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Exposure to Lithium and Cesium Through Drinking Water and Thyroid Function During Pregnancy: A Prospective Cohort Study.

ABSTRACT: Impaired thyroid function is a common side effect of lithium medication. Recent data indicate that lithium exposure through drinking water, although providing much lower doses than the medication, may also affect thyroid hormone levels. However, the effects in susceptible groups like pregnant women are not known.In a population-based mother-child cohort in the Argentinean Andes (n?=?194), an area with varying concentrations of lithium in the drinking water, we assessed lithium exposure repeatedly during pregnancy by measuring the concentrations in blood using inductively coupled plasma mass spectrometry. The markers of thyroid function included thyrotropin (TSH), free/total thyroxine (fT4/T4), free/total triiodothyronine (fT3/T3), thyroglobulin, and transthyretin in serum, sampled at the same time. Multiple potential confounders, including exposure to arsenic, cesium, and boron (elevated in water) as well as selenium and iodine (essential for thyroid function) were considered.The lithium concentrations in blood [median 25??g/L (0.0036?mmol/L); range 1.9-145??g/L (0.000027-0.021?mmol/L)] correlated significantly with those in urine and drinking water (rs?=?0.84, p?

SUBMITTER: Harari F

PROVIDER: S-EPMC4652143 | biostudies-other | 2015 Nov

REPOSITORIES: biostudies-other

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Exposure to Lithium and Cesium Through Drinking Water and Thyroid Function During Pregnancy: A Prospective Cohort Study.

Harari Florencia F Bottai Matteo M Casimiro Esperanza E Palm Brita B Vahter Marie M

Thyroid : official journal of the American Thyroid Association 20150902 11

<h4>Background</h4>Impaired thyroid function is a common side effect of lithium medication. Recent data indicate that lithium exposure through drinking water, although providing much lower doses than the medication, may also affect thyroid hormone levels. However, the effects in susceptible groups like pregnant women are not known.<h4>Methods</h4>In a population-based mother-child cohort in the Argentinean Andes (n = 194), an area with varying concentrations of lithium in the drinking water, we ...[more]

PMID: 26332132

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Project description:BackgroundArsenic, a common groundwater pollutant, is associated with adverse reproductive health but few studies have examined its effect on maternal health.MethodsA prospective cohort was recruited in Bangladesh from 2008-2011 (N?=?1,458). At enrollment (<16 weeks gestational age [WGA]), arsenic was measured in personal drinking water using inductively-coupled plasma mass spectrometry. Questionnaires collected health data at enrollment, at 28 WGA, and within one month of delivery. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) for self-reported health symptoms were estimated for each arsenic quartile using logistic regression.ResultsOverall, the mean concentration of arsenic was 38 ?g/L (Standard deviation, 92.7 ?g/L). A total of 795 women reported one or more of the following symptoms during pregnancy (cold/flu/infection, nausea/vomiting, abdominal cramping, headache, vaginal bleeding, or swollen ankles). Compared to participants exposed to the lowest quartile of arsenic (?0.9 ?g/L), the aOR for reporting any symptom during pregnancy was 0.62 (95% CI?=?0.44-0.88) in the second quartile, 1.83 (95% CI?=?1.25-2.69) in the third quartile, and 2.11 (95% CI?=?1.42-3.13) in the fourth quartile where the mean arsenic concentration in each quartile was 1.5 ?g/L, 12.0 ?g/L and 144.7 ?g/L, respectively. Upon examining individual symptoms, only nausea/vomiting and abdominal cramping showed consistent associations with arsenic exposure. The odds of self-reported nausea/vomiting was 0.98 (95% CI: 0.68, 1.41), 1.52 (95% CI: 1.05, 2.18), and 1.81 (95% CI: 1.26, 2.60) in the second, third and fourth quartile of arsenic relative to the lowest quartile after adjusting for age, body mass index, second-hand tobacco smoke exposure, educational status, parity, anemia, ferritin, medication usage, type of sanitation at home, and household income. A positive trend was also observed for abdominal cramping (P for trend <0.0001). A marginal negative association was observed between arsenic quartiles and odds of self-reported cold/flu/infection (P for trend?=?0.08). No association was observed between arsenic and self-reported headache (P for trend?=?0.19).ConclusionModerate exposure to arsenic contaminated drinking water early in pregnancy was associated with increased odds of experiencing nausea/vomiting and abdominal cramping. Preventing exposure to arsenic contaminated drinking water during pregnancy could improve maternal health.

