Risk of Stillbirth in the Relation to Water Disinfection By-Products A Population-Based Case-Control Study in Taiwan 英文参考文献.docVIP

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Risk of Stillbirth in the Relation to Water Disinfection By-Products A Population-Based Case-Control Study in Taiwan 英文参考文献.doc

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Risk of Stillbirth in the Relation to Water Disinfection By-Products A Population-Based Case-Control Study in Taiwan 英文参考文献

RiskofStillbirthintheRelationtoWaterDisinfection By-Products:APopulation-BasedCase-ControlStudy inTaiwan Bing-FangHwang1*,JouniJ.K.Jaakkola2 1DepartmentandGraduateInstituteofOccupationalSafetyandHealth,CollegeofPublicHealth,ChinaMedicalUniversity,Taichung,Taiwan,RepublicofChina,2Center forEnvironmentalandRespiratoryHealthResearch,InstituteofHealthSciences,UniversityofOulu,Oulu,Finland Abstract Background:Fewepidemiologicalstudiesthathaveassessedtherelationbetweenwaterdisinfectionby-products(DBPs) andtheriskofstillbirthprovideinconsistentresults.Theobjectivewastoassesstherelationbetweenexposuretowater disinfectionby-productsandtheriskofstillbirth. Methods:Weconductedapopulation-basedcase-controlstudyof3,289casesofstillbirthandarandomsampleof32,890 controlsubjectsfrom396,049Taiwanesenewbornsin2001–2003usinginformationfromtheBirthRegistryandWaterworks RegistryinTaiwan.Wecomparedtheriskofstillbirthinfourdisinfectionby-productexposurecategoriesbasedonthelevels oftotaltrihalomethanes(TTHMs)representinghigh(TTHMs20+mg/L),medium(TTHMs10–19mg/L),lowexposure(TTHMs 5–9mg/L),and0–4mg/Lasthereferencecategory.Inaddition,weconductedameta-analysisoftheresultsfromthepresent and5previousstudiesfocusingonstillbirth. Findings:Inlogisticregressionanalysisadjustingforgender,maternalage,plurality,conceptionofseasonandpopulation density ofthemunicipalitywhere themother livedduringpregnancy, theodds ratio(OR)forstillbirth was1.10(95%CI 1.00–1.21)formediumexposureand1.06(95%0.96–1.17)forhighexposurecomparedtoreferencecategory.Inthemeta- analysis,thesummaryoddsratioforstillbirth(1.11,95%CI:1.03,1.19)wasconsistentlyelevated. Conclusions:Thepresentstudyisconsistentwiththehypothesisthattheriskofstillbirthisrelatedtoprenatalexposureto disinfectionby-products.Thisfindingonstillbirthisconsistentwithpreviousepidemiologicstudies,whichstrengthensthe weightofevidence. Citation: Hwang B-F, Jaakkola JJK (2012) Risk of Stillbirth in the Relation to Water Disinfection By-Products: A Population-Based C