Occup Environ Med doi:10.1136/oemed-2012-101093
  • Exposure assessment
  • Original article

Risk of congenital anomalies in relation to the uptake of trihalomethane from drinking water during pregnancy

Open Access
  1. Mark J Nieuwenhuijsen4,5,6
  1. 1Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
  2. 2Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  3. 3Clinic of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  4. 4Center for Research in Environmental Epidemiology (CREAL), Parc de Recerca Biomedica de Barcelona (PRBB), Barcelona, Spain
  5. 5Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
  6. 6CIBER Epidemiologia y Salud Pública (CIBERESP) Madrid, Spain
  1. Correspondence to Professor Regina Grazuleviciene, Department of Environmental Sciences, Faculty of Natural Sciences, Vytauto Didžiojo universitetas, Str. Donelaicio 58, Kaunas 44248, Lithuania; r.grazuleviciene{at}
  • Received 2 August 2012
  • Revised 14 January 2013
  • Accepted 16 January 2013
  • Published Online First 12 February 2013


Objectives Congenital anomalies have been inconsistently associated with maternal crude estimated exposure to drinking water trihalomethane (THM). We investigated the relationship between individual THM uptake during the first trimester of pregnancy and congenital anomalies.

Methods We estimated maternal THM uptake for 3074 live births using residential tap water concentrations, drinking water ingestion, showering and bathing, and uptake factors of THM in the blood. Multiple logistic regression was used to investigate the association of THM exposure with congenital anomalies.

Results We observed no statistically significant relationships between congenital anomalies and the total THM internal dose. We found little indication of a dose-response relationship for brominated THM and congenital heart anomalies. The relationship was statistically significant for bromodichloromethane (BDCM) (OR=2.16, 95% CI 1.05 to 4.46, highest vs lowest tertile) during the first month of pregnancy. During the first trimester of pregnancy, the probability of developing heart anomalies increased for every 0.1 μg/d increase in the BDCM and for every 0.01 μg/d increase in the internal dibromochloromethane (DBCM) dose (OR 1.70, 95% CI 1.09 to 2.66, and OR 1.25, 95% CI 1.01 to 1.54, respectively). A dose-response relationship was evident for musculoskeletal anomalies and DBCM exposure during the first and second months of pregnancy, while BDCM exposure tended to increase the risk of urogenital anomalies.

Conclusions This study shows some evidence for an association between the internal dose of THM and the risk of congenital anomalies. In particular, increased prenatal exposure to brominated THM might increase the risk of congenital heart and musculoskeletal anomalies.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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