Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses.
Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses.
复制标题
饮用水中的氯化消毒副产物和先天性异常：回顾和荟萃分析。
DOI：
10.1289/ehp.0900677
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发表时间：
2009-10
影响因子：
10.4
通讯作者：
Toledano, Mireille B.
中科院分区：
文献类型：
--
作者：
Nieuwenhuijsen, Mark J.;Martinez, David;Grellier, James;Bennett, James;Best, Nicky;Iszatt, Nina;Vrijheid, Martine;Toledano, Mireille B.
关键词：
本研究的目的是回顾流行病学证据，提供暴露于氯化消毒副产物（DBPs）与先天性异常之间关系的简要风险估计，并为未来的研究提供建议。我们纳入了所有已发表的流行病学研究，这些研究评估了DBP暴露指数（治疗、水源、DBP测量以及DBP测量和个人特征）与先天性异常风险之间的关系。当三个或更多的研究检查相同的暴露指数和先天性异常时，我们进行了荟萃分析，以获得比较最高暴露组和最低暴露组的总风险估计。当五个或更多的研究检查了总三卤甲烷（TTHM）暴露和特定的先天性异常时，我们进行了荟萃分析，以获得每10 μg/L TTHM的暴露反应风险估计。对于所有先天性畸形，荟萃分析显示，高氯水或TTHM暴露与低氯水或TTHM暴露相比，存在统计学上显著的超额风险[17%；95%置信区间（CI）， 3-34]基于少量研究。该荟萃分析还表明，室间隔缺损有统计学意义上的额外风险（58%;95% CI, 21-107），但这仅基于三项研究，很少有证据表明暴露-反应关系。我们在其他meta分析中没有观察到统计学上显著的关系。除了泌尿道缺陷和唇腭裂外，我们几乎没有发现发表偏倚的证据。尽管一些个别研究表明氯化消毒副产物与先天性异常之间存在关联，但对所有现有研究的荟萃分析表明，这种关联的证据很少。
The aim of this study was to review epidemiologic evidence, provide summary risk estimates of the association between exposure to chlorination disinfection by-products (DBPs) and congenital anomalies, and provide recommendations for future studies. We included all published epidemiologic studies that evaluated a relationship between an index of DBP exposure (treatment, water source, DBP measurements, and both DBP measurements and personal characteristics) and risk of congenital anomalies. When three or more studies examined the same exposure index and congenital anomaly, we conducted a meta-analysis to obtain a summary risk estimate comparing the highest exposure group with the lowest exposure group. When five or more studies examined total trihalomethane (TTHM) exposure and a specific congenital anomaly, we conducted a meta-analysis to obtain exposure–response risk estimates per 10 μg/L TTHM. For all congenital anomalies combined, the meta-analysis gave a statistically significant excess risk for high versus low exposure to water chlorination or TTHM [17%; 95% confidence interval (CI), 3–34] based on a small number of studies. The meta-analysis also suggested a statistically significant excess risk for ventricular septal defects (58%; 95% CI, 21–107), but this was based on only three studies, and there was little evidence of an exposure–response relationship. We observed no statistically significant relationships in the other meta-analyses. We found little evidence for publication bias, except for urinary tract defects and cleft lip and palate. Although some individual studies have suggested an association between chlorination disinfection by-products and congenital anomalies, meta-analyses of all currently available studies demonstrate little evidence of such an association.
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影响因子：
5
作者：
BOVE, FJ;FULCOMER, MC;SAVRIN, JE
通讯作者：
SAVRIN, JE
影响因子：
5
作者：
Gilboa, SM;Mendola, P;Fixler, DE
通讯作者：
Fixler, DE
高水平的溴化消毒副产品的澳大利亚社区出生缺陷的风险。
影响因子：
10.4
作者：
Chisholm, Kimberley;Cook, Angus;Bower, Carol;Weinstein, Philip
通讯作者：
Weinstein, Philip
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
DOI：
10.1038/sj.jes.7500488
发表时间：
2007-03-01
影响因子：
4.5
作者：
Forssen, Ulla M.;Herring, Amy H.;Wright, J. Michael
通讯作者：
Wright, J. Michael