James Grellier

Exposure to disinfection by-products, fetal growth, and prematurity: a systematic review and meta-analysis.

Background: Exposure to total trihalomethanes in drinking water has been associated with several adverse birth outcomes relating to fetal growth and prematurity. Methods: We carried out a systematic review and meta-analysis of epidemiologic studies featuring original peer-reviewed data on the association of total trihalomethane exposure and health outcomes related to fetal growth and prematurity. Results: A comprehensive literature search yielded 37 studies, 15 of which were selected for the extraction of relative risks relating adverse birth outcomes to trihalomethane exposure. Sufficient data were available for meta-analyses to be carried out for 4 adverse birth outcomes: low birth weight (LBW), term low birth weight (term LBW), preterm delivery, and small for gestational age (SGA) (including intra uterine growth retardation). We found little or no evidence for associations between third trimester trihalomethane exposure and LBW (odds ratio per 10 &mgr;g total trihalomethane/L = 1.00 [95% confidence interval = 0.97–1.03]), term LBW (1.03 [0.93–1.15]), or preterm delivery (0.99 [0.98–1.00]), but some evidence for SGA (1.01 [1.00–1.02]). Conclusions: There was little or no evidence for associations between total trihalomethane concentration and adverse birth outcomes relating to fetal growth and prematurity, with the possible exception of SGA. We discuss these findings and the uncertainties—relating particularly to exposure—that may have affected them.

Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies

BackgroundVarious epidemiological studies have suggested associations between environmental exposures and pregnancy outcomes. Some studies have tempted to combine information from various epidemiological studies using meta-analysis. We aimed to describe the methodologies used in these recent meta-analyses of environmental exposures and pregnancy outcomes. Furthermore, we aimed to report their main findings.MethodsWe conducted a bibliographic search with relevant search terms. We obtained and evaluated 16 recent meta-analyses.ResultsThe number of studies included in each reported meta-analysis varied greatly, with the largest number of studies available for environmental tobacco smoke. Only a small number of the studies reported having followed meta-analysis guidelines or having used a quality rating system. Generally they tested for heterogeneity and publication bias. Publication bias did not occur frequently.The meta-analyses found statistically significant negative associations between environmental tobacco smoke and stillbirth, birth weight and any congenital anomalies; PM2.5 and preterm birth; outdoor air pollution and some congenital anomalies; indoor air pollution from solid fuel use and stillbirth and birth weight; polychlorinated biphenyls (PCB) exposure and birth weight; disinfection by-products in water and stillbirth, small for gestational age and some congenital anomalies; occupational exposure to pesticides and solvents and some congenital anomalies; and agent orange and some congenital anomalies.ConclusionsThe number of meta-analyses of environmental exposures and pregnancy outcomes is small and they vary in methodology. They reported statistically significant associations between environmental exposures such as environmental tobacco smoke, air pollution and chemicals and pregnancy outcomes.

The epidemiology and possible mechanisms of disinfection by-products in drinking water.

This paper summarizes the epidemiological evidence for adverse health effects associated with disinfection by-products (DBPs) in drinking water and describes the potential mechanism of action. There appears to be good epidemiological evidence for a relationship between exposure to DBPs, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers including colorectal cancer is inconclusive and inconsistent. There appears to be some evidence for an association between exposure to DBPs, specifically THMs, and little for gestational age/intrauterine growth retardation and, to a lesser extent, pre-term delivery, but evidence for relationships with other outcomes such as low birth weight, stillbirth, congenital anomalies and semen quality is inconclusive and inconsistent. Major limitations in exposure assessment, small sample sizes and potential biases may account for the inconclusive and inconsistent results in epidemiological studies. Moreover, most studies have focused on total THMs as the exposure metric, whereas other DBPs appear to be more toxic than the THMs, albeit generally occurring at lower levels in the water. The mechanisms through which DBPs may cause adverse health effects including cancer and adverse reproductive effects have not been well investigated. Several mechanisms have been suggested, including genotoxicity, oxidative stress, disruption of folate metabolism, disruption of the synthesis and/or secretion of placental syncytiotrophoblast-derived chorionic gonadotropin and lowering of testosterone levels, but further work is required in this area.

Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses.

Objectives 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. Data sources and extraction 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. Data synthesis 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. Conclusion 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.

