Exposure to Chloramine and Chloroform in Tap Water and Adverse Perinatal Outcomes in Shanghai
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Participants
2.2. Environmental Data
2.3. Confounders
2.4. Perinatal Outcomes
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Mother–Infant Pairs
3.2. Risk of Adverse Perinatal Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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ALL | GDM | GHD | LBW | SGA | Preterm | PROM | |
---|---|---|---|---|---|---|---|
(n = 109,182) | (n = 15,183) | (n = 6791) | (n = 3911) | (n = 2369) | (n = 6240) | (n = 26,618) | |
No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | |
Maternal sociodemographic characteristics | |||||||
Age, mean ± SD, years | 31.01 ± 4.06 | 32.53 ± 4.26 | 31.77 ± 4.40 | 31.48 ± 4.36 | 30.58 ± 4.00 | 31.73 ± 4.37 | 30.758 ± 3.896 |
Pre-gestational BMI, mean ± SD, kg/m2 | 21.23 ± 2.81 | 22.31 ± 3.18 | 23.06 ± 3.57 | 21.31 ± 3.14 | 20.408 ± 2.61 | 21.67 ± 3.14 | 21.191 ± 2.746 |
Marriage | |||||||
Married | 108,202 (99.1) | 15,010 (98.9) | 6713 (98.9) | 3883 (99.3) | 2356 (99.45) | 6198 (99.3) | 26,451 (99.4) |
Single | 979 (0.90) | 173 (1.1) | 78 (1.2) | 28 (0.7) | 13 (0.55) | 42 (0.7) | 167 (0.6) |
Medical insurance | |||||||
Yes | 78,365 (71.8) | 10,814 (71.2) | 4990 (73.5) | 2830 (72.4) | 1687 (71.21) | 4478 (71.8) | 19,545 (73.4) |
No | 30,816 (28.2) | 4369 (28.8) | 1801 (26.5) | 1081 (27.6) | 682 (28.79) | 1762 (28.2) | 7073 (26.6) |
Occupation | |||||||
Employed | 101,825 (93.3) | 13,971 (92.0) | 6235 (91.8) | 3565 (91.1) | 2175 (91.81) | 5726 (91.8) | 25,151 (94.5) |
Self-employed | 3015 (2.8) | 503 (3.3) | 216 (3.2) | 138 (3.5) | 74 (3.12) | 209 (3.4) | 625 (2.4) |
Unemployed | 4341 (4.0) | 709 (4.7) | 340 (5.0) | 208 (5.3) | 120 (5.07) | 305 (4.9) | 842 (3.2) |
Ethnicity | |||||||
Han | 107,694 (98.6) | 14,959 (98.5) | 6685 (98.4) | 3862 (98.8) | 2332 (98.44) | 6166 (98.8) | 26,331 (98.9) |
Minority | 1359 (1.2) | 213 (1.4) | 92 (1.4) | 43 (1.1) | 33 (1.39) | 66 (1.1) | 258 (1.0) |
Foreign | 128 (0.1) | 11 (0.1) | 14 (0.2) | 6 (0.2) | 4 (0.17) | 8 (0.1) | 29 (0.1) |
Education attainment | |||||||
High school or lower | 13,152 (15.6) | 2041 (17.4) | 1166 (23.1) | 548 (19.2) | 282 (16.25) | 869 (18.8) | 3067 (15.0) |
College | 53,869 (63.9) | 7617 (65.1) | 3173 (62.9) | 1792 (62.8) | 1096 (63.2) | 2918 (63.2) | 12,880 (63.1) |
Master or above | 17,229 (20.5) | 2049 (17.5) | 707 (14.0) | 513 (18.0) | 357 (20.6) | 828 (17.9) | 4463 (21.9) |
Smoking during pregnancy | |||||||
No | 86,167 (99.6) | 11,870 (99.5) | 5208 (99.4) | 3006 (99.7) | 1805 (99.8) | 4799 (99.6) | 20,909 (99.6) |
Yes | 350 (0.4) | 60 (0.5) | 32 (0.6) | 10 (0.3) | 4 (0.2) | 20 (0.42) | 84 (0.4) |
Alcohol drinking during pregnancy | |||||||
No | 85,716 (99.1) | 11,809 (99.0) | 5199 (99.2) | 2997 (99.4) | 1799 (99.5) | 4773 (99.05) | 20,778 (99.0) |
