American Journal of Epidemiology Advance Access originally published online on July 16, 2008
American Journal of Epidemiology 2008 168(5):514-521; doi:10.1093/aje/kwn188
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ORIGINAL CONTRIBUTIONS |
Water Disinfection By-Products and Prelabor Rupture of Membranes
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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