Electromagnetic field exposure assessment in Europe radiofrequency fields (10 MHz–6 GHz)

Average levels of exposure to radiofrequency (RF) electromagnetic fields (EMFs) of the general public in Europe are difficult to summarize, as exposure levels have been reported differently in those studies in which they have been measured, and a large proportion of reported measurements were very low, sometimes falling below detection limits of the equipment used. The goal of this paper is to present an overview of the scientific literature on RF EMF exposure in Europe and to characterize exposure within the European population. A comparative analysis of the results of spot or long-term RF EMF measurements in the EU indicated that mean electric field strengths were between 0.08 V/m and 1.8 V/m. The overwhelming majority of measured mean electric field strengths were <1 V/m. It is estimated that <1% were above 6 V/m and <0.1% were above 20 V/m. No exposure levels exceeding European Council recommendations were identified in these surveys. Most population exposures from signals of radio and television broadcast towers were observed to be weak because these transmitters are usually far away from exposed individuals and are spatially sparsely distributed. On the other hand, the contribution made to RF exposure from wireless telecommunications technology is continuously increasing and its contribution was above 60% of the total exposure. According to the European exposure assessment studies identified, three population exposure categories (intermittent variable partial body exposure, intermittent variable low-level whole-body (WB) exposure and continuous low-level WB exposure) were recognized by the authors as informative for possible future risk assessment.

Potential health impacts of residential exposures to extremely low frequency magnetic fields in Europe

Over the last two decades residential exposure to extremely low frequency magnetic fields (ELF MF) has been associated with childhood leukaemia relatively consistently in epidemiological studies, though causality is still under investigation. We aimed to estimate the cases of childhood leukaemia that might be attributable to exposure to ELF MF in the European Union (EU27), if the associations seen in epidemiological studies were causal. We estimated distributions of ELF MF exposure using studies identified in the existing literature. Individual distributions of exposure were integrated using a probabilistic mixture distribution approach. Exposure-response functions were estimated from the most recently published pooled analysis of epidemiological data. Probabilistic simulation was used to estimate population attributable fractions (AFP) and attributable cases of childhood leukaemia in the EU27. By assigning the literature review-based exposure distribution to all EU27 countries, we estimated the total annual number of cases of leukaemia attributable to ELF MF at between ~50 (95% CIs: -14, 132) and ~60 (95% CIs: -9, 610), depending on whether exposure-response was modelled categorically or continuously, respectively, for a non-threshold effect. This corresponds to between ~1.5% and ~2.0% of all incident cases of childhood leukaemia occurring annually in the EU27. Considerable uncertainties are due to scarce data on exposure and the choice of exposure-response model, demonstrating the importance of further research into better understanding mechanisms of the potential association between ELF MF exposure and childhood leukaemia and the need for improved monitoring of residential exposures to ELF MF in Europe.

A Review on the Practical Application of Human Biomonitoring in Integrated Environmental Health Impact Assessment

Environmental health sciences focus on the link between the presence of contaminants in the environment and their relation with possible adverse health effects. Within this context, human biomonitoring (HBM) data have proven to be a valuable addition to, or have even surpassed, estimates of exposure based on environmental measures. Probably the main achievement of HBM data is that it provides an integrated overview of the pollutant dose any constituent is exposed to and incorporates bioaccumulation, excretion, half-life, and other potentially critical toxicokinetic parameters. In an integrated environmental health impact assessment framework, HBM serves as a pivotal point between environment and health, on the one hand leaning on environmental data to provide information on sources and pathways of exposure, and on the other hand clarifying hypotheses on the relationship between internal dose and prevalence of disease clusters. This study reflects the work performed in the INTARESE project (Integrated Assessment of Health Risk of Environmental Stressors in Europe). Because it was perceived that there was an overall lack of knowledge on the general methodology and potential application of HBM data in integrated environmental health impact assessment, an extensive review of literature was performed on past and current developments, potential, and applicability of HBM within the context of integrated environmental health impact assessment. This study covers three main topics that provide guidance for improved interpretation and application of HBM data: (1) sample collection and storage, (2) sample measurement, and (3) data interpretation. These main issues were discussed for 15 of the most common or relevant (classes of) chemicals. For more detailed information, the reader is pointed to the unabridged review (INTARESE, 2007), and consultation is available through the INTARESE web site (www.intarese.org).

Traffic-Related air pollution, noise at school, and behavioral problems in barcelona schoolchildren: A cross-sectional study