Yes | 802 (0.9) | 121 (1.0) | 41 (0.8) | 19 (0.6) | 10 (0.6) | 46 (1.0) | 215 (1.) |
History of reproduction | |||||||
parity | |||||||
0 | 65,812 (60.3) | 8594 (56.6) | 4432 (65.3) | 2496 (63.8) | 1646 (69.5) | 3664 (58.7) | 17,713 (66.6) |
1 | 36,739 (33.7) | 5506 (36.3) | 2026 (29.8) | 1198 (30.6) | 632 (26.7) | 2124 (34.0) | 7891 (29.7) |
≥2 | 6629 (6.1) | 1083 (7.1) | 333 (4.9) | 217 (5.6) | 91 (3.8) | 451 (7.2) | 1013 (3.8) |
Number of previous abortions | |||||||
0 | 57,292 (63.5) | 7206 (57.6) | 3409 (62.5) | 2045 (63.9) | 1329 (70.1) | 3121 (61.0) | 14,246 (65.3) |
1–2 | 29,753 (33.0) | 4669 (37.4) | 1823 (33.4) | 1022 (31.9) | 516 (27.2) | 1749 (34.2) | 6920 (31.7) |
≥3 | 3192 (3.5) | 627 (5.0) | 221 (4.1) | 136 (4.3) | 52 (2.7) | 244 (4.8) | 664 (3.0) |
Previous ectopic pregnancy | |||||||
No | 88,270 (97.8) | 12,155 (97.2) | 5302 (97.2) | 3142 (98.1) | 1870 (98.6) | 4989 (97.6) | 21,388 (98.0) |
Yes | 1967 (2.2) | 347 (2.8) | 151 (2.8) | 61 (1.9) | 27 (1.4) | 125 (2.4) | 442 (2.0) |
ALL | GDM | GHD | LBW | SGA | Preterm | PROM | |
---|---|---|---|---|---|---|---|
(n = 109,182) | (n = 15,183) | (n = 6791) | (n = 3911) | (n = 2369) | (n = 6240) | (n = 26,618) | |
No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) | |
Newborn gender | |||||||
Male | 56,449 (51.7) | 7871 (51.8) | 3482 (51.3) | 1859 (47.5) | 1126 (47.5) | 3539 (56.7) | 14,018 (52.7) |
Female | 52,732 (48.3) | 7312 (48.2) | 3309 (48.7) | 2052 (52.5) | 1243 (52.5) | 2701 (43.3) | 12,600 (47.3) |
Gestational diabetes mellitus | |||||||
No | 93,998 (86.1) | - | 5404 (79.6) | 3190 (81.6) | 2060 (87.0) | 5083 (81.5) | 23,162 (87.0) |
Yes | 15,183 (13.9) | - | 1387 (20.4) | 721 (18.4) | 309 (13.0) | 1157 (18.5) | 3456 (13.0) |
Diabetes mellitus in pregnancy | |||||||
No | 108,544 (99.4) | - | 6658 (98.0) | 3870 (99.0) | 2358 (99.5) | 6162 (98.8) | 26,487 (99.5) |
Yes | 637 (0.6) | - | 133 (2.0) | 41 (1.1) | 11 (0.5) | 78 (1.3) | 131 (0.5) |
Chronic hypertension in pregnancy | |||||||
No | 107,808 (98.7) | 14,823 (97.6) | - | 3766 (96.3) | 2321 (98.0) | 6047 (96.9) | 26,399 (99.2) |
Yes | 1373 (1.3) | 360 (2.4) | - | 145 (3.7) | 48 (2.0) | 193 (3.1) | 219 (0.8) |
Gestational hypertensive disorder | |||||||
No | 102,390 (93.8) | 13,796 (90.9) | - | 3040 (77.7) | 1963 (82.9) | 5267 (84.4) | 25,472 (95.7) |
Gestational hypertension | 3023 (2.8) | 632 (4.2) | - | 134 (3.4) | 88 (3.7) | 183 (2.9) | 644 (2.4) |
Preeclampsia | 2395 (2.2) | 495 (3.3) | - | 191 (4.9) | 110 (4.6) | 198 (3.2) | 375 (1.4) |
Sever preeclampsia | 1373 (1.3) | 260 (1.7) | - | 546 (14.0) | 208 (8.8) | 592 (9.5) | 127 (0.5) |
Intrahepatic cholestasis of pregnancy | |||||||
No | 108,345 (99.2) | 15,064 (99.2) | 6684 (98.4) | 3838 (98.1) | 2344 (98.9) | 6088 (97.6) | 26,517 (99.6) |
Yes | 836 (0.8) | 119 (0.8) | 107 (1.6) | 73 (1.9) | 25 (1.1) | 152 (2.4) | 101 (0.4) |
Gestational thyroid dysfunction | |||||||
No | 101,419 (92.9) | 14,069 (92.7) | 6252 (92.1) | 3630 (92.8) | 2195 (92.7) | 5809 (93.1) | 24,790 (93.1) |
Hyperthyroidism | 1102 (1.0) | 163 (1.1) | 96 (1.4) | 52 (1.3) | 30 (1.3) | 78 (1.3) | 283 (1.1) |
Hypothyroidism | 6660 (6.1) | 951 (6.3) | 443 (6.5) | 229 (5.9) | 144 (6.1) | 353 (5.7) | 1545 (5.8) |
Mode of delivery | |||||||
Vaginal | 57,161 (52.4) | 6852 (45.1) | 2143 (31.6) | 1436 (36.7) | 1139 (48.1) | 2648 (42.4) | 17,918 (67.3) |
Cesarean section | 47,569 (43.6) | 7785 (51.3) | 4382 (64.5) | 2398 (61.3) | 1118 (47.2) | 3463 (55.5) | 7114 (26.7) |
Instrumental | 4451 (4.1) | 546 (3.6) | 266 (3.9) | 77 (2.0) | 112 (4.7) | 129 (2.1) | 1586 (6.0) |
Assisted reproductive technology | |||||||
No | 101,731 (93.2) | 13,585 (89.5) | 5966 (87.9) | 3595 (91.9) | 2207 (93.2) | 5713 (91.7) | 25,039 (94.1) |
Yes | 7439 (6.8) | 1598 (10.5) | 823 (12.1) | 315 (8.1) | 161 (6.8) | 516 (8.3) | 1576 (5.9) |
GDM OR (95% CI) | GHD OR (95% CI) | LBW OR (95% CI) | SGA OR (95% CI) | PTB OR (95% CI) | PROM OR (95% CI) | |
---|---|---|---|---|---|---|
Monochloramine (100μg/L) | ||||||
T1 | 1.06 (1.03, 1.09) | 0.99 (0.95, 1.03) | 0.95 (0.92, 0.99) | 1.00 (0.95, 1.05) | 0.95 (0.92, 0.99) | 0.95 (0.93, 0.97) |
T2 | 1.00 (0.98, 1.03) | 1.13 (1.09, 1.17) | 0.98 (0.94, 1.02) | 0.94 (0.89, 0.99) | 1.04 (1.00, 1.08) | 1.02 (0.99, 1.04) |
T3 | - | - | 1.06 (1.01, 1.11) | 1.03 (0.97, 1.09) | 1.02 (0.98, 1.06) | 1.04 (1.01, 1.07) |
All | 0.93 (0.88, 0.98) | 1.22 (1.13, 1.31) | 1.02 (0.94, 1.10) | 0.95 (0.85, 1.05) | 1.1 (1.03, 1.19) | 1.07 (1.03, 1.12) |
CHCl3 (μg/L) | ||||||
T1 | 1.00 (0.98, 1.01) | 1.00 (0.98, 1.02) | 1.05 (1.03, 1.07) | 0.99 (0.96, 1.02) | 1.04 (1.02, 1.07) | 1.00 (0.99, 1.00) |
T2 | 1.01 (0.99, 1.03) | 1.02 (0.99, 1.05) | 0.95 (0.93, 0.98) | 1.00 (0.96, 1.03) | 0.97 (0.94, 0.99) | 1.01 (1.00, 1.01) |
T3 | - | - | 1.13 (1.09, 1.16) | 1.00 (0.96, 1.05) | 1.05 (1.01, 1.08) | 1.01 (1.00, 1.01) |
All | 1.01 (0.98, 1.04) | 1.04 (1.00, 1.08) | 1.05 (1.02, 1.08) | 0.97 (0.92, 1.02) | 1.07 (1.03, 1.11) | 1.02 (1.01, 1.03) |
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Zhu, S.-M.; Li, C.; Xu, J.-J.; Zhang, H.-Q.; Su, Y.-F.; Wu, Y.-T.; Huang, H.-F. Exposure to Chloramine and Chloroform in Tap Water and Adverse Perinatal Outcomes in Shanghai. Int. J. Environ. Res. Public Health 2022, 19, 6508. https://doi.org/10.3390/ijerph19116508
Zhu S-M, Li C, Xu J-J, Zhang H-Q, Su Y-F, Wu Y-T, Huang H-F. Exposure to Chloramine and Chloroform in Tap Water and Adverse Perinatal Outcomes in Shanghai. International Journal of Environmental Research and Public Health. 2022; 19(11):6508. https://doi.org/10.3390/ijerph19116508
Chicago/Turabian StyleZhu, Si-Meng, Cheng Li, Jing-Jing Xu, Han-Qiu Zhang, Yun-Fei Su, Yan-Ting Wu, and He-Feng Huang. 2022. "Exposure to Chloramine and Chloroform in Tap Water and Adverse Perinatal Outcomes in Shanghai" International Journal of Environmental Research and Public Health 19, no. 11: 6508. https://doi.org/10.3390/ijerph19116508