Toxic metal mixtures in private well water and increased risk for preterm birth in North Carolina

• Published in: Environmental health Vol. 22; no. 1; p. 69
• Main Authors: Eaves, Lauren A, Keil, Alexander P, Jukic, Anne Marie, Dhingra, Radhika, Brooks, Jada L, Manuck, Tracy A, Rager, Julia E, Fry, Rebecca C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-10-2023; BioMed Central; BMC
• Subjects: Analysis; Arsenic; Birth; Cadmium; Census; Censuses; Chromium; Contaminants; Copper; Drinking water; Environmental health; Ethnicity; Expected values; Exposure; Female; Health aspects; Health disparities; Heavy metals; Humans; Infant, Newborn; Lead; Manganese; Metals; Minority & ethnic groups; Mixtures; North Carolina - epidemiology; Pollutants; Population studies; Pregnancy; Premature birth; Premature Birth - chemically induced; Premature Birth - epidemiology; Prenatal experience; Prenatal exposure; Preterm birth; Prevention; Private well; Public health; Race; Racism; Regression analysis; Regression models; Risk; Risk factors; Toxicity testing; Water quality; Well water; Zinc; North Carolina; United States > US; Drinking water; Preterm birth; Mixtures; Private well; Metals
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-023-01021-7

Prenatal exposure to metals in private well water may increase the risk of preterm birth (PTB) (delivery < 37 weeks' gestation). In this study, we estimated associations between arsenic, manganese, lead, cadmium, chromium, copper, and zinc concentrations in private well water and PTB incidence in North Carolina (NC).
Birth certificates from 2003-2015 (n = 1,329,071) were obtained and pregnancies were assigned exposure using the mean concentration and the percentage of tests above the maximum contaminant level (MCL) for the census tract of each individuals' residence at the time of delivery using the NCWELL database (117,960 well water tests from 1998-2019). We evaluated associations between single metals and PTB using adjusted logistic regression models. Metals mixtures were assessed using quantile-based g-computation.
Compared with those in other census tracts, individuals residing in tracts where > 25% of tests exceeded the MCL for lead (aOR 1.10, 95%CI 1.02,1.18) or cadmium (aOR 1.11, 95% CI 1.00,1.23) had an increased odds of PTB. Conversely, those residing in areas with > 25% MCL for zinc (aOR 0.77 (95% CI: 0.56,1.02) and copper (aOR 0.53 (95% CI: 0.13,1.34)) had a reduced odds of PTB. A quartile increase in the concentrations of a mixture of lead, cadmium, and chromium was associated with a small increased odds for PTB (aOR 1.02, 95% CI 1.01, 1.03). This metal mixture effect was most pronounced among American Indian individuals (aOR per quartile increase in all metals: 1.19 (95% CI 1.06,1.34)).
In a large study population of over one million births, lead and cadmium were found to increase the risk of PTB individually and in a mixture, with additional mixtures-related impacts estimated from co-exposure with chromium. This study highlights critical racial and ethnic health disparities in relation to private well water thereby emphasizing the urgent need for improved private well water quality to protect vulnerable populations.