American Journal of Epidemiology Advance Access published online on September 6, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj300
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1 Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC; Current affiliation: Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
* To whom correspondence should be addressed. Previous research has suggested that exposure to elevated levels of drinking water disinfection by-products (DBPs) may cause pregnancy loss. In 2000-2004, the authors conducted a study in three US locations of varying DBP levels and evaluated 2,409 women in early pregnancy to assess their tap water DBP concentrations, water use, other risk factors, and pregnancy outcome. Tap water concentrations were measured in the distribution system weekly or biweekly. The authors considered DBP concentration and ingested amount and, for trihalomethanes only, bathing/showering and integrated exposure that included ingestion. On the basis of 258 pregnancy losses, they did not find an increased risk of pregnancy loss in relation to trihalomethane, haloacetic acid, or total organic halide concentrations; ingested amounts; or total exposure. In contrast to a previous study, pregnancy loss was not associated with high personal trihalomethane exposure (
Received November 16, 2005
Accepted August 4, 2006
ORIGINAL CONTRIBUTIONS
Exposure to Drinking Water Disinfection By-Products and Pregnancy Loss
David A. Savitz 1 *, Philip C. Singer 2, Amy H. Herring 3, Katherine E. Hartmann 4, Howard S. Weinberg 2, and Christina Makarushka 5
2 Department of Environmental Sciences and Engineering, University of North Carolina School of Public Health, Chapel Hill, NC
3 Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC
4 Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
5 Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC
David A. Savitz, E-mail: david.savitz{at}mssm.edu
Abstract 
75 µg/liter and 5 glasses of water/day) (odds ratio = 1.1, 95% confidence interval: 0.7, 1.7). Sporadic elevations in risk were found across DBPs, most notably for ingested total organic halide (odds ratio = 1.5, 95% confidence interval: 1.0, 2.2 for the highest exposure quintile). These results provide some assurance that drinking water DBPs in the range commonly encountered in the United States do not affect fetal survival.
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