Drinking water nitrate and risk of pregnancy loss: a nationwide cohort study.

Ninna Hinchely Ebdrup, Jörg Schullehner, Ulla Breth Knudsen, Zeyan Liew, Anne Marie Ladehoff Thomsen, Julie Lyngsø, Bjørn Bay, Linn Håkonsen Arendt, Pernille Jul Clemmensen, Torben Sigsgaard, Birgitte Hansen, Cecilia Høst Ramlau-Hansen
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引用次数: 7

Abstract

Background: Nitrate 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.

Methods: We 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.

Results: No 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.

Conclusion: No 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.

Abstract Image

Abstract Image

饮用水硝酸盐与流产风险:一项全国性队列研究。
背景:硝酸盐污染在全世界的饮用水中都很常见。硝酸盐可以通过胎盘屏障。尽管有胎儿伤害的暗示证据,但饮用水中硝酸盐暴露与妊娠流产之间的潜在联系仍有待研究。我们的目的是调查饮用水中的硝酸盐是否与流产风险有关。方法:在1996-2002年期间,我们在丹麦国家出生队列(DNBC)中对100,410例妊娠(孕11周左右)进行了一项全国性队列研究。从丹麦国家患者登记处和DNBC妊娠访谈中确定妊娠22周前的自然流产。利用国家饮用水质量监测数据库Jupiter,我们通过将地理编码的产妇居住地址与供水区域联系起来,估计了个体和特定时间的硝酸盐暴露。采用对数变换连续水平的样条模型对硝酸盐暴露进行了分析,并将其分为五类。我们使用Cox比例风险模型来估计硝酸盐与妊娠损失之间的关系,并使用胎龄(天)作为时间尺度,调整了人口统计学、健康和生活方式变量。结果:当将暴露作为分类变量进行调查时,没有发现一致的关联,在妊娠期特异性分析中也没有发现任何结果。在使用连续暴露变量的样条模型中,在硝酸盐暴露在1至10 mg/L之间的前三个月观察到妊娠损失的风险适度增加,其中最高。在5 mg/L硝酸盐时调整风险比为1.16 (95% CI: 1.01, 1.34)。这种趋势在较高的暴露范围内减弱。结论:在将饮用水硝酸盐暴露作为分类变量进行调查时,未发现饮用水硝酸盐与流产风险之间存在关联。当我们将暴露建模为连续变量时,发现妊娠早期饮用水硝酸盐暴露与妊娠丢失风险之间存在剂量依赖关系。本研究未考虑非常早期的妊娠损失,生存偏倚是否影响结果有待进一步探讨。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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