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American Journal of Epidemiology Advance Access published online on July 16, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn188
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American Journal of Epidemiology © 2008 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Original Contribution

Water Disinfection By-Products and Prelabor Rupture of Membranes

Sarah J. Joyce1, Angus Cook1, John Newnham2, Michael Brenters2, Chantal Ferguson1 and Philip Weinstein1

1 School of Population Health, University of Western Australia, Crawley, Western Australia, Australia
2 School of Women's and Infants' Health, University of Western Australia, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia

Correspondence to Dr. Angus Cook, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia (e-mail: angus.cook{at}uwa.edu.au).

Received for publication April 3, 2008. Accepted for publication May 29, 2008.

The causes of term prelabor rupture of membranes (term PROM) remain poorly defined. The authors conducted a record-based prevalence study to explore a possible relation between disinfection by-products in drinking water and term PROM in an Australian community with spatially variable trihalomethane and nitrate levels. A multilevel statistical model was used to examine the relation between factors operating at the levels of the individual, district, and water distribution zone and the prevalence of PROM at term among 16,229 women in Perth, Western Australia (2002–2004). Adjusted odds ratios for term PROM increased with increasing tertiles of nitrate exposure (moderate exposure: odds ratio = 1.23, 95% confidence interval: 1.03, 1.52; high exposure: odds ratio = 1.47, 95% confidence interval: 1.20, 1.79), but there was no significant relation with exposure to trihalomethanes. This study raises the possibility that water contaminants may promote the development of PROM at term.

disinfection; fetal membranes, premature rupture; nitrates; nitrosamines; reactive oxygen species; trihalomethanes; water purification

Abbreviations: CI, confidence interval; MMP, matrix metalloproteinase; OR, odds ratio; PROM, prelabor rupture of membranes; SEIFA, Socio-Economic Indexes for Areas


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