Ornelas Van Horne Yoshira, Wylie Blair J, Cerna-Turoff Ilan, Braun Joseph M, McArthur Kristen L, Karagas Margaret R, Ames Jennifer L, Sherris Allison R, Bulka Catherine M, Padula Amy M, Howe Caitlin G, Fry Rebecca C, Eaves Lauren A, Breton Carrie V, Cassidy-Bushrow Andrea E, Lewis Johnnye, MacKenzie Debra, Beene Daniel, Farzan Shohreh F, Sathyanarayana Sheela, Hipwell Alison E, Morello-Frosch Rachel, Snyder Brittney M, Hartert Tina V, Elliott Amy J, O'Connor Thomas G, Kress Amii M
Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2025 Jun 2;8(6):e2514084. doi: 10.1001/jamanetworkopen.2025.14084.
Inorganic arsenic is associated with adverse birth outcomes, but evidence is limited for public water concentrations (modifiable by federal regulatory action) in US populations.
To evaluate the association between prenatal public water arsenic exposure below the federal regulatory standard of 10 μg/L and birth outcomes in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed observational pregnancy cohort data from the Environmental Influences on Child Health Outcomes (ECHO) Cohort for birthing parent-infant dyads from 35 pregnancy cohort sites. Infants were born between 2005 and 2020. The data were analyzed between 2024 and 2025.
Individual, time-weighted, mean prenatal public water arsenic exposures were estimated by joining Zip Code Tabulation Area-level public water arsenic concentrations with monthly residential history data during pregnancy.
Adjusted risk ratios (RRs) of preterm birth, low birth weight, and small for gestational age were evaluated. Adjusted RRs, mean differences in birth weight-for-gestational age z score and birth weight, and the geometric mean ratio of gestational age at birth were calculated via cubic splines, per 1 μg/L higher prenatal water arsenic, and across policy-relevant categories of exposure.
The cohort comprised 13 998 birthing parents (mean [SD] age, 30.8 [5.6] years) of whom 4.5% were of American Indian, Alaska Native, Native Hawaiian, or Pacific Islander; 7.2% Asian; 12.4% Black; 56.1% White; 4.2% multiple races; and 8.5% another race and 28.1% were of Hispanic/Latino and 70.4% non-Hispanic/Latino ethnicity. Prenatal public water arsenic ranged from less than 0.35 to 37.28 μg/L. In spline models, prenatal public water arsenic was associated with a higher risk of low birth weight, lower birth weight, and lower birth weight-for-gestational age z score, although effect estimates lacked precision. The RR of low birth weight per 1 μg/L higher prenatal water arsenic was higher among Black (1.02; 95% CI, 1.01-1.03), Hispanic/Latino (1.07; 95% CI 1.02-l.12), and White (1.04; 95% CI, 102-1.06) birthing parents, and the RR for preterm birth was higher among Hispanic/Latino birthing parents (1.05; 95% CI, 1.01-1.09). The mean difference of birth weight and birth weight-for-gestational age z score per 1 μg/L higher prenatal water arsenic was more pronounced among White birthing parents (-10 g [95% CI, -17 to -3 g]; -0.02 SDs [95% CI -0.03 to -0.01 SDs]). No evidence that prenatal public water arsenic mediated the association between birthing parent race and ethnicity and adverse birth outcomes was observed.
In this cohort study of birthing parent-infant dyads across the US, arsenic measured in public water systems was associated with birth outcomes at levels below the current US Environmental Protection Agency's maximum contaminant level. The findings suggest that further reducing the maximum contaminant level for arsenic may decrease the number of infants with low birth weight in the US.
无机砷与不良出生结局相关，但在美国人群中，关于公共用水中砷浓度（可通过联邦监管行动进行调整）的证据有限。
评估美国产前公共用水中砷暴露低于联邦监管标准10μg/L与出生结局之间的关联。
设计、地点和参与者：这项队列研究分析了来自环境对儿童健康结局（ECHO）队列中35个妊娠队列地点的分娩父母与婴儿二元组的观察性妊娠队列数据。婴儿于2005年至2020年出生。数据于2024年至2025年进行分析。
通过将邮政编码区域级公共用水砷浓度与孕期每月居住史数据相结合，估算个体的时间加权平均产前公共用水砷暴露量。
评估早产、低出生体重和小于胎龄儿的校正风险比（RR）。通过三次样条函数计算每升高1μg/L产前用水砷时的校正RR、出生体重与胎龄z评分和出生体重的平均差异，以及出生时胎龄的几何平均比，并针对与政策相关的暴露类别进行计算。
该队列包括13998名分 娩父母（平均[标准差]年龄为30.8[5.6]岁），其中4.5%为美洲印第安人、阿拉斯加原住民、夏威夷原住民或太平洋岛民；7.2%为亚洲人；12.4%为黑人；56.1%为白人；4.2%为多种族；8.5%为其他种族，28.1%为西班牙裔/拉丁裔，70.4%为非西班牙裔/拉丁裔。产前公共用水中的砷含量范围为低于0.35至37.28μg/L。在样条模型中，产前公共用水中的砷与低出生体重、出生体重较低以及出生体重与胎龄z评分较低的风险较高相关，尽管效应估计缺乏精确性。每升高1μg/L产前用水砷，黑人（1.02；95%置信区间，1.01 - 1.03）、西班牙裔/拉丁裔（1.07；95%置信区间1.02 - 1.12）和白人（1.04；95%置信区间，1.02 - 1.06）分娩父母的低出生体重RR较高，西班牙裔/拉丁裔分娩父母的早产RR较高（1.05；95%置信区间，1.01 - 1.09）。每升高1μg/L产前用水砷，白人分娩父母的出生体重和出生体重与胎龄z评分的平均差异更为明显（-10g[95%置信区间，-17至-3g]；-0.02标准差[95%置信区间-0.03至-0.01标准差]）。未观察到产前公共用水中的砷介导分娩父母种族和族裔与不良出生结局之间关联的证据。
在这项针对美国分娩父母与婴儿二元组的队列研究中，公共供水系统中测得的砷与低于美国环境保护局当前最大污染物水平的出生结局相关。研究结果表明，进一步降低砷的最大污染物水平可能会减少美国低出生体重婴儿的数量。
