Swan S H, Waller K, Hopkins B, Windham G, Fenster L, Schaefer C, Neutra R R
Environmental Health Investigations Branch, Department of Health Services, Emeryville, CA, USA.
Epidemiology. 1998 Mar;9(2):126-33.
In 1992, we published four retrospective studies, conducted primarily within a single California county, which found higher spontaneous abortion rates among women who drank more tapwater than bottled water in early pregnancy. The current prospective study extends that investigation to other water systems. Pregnant women from three regions in California were interviewed during their first trimester. Multivariate analyses modeled the amount and type of water consumed at 8 weeks' gestation in each region in relation to spontaneous abortion rate. In Region I, which was within the previous study area, the adjusted odds ratio (OR) comparing high (> or = 6 glasses per day) consumption of cold tapwater with none was 2.17 [95% confidence interval (CI) = 1.22-3.87]. Furthermore, when women with high cold tapwater and no bottled water consumption were compared with those with high bottled water and no cold tapwater consumption, the adjusted odds ratio was 4.58 (95% CI = 1.97-10.64). Conversely, women with high bottled water consumption and no tapwater had a reduced rate of spontaneous abortion compared with those drinking tapwater and no bottled water (adjusted OR = 0.22; 95% CI = 0.09-0.51). Neither tap nor bottled water consumption altered the risk of spontaneous abortion in Regions II and III. Although controlling for age, prior spontaneous abortion, race, gestational age at interview, and weight somewhat strengthened the association in Region I, the distribution of these confounders did not vary appreciably across regions. This study confirms the association between cold tapwater and spontaneous abortion first seen in this county in 1980. If causal, the agent(s) is not ubiquitous but is likely to have been present in Region I for some time.
1992年，我们发表了四项回顾性研究，主要在加利福尼亚州的一个县内进行，研究发现，怀孕早期饮用自来水多于瓶装水的女性自然流产率更高。当前的前瞻性研究将该调查扩展到了其他供水系统。对加利福尼亚州三个地区的孕妇在孕早期进行了访谈。多变量分析对每个地区妊娠8周时饮用的水的量和类型与自然流产率的关系进行了建模。在第一个地区，即之前研究区域内，将大量饮用（每天≥6杯）冷水自来水与不饮用的情况进行比较，调整后的优势比（OR）为2.17[95%置信区间（CI）=1.22 - 3.87]。此外，将大量饮用冷水自来水且不饮用瓶装水的女性与大量饮用瓶装水且不饮用冷水自来水的女性进行比较时，调整后的优势比为4.58（95%CI = 1.97 - 10.64）。相反，与饮用自来水且不饮用瓶装水的女性相比，大量饮用瓶装水且不饮用自来水的女性自然流产率降低（调整后的OR = 0.22；95%CI = 0.09 - 0.51）。在第二和第三地区，饮用自来水或瓶装水均未改变自然流产风险。尽管对年龄、既往自然流产史、种族、访谈时的孕周和体重进行控制在一定程度上加强了第一地区的关联，但这些混杂因素在各地区的分布并无明显差异。本研究证实了1980年在本县首次发现的冷水自来水与自然流产之间的关联。如果存在因果关系，致病因素并非普遍存在，而是可能在第一地区已经存在一段时间了。
