Background: Evidence associating exposure to water disinfection by-products with reduced birth weight and altered duration of gestation remains inconclusive. Objective: We assessed exposure to trihalomethanes (THMs) during pregnancy through different water uses and evaluated the association with birth weight, small for gestational age (SGA), low birth weight (LBW), and preterm delivery. Methods: Mother–child cohorts set up in five Spanish areas during the years 2000–2008 contributed data on water ingestion, showering, bathing, and swimming in pools. We ascertained residential THM levels during pregnancy periods through ad hoc sampling campaigns (828 measurements) and regulatory data (264 measurements), which were modeled and combined with personal water use and uptake factors to estimate personal uptake. We defined outcomes following standard definitions and included 2,158 newborns in the analysis. Results: Median residential THM ranged from 5.9 μg/L (Valencia) to 114.7 μg/L (Sabadell), and speciation differed across areas. We estimated that 89% of residential chloroform and 96% of brominated THM uptakes were from showering/bathing. The estimated change of birth weight for a 10% increase in residential uptake was –0.45 g (95% confidence interval: –1.36, 0.45 g) for chloroform and 0.16 g (–1.38, 1.70 g) for brominated THMs. Overall, THMs were not associated with SGA, LBW, or preterm delivery. Conclusions: Despite the high THM levels in some areas and the extensive exposure assessment, results suggest that residential THM exposure during pregnancy driven by inhalation and dermal contact routes is not associated with birth weight, SGA, LBW, or preterm delivery in Spain.

This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041; from Fondo de Investigación Sanitaria (FIS): FIS-FEDER (Fondo Europeo de Desarrollo Regional) 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, PI080533, FIS-PI041436, FIS-PI06/0867, FIS-PI081151, FIS-S09-PS09/02311); CIBER (AA08_012); Generalitat de Catalunya-CIRIT (1999SGR 00241); Departamento de Sanidad del Gobierno Vasco (BIOEF06/002); Diputación Foral de Gipuzkoa (DFG06/004); Consejería de Salud, Junta de Andalucía (PI-0183/2007); Conselleria de Sanitat Generalitat Valenciana; Fundació Roger Torné; and HI-WATE (Health Impacts of Long-Term Exposure to Disinfection By-Products in Drinking Water) project (FP6-2005-FOOD-4B, reg. 036224)