Project description:ObjectiveTo evaluate the association between arsenic exposure and mortality from cardiovascular disease and to assess whether cigarette smoking influences the association.DesignProspective cohort study with arsenic exposure measured in drinking water from wells and urine.SettingGeneral population in Araihazar, Bangladesh.Participants11,746 men and women who provided urine samples in 2000 and were followed up for an average of 6.6 years.Main outcome measureDeath from cardiovascular disease.Results198 people died from diseases of circulatory system, accounting for 43% of total mortality in the population. The mortality rate for cardiovascular disease was 214.3 per 100,000 person years in people drinking water containing <12.0 µg/L arsenic, compared with 271.1 per 100,000 person years in people drinking water with ≥ 12.0 µg/L arsenic. There was a dose-response relation between exposure to arsenic in well water assessed at baseline and mortality from ischaemic heart disease and other heart disease; the hazard ratios in increasing quarters of arsenic concentration in well water (0.1-12.0, 12.1-62.0, 62.1-148.0, and 148.1-864.0 µg/L) were 1.00 (reference), 1.22 (0.65 to 2.32), 1.35 (0.71 to 2.57), and 1.92 (1.07 to 3.43) (P = 0.0019 for trend), respectively, after adjustment for potential confounders including age, sex, smoking status, educational attainment, body mass index (BMI), and changes in urinary arsenic concentration since baseline. Similar associations were observed when baseline total urinary arsenic was used as the exposure variable and for mortality from ischaemic heart disease specifically. The data indicate a significant synergistic interaction between arsenic exposure and cigarette smoking in mortality from ischaemic heart disease and other heart disease. In particular, the hazard ratio for the joint effect of a moderate level of arsenic exposure (middle third of well arsenic concentration 25.3-114.0 µg/L, mean 63.5 µg/L) and cigarette smoking on mortality from heart disease was greater than the sum of the hazard ratios associated with their individual effect (relative excess risk for interaction 1.56, 0.05 to 3.14; P = 0.010).ConclusionsExposure to arsenic in drinking water is adversely associated with mortality from heart disease, especially among smokers.

Project description:BACKGROUND:The synthetic solvent tetrachloroethylene (PCE), commonly used in dry cleaning operations, is a human neurotoxicant and carcinogen. However, its effect on reproduction is poorly understood, as prior studies have been limited to small occupational cohorts. We examined the association between PCE exposure from contamination of the public drinking water supply and time-to-pregnancy (TTP) in a cohort of mothers from Cape Cod, Massachusetts. METHODS:The Cape Cod Family Health Study is a retrospective cohort study designed to examine the reproductive and developmental health effects of exposure to PCE-contaminated drinking water. Our analysis included 1565 women who reported 3826 planned pregnancies from 1949 to 1990. Women completed self-administered questionnaires that ascertained TTP for each of her pregnancies, regardless of the outcome, as well as residential history and demographic information. We utilized EPANET water distribution system modeling software and a leaching and transport model to assess PCE exposure for each pregnancy. We used log-binomial regression models to estimate relative risks (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We performed a probabilistic bias analysis to examine the effect of outcome misclassification on our results. RESULTS:Any cumulative PCE exposure before pregnancy was associated with a 15% reduction in risk of TTP?>?12 months (RR = 0.85, 95% CI: 0.70, 1.03). However, women with the highest average monthly PCE exposure around the time of the pregnancy attempt (? 2.5?g) had increased risk of TTP?>?12 months (RR = 1.36, 95% CI: 1.06, 1.76). CONCLUSIONS:We found little evidence for long-term, cumulative adverse effects of PCE exposure on TTP, but high levels of PCE exposure around the time of the pregnancy attempt were associated with longer TTP. These associations may be underestimated due to the exclusion of unsuccessful pregnancy attempts from our study population, and may be biased by outcome and exposure misclassification given the long-term recall of TTP and use of a leaching and transport model to estimate PCE exposure.

Project description:BackgroundNitrate contamination is seen in drinking water worldwide. Nitrate may pass the placental barrier. Despite suggestive evidence of fetal harm, the potential association between nitrate exposure from drinking water and pregnancy loss remains to be studied. We aimed to investigate if nitrate in drinking water was associated with the risk of pregnancy loss.MethodsWe conducted a nationwide cohort study of 100,410 pregnancies (enrolled around gestational week 11) in the Danish National Birth Cohort (DNBC) during 1996-2002. Spontaneous pregnancy losses before gestational week 22 were ascertained from the Danish National Patient Registry and DNBC pregnancy interviews. Using the national drinking water quality-monitoring database Jupiter, we estimated the individual and time-specific nitrate exposure by linking geocoded maternal residential addresses with water supply areas. The nitrate exposure was analyzed in spline models using a log-transformed continuous level or classified into five categories. We used Cox proportional hazards models to estimate associations between nitrate and pregnancy loss and used gestational age (days) as the time scale, adjusting for demographic, health, and lifestyle variables.ResultsNo consistent associations were found when investigating the exposure as a categorical variable and null findings were also found in trimester specific analyses. In the spline model using the continuous exposure variable, a modestly increased hazard of pregnancy loss was observed for the first trimester at nitrate exposures between 1 and 10 mg/L, with the highest. adjusted hazard ratio at 5 mg/L of nitrate of 1.16 (95% CI: 1.01, 1.34). This trend was attenuated in the higher exposure ranges.ConclusionNo association was seen between drinking water nitrate and the risk of pregnancy loss when investigating the exposure as a categorical variable. When we modelled the exposure as a continuous variable, a dose-dependent association was found between drinking water nitrate exposure in the first trimester and the risk of pregnancy loss. Very early pregnancy losses were not considered in this study, and whether survival bias influenced the results should be further explored.

Project description:BACKGROUND:Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately. OBJECTIVES:We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort. METHODS:Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity. RESULTS:Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ? 1.82 vs. < 1.05 ?g/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption. CONCLUSIONS:To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa. CITATION:Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MB. 2016. Birth weight, ethnicity, and exposure to trihalomethanes and haloacetic acids in drinking water during pregnancy in the Born in Bradford cohort. Environ Health Perspect 124:681-689; http://dx.doi.org/10.1289/ehp.1409480.

Dataset Information

Exposure to Lithium and Cesium Through Drinking Water and Thyroid Function During Pregnancy: A Prospective Cohort Study.

Publications

Exposure to Lithium and Cesium Through Drinking Water and Thyroid Function During Pregnancy: A Prospective Cohort Study.

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