Drinking water contaminants, gene

polymorphisms, and fetal growth

Claire Infante-Rivard
Environmental Health Perspectives vol.112, no.11, 2004

presented by:
SULTAN BURAENA
ADRIATI ALI SAKTI
FREDDY CHANDRA MONTOLALU

 Author of the study: Claire Infante-Rivard

Place of work: Department of Epidemiology,

Biostatistics, and Occupational Health,
Faculty of Medicine, McGill University,
Montral, Qubec, Canada

Background:
There are still many uncertainties
regarding the risk of adverse pregnancy
outcomes associated with exposure to
drinking water disinfection by-products
(DBPs)
No study has considered the role of
genetic polymorphisms on the relationship
between DBPs and fetal growth

Research question:

Is there an association
between chemical water
contaminants and fetal
growth ?

Research was conducted at:

Largest university-based mother-child

center in Montral, Qubec, Canada

Study design:
This is a case-control study.
Cases were newborns whose birth weight
was below the 10th percentile for
gestational age and sex, based on
Canadian standards
Controls were newborns who were born at
the same hospital and met the same
eligibility criteria, except that their birth
weight was at or above the 10th percentile

 Study subjects:
Newborns whose birth
weight was below the 10th
percentile for gestational
age and sex, based on
Canadian standards, who
were born singleton, alive
after 24th week of
gestation, without severe
congenital anomalies
There were 493 cases and
472 controls
All cases seen at the
largest university-based
mother-child center who
met the eligibility criteria
were taken as study
subjects

Variables:
Maternal characteristics: race, age,
education, prepregnancy BMI, weight gain
during pregnancy, previous IUGR,
cigarette smoking
Trihalomethanes (THMs) concentration
Showering and drinking water habits
CYP2E1*5 and MTHFR C677T
polymorphism

Statistical analysis:
Unconditional logistic
regression analysis were
applied to estimate odds
ratio and 95% confidence
intervals because the
matching involved only
categorical factors
Chi-square test were
used to test for geneenvironment interactions

Results:

Results:

Results:

Results:

Results:
Case mothers were older, had gain less weight
during pregnancy and lower BMI before
pregnancy, smoked during 3rd trimester,
primiparous, have preeclampsia, previous
pregnancy with IUGR
Use of domestic water filter were higher among
controls
No increased risk was observed for any of the
specific THMs or for total THMs
There were no association between exposure to
THMs from DBPs and risk of IUGR

Other studies used as comparison:

4 studies (Bove et al. 1995; Gallagher et al.
1998; Kramer et al. 1992; Wright et al. 2003)
reported that there were an association between
exposure to water contaminants and risk of
IUGR, and 5 did not (Dodds et al. 1999; Jaakkola
et al. 2001; Kallen and Robert 2000; Savitz et al.
1995; Yang et al. 2000).
1 toxicologic study (Chen et al. 2003)
2 studies about MTHFR C677T polymorphism
(Chen et al. 2003, Alston 1991)
1 study about CYP2E1*5 gene (Hayashi et al.
1991)

Authors conclusion:
The study were unable to show effects of
exposure to THMs from DBPs on the risk
of IUGR
Among newborn carriers of a CYP2E1*5
gene variant, important effect were
observed

Authors suggestion:
The result about CYP2E1*5 gene need
confirmation
Accounting for genetic susceptibility is a
sensible way to study the effects of
environmental exposures when there is
information on the candidate genes
involved in the metabolism of these
agents.

Our impression about the study:

Despite the result, it is a well-designed study

with thorough approaches in methodology
and statistical analysis