Reif J S, Hatch M C, Bracken M, Holmes L B, Schwetz B A, Singer P C
Department of Environmental Health, Colorado State University, Fort Collins 80523, USA.
Environ Health Perspect. 1996 Oct;104(10):1056-61. doi: 10.1289/ehp.961041056.
Recent epidemiologic studies have reported associations between the consumption of chlorinated drinking water and reproductive and developmental effects. Here we review the available epidemiologic data, assess the hazard potential posed by exposure to disinfection by-products, identify critical data gaps, and offer recommendations for further research. The epidemiologic evidence supporting associations between exposure to water disinfection by-products (DBPs) and adverse pregnancy outcomes is sparse, and positive findings should be interpreted cautiously. The methods used during the early stages of research in this area have been diverse. Variability in exposure assessment and endpoints makes it difficult to synthesize or combine the available data. Exposure misclassification and unmeasured confounding may have lead to bias in risk estimation. Future studies of reproductive outcome and exposure to chlorinated water should use improved methods for exposure assessment to 1) assure selection of appropriate exposure markers, 2) assess seasonal and annual fluctuations in DBPs, 3) assess variability within the distribution system, and 4) assess exposure through multiple routes such as bathing and showering, as well as consumption. Population-based studies should be conducted to evaluate male and female fertility, conception delay, growth retardation, and specific birth defects. The reproductive and developmental effects of exposure to DBPs could be efficiently explored in ongoing investigations by incorporating valid exposure markers and relevant questionnaire information. Future studies should make use of naturally occurring variability in the concentrations of DBPs and may incorporate biomarkers of exposure and effect in their design. Epidemiologic investigations should be conducted in parallel with laboratory-based and animal studies in a coordinated, multidisciplinary approach.
近期的流行病学研究报告了饮用氯化水与生殖及发育影响之间的关联。在此，我们回顾现有的流行病学数据，评估接触消毒副产物所带来的潜在危害，识别关键的数据缺口，并为进一步研究提供建议。支持接触水消毒副产物（DBPs）与不良妊娠结局之间存在关联的流行病学证据并不充分，对于阳性研究结果应谨慎解读。该领域早期研究中所使用的方法多种多样。暴露评估和研究终点的差异使得难以综合或合并现有数据。暴露错误分类和未测量的混杂因素可能导致风险估计出现偏差。未来关于生殖结局与接触氯化水的研究应采用改进的暴露评估方法，以便：1）确保选择合适的暴露标志物；2）评估消毒副产物的季节性和年度波动情况；3）评估分配系统内的变异性；4）评估通过多种途径（如沐浴、淋浴以及饮水）的暴露情况。应开展基于人群的研究来评估男性和女性的生育能力、受孕延迟、生长发育迟缓以及特定出生缺陷。通过纳入有效的暴露标志物和相关问卷信息，在正在进行的调查中可以有效地探索接触消毒副产物对生殖和发育的影响。未来的研究应利用消毒副产物浓度的自然变异性，并在设计中纳入暴露和效应的生物标志物。流行病学调查应与基于实验室和动物的研究并行开展，采用协调一致的多学科方法。
