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Title: Drinking water salinity and the risk of (pre)eclampsia and gestational hypertension in coastal Bangladesh : impacts of climate change
Author: Khan, Aneire
ISNI:       0000 0005 0731 7980
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2014
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Hypertensive disorders in pregnancy are among the leading causes of death and disabilities in women of child-bearing age in low-income countries. Despite the high burden, the pathophysiology and aetiology of these disorders are poorly understood, making effective prevention difficult. Excessive dietary salt intake is an established risk factor for hypertension, but much less is known about the health effects of water salinity. This epidemiological study investigated the relationship between high salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension among pregnant women in a rural coastal community in Dacope, Bangladesh, where both surface- and groundwater have been affected by severe salinity, exacerbated by the effects of sea-level rise and climate change. The population-based case-control study accrued 202 cases of (pre)eclampsia and gestational hypertension and 1,006 controls. The study showed that women in Dacope were exposed to exceptionally high levels of sodium in their drinking water, and found a significant association with the risk of (pre)eclampsia and gestational hypertension. The risks increased in a dose-response manner for increasing quartiles of sodium concentrations in drinking water (ORs 3.36 [95% CI 2.07 - 5.60], 4.35 [2.61 - 6.94] and 5.40 [3.28 - 8.92]), (p-trend<0.001). The associations persisted after adjusting for multiple potential confounders and in several sensitivity analyses. These findings shed light on a previous observation of high rates of (pre)eclampsia and gestational hypertension in the dry season, when salinity levels in surface and groundwater were higher than in the monsoon season. The study provides an evidence base for creating guidelines on sodium consumption for the prevention of hypertensive disorders in pregnant women and the general population living in coastal areas. Furthermore, the study findings can inform policy makers about the urgent need to find sustainable solutions, for example, by finding alternative sources of drinking water. It is likely that climate change will considerably worsen the current situation, and this adds further impetus to the need for intervention.
Supervisor: Vineis, Paolo; Chan, Queenie Sponsor: Grantham Institute for Climate Change
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral