Use this URL to cite or link to this record in EThOS:
Title: Assessment and validation of exposure to disinfection by-products during pregnancy, in an epidemiological study examining associated risk of adverse fetal growth outcomes
Author: Smith, Rachel B.
ISNI:       0000 0004 2695 876X
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2011
Availability of Full Text:
Access from EThOS:
Access from Institution:
Studies investigating exposure to disinfection by-products (DBPs) via chlorinated waters during pregnancy and adverse fetal growth outcomes have been limited by potential exposure measurement error, lack of exposure assessment validation and potential residual confounding. Factors driving DBP exposure are poorly understood, making it difficult to target resources appropriately in order to improve exposure assessment. These issues were investigated through DBP exposure assessment and validation for a new investigation of DBPs and fetal growth within the Born in Bradford (BiB) cohort study. Analysis of individual water use in the BiB cohort found that water consumption, showering, bathing and swimming varied by demographic and lifestyle factors. Sampling, analysis, and modelling of trihalomethanes (THMs) in tap water showed that THM concentrations exhibited clear seasonal variation, but spatial variability was limited across the study area. Various metrics of exposure to THMs during pregnancy were created, including ‘personalised’ semi-individual metrics. Analysis of these metrics revealed individual water use to be the main driver of THM exposure in this cohort, with spatial and temporal variability having little influence. Compared with a fully integrated THM exposure metric (incorporating ingestion, showering/bathing and swimming), metrics based only on THM concentrations or THM ingestion misclassified over 50% of women. A nested validation study was conducted using a 7-day water diary and urinary trichloroacetic acid (TCAA) biomarker. This found error in self-reported water use and TCAA ingestion estimates to vary by employment status - error being greater for employed women. Urinary TCAA was not correlated with TCAA in tap water, reinforcing that individual water use is the most influential driver of DBP exposure in this cohort. Recommendations for future research include improved individual water use assessment covering more activities and time-points in pregnancy, stratified analysis of questionnaire validation studies, and use of urinary TCAA as a main exposure measure in epidemiological studies.
Supervisor: Toledano, Mireille ; Nieuwenhuijsen, Mark Sponsor: ESRC ; Joint Environment & Human Health Programme (NERC) ; HiWATE (EU Sixth Framework Programme)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral