risk of stillbirth in the relation to water disinfection by-products a population-based case-control study in taiwan死产的风险与水消毒副产品在台湾以人群为基础的病例对照研究.pdfVIP
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risk of stillbirth in the relation to water disinfection by-products a population-based case-control study in taiwan死产的风险与水消毒副产品在台湾以人群为基础的病例对照研究
Risk of Stillbirth in the Relation to Water Disinfection
By-Products: A Population-Based Case-Control Study
in Taiwan
1 2
Bing-Fang Hwang *, Jouni J. K. Jaakkola
1 Department and Graduate Institute of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan, Republic of China, 2 Center
for Environmental and Respiratory Health Research, Institute of Health Sciences, University of Oulu, Oulu, Finland
Abstract
Background: Few epidemiological studies that have assessed the relation between water disinfection by-products (DBPs)
and the risk of stillbirth provide inconsistent results. The objective was to assess the relation between exposure to water
disinfection by-products and the risk of stillbirth.
Methods: We conducted a population-based case-control study of 3,289 cases of stillbirth and a random sample of 32,890
control subjects from 396,049 Taiwanese newborns in 2001–2003 using information from the Birth Registry and Waterworks
Registry in Taiwan. We compared the risk of stillbirth in four disinfection by-product exposure categories based on the levels
of total trihalomethanes (TTHMs) representing high (TTHMs 20+ mg/L), medium (TTHMs 10–19 mg/L), low exposure (TTHMs
5–9 mg/L), and 0–4 mg/L as the reference category. In addition, we conducted a meta-analysis of the results from the present
and 5 previous studies focusing on stillbirth.
Findings: In logistic regression analysis adjusting for gender, maternal age, plurality, conception of season and population
density of the municipality where the mother lived during pregnancy, the odds ratio (OR) for stillbirth was 1.10 (95% CI
1.00–1.21) for medium exposure and 1.06 (95% 0.96–1.17) for high exposure compared to reference category. In the meta-
analysis, the summary odds ratio for stillbirth (1.11, 95% CI: 1.03, 1.19) was
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