American Journal of Epidemiology Advance Access originally published online on March 8, 2006
American Journal of Epidemiology 2006 163(7):662-669; doi:10.1093/aje/kwj089
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Original Contribution |
Pregnancy Outcomes, Infant Mortality, and Arsenic in Drinking Water in West Bengal, India
1 School of Public Health, University of California, Berkeley, CA
2 Institute for Postgraduate Medical Education and Research, Kolkata, India
3 Division of Environmental and Occupational Disease Control, California Department of Health Services, Oakland, CA
4 Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
5 School of Public Health and Community Medicine, University of Washington, Seattle, WA
Reprint requests to Dr. Allan H. Smith, Arsenic Health Effects Research Program, University of California School of Public Health, 140 Warren Hall, Berkeley, CA 94720-7360 (e-mail: ahsmith{at}berkeley.edu).
Between 2001 and 2003, the authors studied pregnancy outcomes and infant mortality among 202 married women in West Bengal, India. Reproductive histories were ascertained using structured interviews. Arsenic exposure during each pregnancy, including all water sources used, was assessed; this involved measurements from 409 wells. Odds ratios for spontaneous abortion, stillbirth, neonatal mortality, and infant mortality were estimated with logistic regression based on the method of generalized estimating equations. Exposure to high concentrations of arsenic (
200 µg/liter) during pregnancy was associated with a sixfold increased risk of stillbirth after adjustment for potential confounders (odds ratio (OR) = 6.07, 95% confidence interval (CI): 1.54, 24.0; p = 0.01). Arsenic-related skin lesions were found in 12 women who had a substantially increased risk of stillbirth (OR = 13.1, 95% CI: 3.17, 54.0; p = 0.002). The odds ratio for neonatal death was 2.81 (95% CI: 0.73, 10.8). No association was found between arsenic exposure and spontaneous abortion (OR = 1.01, 95% CI: 0.38, 2.70) or overall infant mortality (OR = 1.33, 95% CI: 0.43, 4.04). This study adds to the limited evidence that exposure to high concentrations of arsenic during pregnancy increases the risk of stillbirth. However, there was no indication of the increased rates of spontaneous abortion and overall infant mortality that have been reported in some studies.
arsenic; India; infant mortality; pregnancy outcomes; stillbirth; water pollutants
Abbreviations: CI, confidence interval; GEE, generalized estimating equations; OR, odds ratio
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