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Chlorination disinfection byproducts in water and their association with adverse reproductive outcomes: a review.

机译：水中的氯化消毒副产物及其与不良繁殖结局的关系：综述。

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OBJECTIVES AND METHODS: Chlorination has been the major disinfectant process for domestic drinking water for many years. Concern about the potential health effects of the byproducts of chlorination has prompted the investigation of the possible association between exposure to these byproducts and incidence of human cancer, and more recently, with adverse reproductive outcomes. This paper evaluates both the toxicological and epidemiological data involving chlorination disinfection byproducts (DBPs) and adverse reproductive outcomes, and makes recommendations for future research. RESULTS AND CONCLUSIONS: Relatively few toxicological and epidemiological studies have been carried out examining the effects of DBPs on reproductive health outcomes. The main outcomes of interest so far have been low birth weight, preterm delivery, spontaneous abortions, stillbirth, and birth defects--in particular central nervous system, major cardiac defects, oral cleft, and respiratory, and neural tube defects. Various toxicological and epidemiological studies point towards an association between trihalomethanes (THMs), one of the main DBPs and marker for total DBP load, and (low) birth weight, although the evidence is not conclusive. Administered doses in toxicological studies have been high and even though epidemiological studies have mostly shown excess risks, these were often not significant and the assessment of exposure was often limited. Some studies have shown associations for DBPs and other outcomes such as spontaneous abortions, stillbirth and birth defects, and although the evidence for these associations is weaker it is gaining weight. There is no evidence for an association between THMs and preterm delivery. The main limitation of most studies so far has been the relatively crude methodology, in particular for assessment of exposure. RECOMMENDATIONS: Large, well designed epidemiological studies focusing on well defined end points taking into account relevant confounders and with particular emphasis on exposure characterisation are ideally needed to confirm or refute these preliminary findings. In practice, these studies may be impracticable, partly due to the cost involved, but this is an issue that can be put right--for example, by use of subsets of the population in the design of exposure models. The studies should also reflect differences of culture and water treatment in different parts of the world. To identify the specific components that may be of aetiological concern and hence to fit the most appropriate exposure model with which to investigate human exposure to chlorinated DBPs, further detailed toxicological assessments of the mixture of byproducts commonly found in drinking water are also needed.
机译：目的和方法：多年来，氯化一直是生活饮用水的主要消毒工艺。对氯化副产物对健康的潜在影响的关注促使人们对接触这些副产物与人类癌症发生率以及最近与不良生殖结果之间的可能联系进行了调查。本文评估了涉及氯化消毒副产物（DBPs）和不良生殖结果的毒理学和流行病学数据，并为今后的研究提供了建议。结果与结论：相对较少的毒理学和流行病学研究进行了研究，以研究DBPs对生殖健康结局的影响。迄今为止，关注的主要结果是低出生体重，早产，自然流产，死产和出生缺陷，特别是中枢神经系统，主要心脏缺陷，口腔left裂，呼吸道和神经管缺陷。各种毒理学和流行病学研究都指出，三卤甲烷（THM），主要DBP之一和总DBP负荷的标志物与（低）出生体重之间存在关联，尽管证据尚无定论。毒理学研究中的给药剂量很高，尽管流行病学研究大多显示出过度的风险，但这些风险通常并不显着，暴露的评估常常受到限制。一些研究表明与DBP和其他结果（如自然流产，死产和出生缺陷）的关联，尽管这些关联的证据较弱，但正在增加。没有证据表明THM与早产之间存在关联。迄今为止，大多数研究的主要局限性是相对粗糙的方法，特别是对于暴露评估。建议：理想情况下，需要进行大型的，设计良好的流行病学研究，重点是明确定义的终点，同时要考虑相关的混杂因素，尤其要强调暴露特征，以确认或反驳这些初步发现。实际上，这些研究可能不切实际，部分原因是所涉及的成本，但这是可以解决的问题，例如，通过在暴露模型的设计中使用总体子集。这些研究还应反映出世界不同地区的文化和水处理差异。为了确定可能是病原学关注的特定成分，从而适合调查人类接触氯化DBP所接触的最合适的接触模型，还需要对饮用水中常见的副产物混合物进行更详细的毒理学评估。

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