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American Journal of Epidemiology Advance Access originally published online on September 6, 2006
American Journal of Epidemiology 2006 164(11):1052-1055; doi:10.1093/aje/kwj301
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Invited Commentary

Invited Commentary: Disinfection By-Products and Pregnancy Loss—Lessons

Penelope P. Howards1 and Irva Hertz-Picciotto2

1 Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, MD
2 Department of Public Health Sciences, Divisions of Environmental and Occupational Health and of Epidemiology, University of California, Davis, Davis, CA

Correspondence to Dr. Irva Hertz-Picciotto, Department of Public Health Sciences, TB #168, University of California, Davis, Davis, CA 95616 (e-mail: ihp@ucdavis.edu).

Received for publication June 19, 2006. Accepted for publication June 21, 2006.

Abbreviations: BDCM, bromodichloromethane; DBP, disinfection by-product; THM, trihalomethane

The first 150 words of the full text of this article appear below.

Chlorine was first used to purify water in the United States almost 100 years ago (1). Since that time, the technique has been improved upon and its use expanded so that most water systems today are disinfected (1). In 1995, approximately 64 percent of community water systems (systems that provide water to the same people year-round) specifically added chlorine as a disinfectant, and the remaining systems commonly added chloramine, according to an Environmental Protection Agency survey (1). Disinfection protects against waterborne pathogens, but chlorine reacts with organic matter in the water to form both halogenated and nonhalogenated disinfection by-products (DBPs), including trihalomethanes (THMs) (2). The Environmental Protection Agency set standards for total THM levels in community water systems after the Safe Drinking Water Act of 1974 was implemented (1). As a result, exposure to THMs is generally at levels currently . . . [Full Text of this Article]


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