Background: The available evidence of the effects of air pollution and noise on behavioral development is limited, and it overlooks exposure at schools, where children spend a considerable amount of time. Objective: We aimed to investigate the associations of exposure to traffic-related air pollutants (TRAPs) and noise at school on behavioral development of schoolchildren. Methods: We evaluated children 7–11 years of age in Barcelona (Catalonia, Spain) during 2012–2013 within the BREATHE project. Indoor and outdoor concentrations of elemental carbon (EC), black carbon (BC), and nitrogen dioxide (NO2) were measured at schools in two separate 1-week campaigns. In one campaign we also measured noise levels inside classrooms. Parents filled out the strengths and difficulties questionnaire (SDQ) to assess child behavioral development, while teachers completed the attention deficit/hyperactivity disorder criteria of the DSM-IV (ADHD-DSM-IV) list to assess specific ADHD symptomatology. Negative binomial mixed-effects models were used to estimate associations between the exposures and behavioral development scores. Results: Interquartile range (IQR) increases in indoor and outdoor EC, BC, and NO2 concentrations were positively associated with SDQ total difficulties scores (suggesting more frequent behavioral problems) in adjusted multivariate models, whereas noise was significantly associated with ADHD-DSM-IV scores. Conclusion: In our study population of 7- to 11-year-old children residing in Barcelona, exposure to TRAPs at school was associated with increased behavioral problems in schoolchildren. Noise exposure at school was associated with more ADHD symptoms. Citation: Forns J, Dadvand P, Foraster M, Alvarez-Pedrerol M, Rivas I, López-Vicente M, Suades-Gonzalez E, Garcia-Esteban R, Esnaola M, Cirach M, Grellier J, Basagaña X, Querol X, Guxens M, Nieuwenhuijsen MJ, Sunyer J. 2016. Traffic-related air pollution, noise at school, and behavioral problems in Barcelona schoolchildren: a cross-sectional study. Environ Health Perspect 124:529–535; http://dx.doi.org/10.1289/ehp.1409449

Assessing the human health impacts of exposure to disinfection by-products — A critical review of concepts and methods ☆

Understanding the public health implications of chemical contamination of drinking water is important for societies and their decision-makers. The possible population health impacts associated with exposure to disinfection by-products (DBPs) are of particular interest due to their potential carcinogenicity and their widespread occurrence as a result of treatments employed to control waterborne infectious disease. We searched the literature for studies that have attempted quantitatively to assess population health impacts and health risks associated with exposure to DBPs in drinking water. We summarised and evaluated these assessments in terms of their objectives, methods, treatment of uncertainties, and interpretation and communication of results. In total we identified 40 studies matching our search criteria. The vast majority of studies presented estimates of generic cancer and non-cancer risks based on toxicological data and methods that were designed with regulatory, health-protective purposes in mind, and therefore presented imprecise and biased estimates of health impacts. Many studies insufficiently addressed the numerous challenges to DBP risk assessment, failing to evaluate the evidence for a causal relationship, not appropriately addressing the complex nature of DBP occurrence as a mixture of chemicals, not adequately characterising exposure in space and time, not defining specific health outcomes, not accounting for characteristics of target populations, and not balancing potential risks of DBPs against the health benefits related with drinking water disinfection. Uncertainties were often poorly explained or insufficiently accounted for, and important limitations of data and methods frequently not discussed. Grave conceptual and methodological limitations in study design, as well as erroneous use of available dose-response data, seriously impede the extent to which many of these assessments contribute to understanding the public health implications of exposure to DBPs. In some cases, assessment results may cause unwarranted alarm among the public and potentially lead to poor decisions being made in sourcing, treatment, and provision of drinking water. We recommend that the assessment of public health impacts of DBPs should be viewed as a means of answering real world policy questions relating to drinking water quality, including microbial contaminants; that they should be conducted using the most appropriate and up-to-date data and methods, and that associated uncertainties and limitations should be accounted for using quantitative methods where appropriate.

Prenatal exposure to polychlorinated biphenyls and child neuropsychological development in 4-year-olds: an analysis per congener and specific cognitive domain.

Polychlorinated biphenyls (PCB) are synthetic organochlorine compounds with potential neurotoxic effects. Although negative effects on neuropsychological development have been observed in previous studies on PCB exposure, there are inconsistencies in these effects at current exposure levels of these compounds which are much lower than for previous generations. This study aimed to disentangle the effects of prenatal and postnatal PCB exposure on neuropsychological development at 4 years of age. This study is based on a population-based birth cohort design established in Menorca (Spain) as part of the INMA [Environment and Childhood] Project. We assessed general neuropsychological development using the McCarthy Scales of Childrens Abilities (MCSA). A total of 422 4-year old children were assessed with the MCSA. Levels of PCBs were measured in cord blood (n=405) and in blood samples taken at 4 years (n=285). We found no statistically significant effects of the sum of prenatal PCBs on MCSA scores. Nevertheless, individual congener analyses yielded significant detrimental effects of prenatal PCB153 on the majority of MCSA scores, while no effects were reported for other congeners. The levels of PCBs at 4 years of age were not associated with neuropsychological development. Thus, prenatal exposure to low-level concentrations of PCBs, particularly PCB153, was associated with an overall deleterious effect on neuropsychological development at 4 years of age, including negative effects on executive function, verbal functions and visuospatial abilities, but not on motor development.