Consumption of low-moderate level arsenic contaminated water does not increase spontaneous pregnancy loss: a case control study.
Consumption of low-moderate level arsenic contaminated water does not increase spontaneous pregnancy loss: a case control study.
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DOI：
10.1186/1476-069x-13-81
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发表时间：
2014-10-13
期刊：
影响因子：
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通讯作者：
Gurzau ES
中科院分区：
文献类型：
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作者：
Bloom MS;Neamtiu IA;Surdu S;Pop C;Lupsa IR;Anastasiu D;Fitzgerald EF;Gurzau ES
先前的研究表明，饮用水源中无机砷（iAs）的高水平（10 μg/L）与自然流产的风险增加有关。然而，迄今为止，很少有人关注饮用水中低水平iAs （<10 μg/L）的影响。为了解决这一数据缺口，我们在罗马尼亚蒂米斯县开展了一项以医院为基础的病例对照研究。我们招募了完成妊娠5-20周的自发性流产妇女作为病例（n = 150），以及与胎龄（±1周）匹配的持续妊娠妇女作为对照（n = 150）。参与者完成了一份医生管理的问卷，我们从住宅饮用水源收集了水样。我们用氢化物发生-原子吸收光谱法（HG-AAS）测定的iAs加权问卷数据重建了居民饮用水暴露史。使用Logistic回归模型生成风险暴露与损失之间的比值比（OR）和95%置信区间（CI），以胎龄为条件，并根据母亲年龄、吸烟情况、教育程度和产前维生素使用情况进行调整。我们在第二组模型中探索了潜在的相互作用。饮用水砷浓度范围为0.0 ~ 175.1 μg/L，中位数为0.4 μg/L， 90%为9.4 μg/L。在损失与饮用水中平均或峰值的iAs浓度（or 0.98, 95% CI 0.96-1.01）或每日iAs摄入量（or 1.00, 95% CI 0.98-1.02）之间没有统计学上的显著关联。我们发现了怀孕期间平均碘含量与吸烟之间相互作用的适度证据（P = 0.057），以及每日碘含量暴露和产前维生素使用之间的相互作用（P = 0.085）。这些结果表明，低至中等水平的饮用水暴露并没有增加自然流产的风险。虽然不精确，但我们的数据也提高了吸烟者患病风险增加的可能性。考虑到总体上的低暴露，这些数据应该使孕妇和政策制定者对饮用水砷对妊娠早期的潜在影响放心，尽管值得进行更大更明确的研究，以调查与吸烟有关的潜在风险增加。
Previous work suggests an increased risk for spontaneous pregnancy loss linked to high levels of inorganic arsenic (iAs) in drinking water sources (>10 μg/L). However, there has been little focus to date on the impact of low-moderate levels of iAs in drinking water (<10 μg/L). To address this data gap we conducted a hospital-based case–control study in Timis County, Romania. We recruited women with incident spontaneous pregnancy loss of 5–20 weeks completed gestation as cases (n = 150), and women with ongoing pregnancies matched by gestational age (±1 week) as controls (n = 150). Participants completed a physician-administered questionnaire and we collected water samples from residential drinking sources. We reconstructed residential drinking water exposure histories using questionnaire data weighted by iAs determined using hydride generation-atomic absorption spectrometry (HG-AAS). Logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) for associations between iAs exposure and loss, conditioned on gestational age and adjusted for maternal age, cigarette smoking, education and prenatal vitamin use. We explored potential interactions in a second set of models. Drinking water arsenic concentrations ranged from 0.0 to 175.1 μg/L, with median 0.4 μg/L and 90th%tile 9.4 μg/L. There were no statistically significant associations between loss and average or peak drinking water iAs concentrations (OR 0.98, 95% CI 0.96-1.01), or for daily iAs intake (OR 1.00, 95% CI 0.98-1.02). We detected modest evidence for an interaction between average iAs concentration and cigarette smoking during pregnancy (P = 0.057) and for daily iAs exposure and prenatal vitamin use (P = 0.085). These results suggest no increased risk for spontaneous pregnancy loss in association with low to moderate level drinking water iAs exposure. Though imprecise, our data also raise the possibility for increased risk among cigarette smokers. Given the low exposures overall, these data should reassure pregnant women and policy makers with regard to the potential effect of drinking water iAs on early pregnancy, though a larger more definitive study to investigate the potential risk increase in conjunction with cigarette smoking is merited.