(34.228.41.66) 您好!臺灣時間:2018/12/12 19:58
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
本論文永久網址: 
line
研究生:李依恬
研究生(外文):Yi-Tien Lee
論文名稱:台灣地區飲用水中消毒副產物與生殖異常之相關性探討
論文名稱(外文):Maternal exposure to disinfection by-products in drinking water and risk of adverse birth outcomes in Taiwan
指導教授:王根樹王根樹引用關係
指導教授(外文):Gen-Shuh Wang
口試委員:蔡詩偉
口試日期:2011-08-01
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:環境衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2011
畢業學年度:99
語文別:英文
論文頁數:111
中文關鍵詞:台灣消毒副產物總三鹵甲烷飲用水生殖異常
外文關鍵詞:TaiwanDisinfection by-productstotal THMs (TTHMs)Drinking wateradverse birth outcomes
相關次數:
  • 被引用被引用:0
  • 點閱點閱:438
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
加氯消毒是台灣地區飲用水主要的消毒方式。加氯消毒的過程會產生許多消毒副產物,例如三鹵甲烷、含鹵乙酸。消毒副產物造成可能的健康危害已經被大量研究及討論。許多毒理研究、動物實驗與流行病學研究均指出,暴露於消毒副產物和癌症、生殖異常可能有相關性,但結果仍不一致。本研究的目的,為探討母親在懷孕的第一孕程和第三孕程中,暴露到飲用水中的總三鹵甲烷,與生殖異常的相關性。探討之生殖異常包括總缺陷、心臟缺陷、神經系統缺陷、唇顎裂、死產、足月低出生體重和子宮內成長遲滯。
研究族群為國健局出生通報資料庫中,2001-2009年於台灣出生之單胞胎新生兒及死產。共有1,126,714個活產和10,337個死產納入第一孕程的分析,1,148,308個活產納入第三孕程的分析。本研究使用2001-2005、2007-2009年環保署定期監測之配水系統中總三鹵甲烷濃度作為暴露資料,計算出不同區域每年每月平均總三鹵甲烷濃度,並以複迴歸模式推估缺乏監測資料之月平均總三鹵甲烷濃度。利用羅吉斯迴歸模式估計勝算比(Odds ratio, OR)及其95%信賴區間,探討母親於第一孕程和第三孕程暴露之平均總三鹵甲烷濃度與生殖異常的關係。暴露濃度以兩種方式分組。
研究結果顯示,即使我們改進先前的暴露評估,以及改善台灣總三鹵甲烷濃度過低所造成的研究限制,仍發現只有死產在兩種分組方式之高暴露濃度組,以及將濃度視為連續變項時,有達到正相關之統計上顯著差異(OR=1.077, 95%CI=1.01-1.49; OR=1.148, 95%CI=1.056-1.248; and OR=1.003, 95%CI=1.001-1.006)。其他生殖異常在不同暴露濃度組間皆未達到正相關之統計上顯著差異。在總三鹵甲烷與足月低出生體重和死產之間,發現些微劑量效應之關係。
依研究結果我們可暫時推論,在平均總三鹵甲烷濃度為9.86±10.05 µg/L的狀況下,不需要擔心總三鹵甲烷對生殖異常的影響。因此從本研究結果來看,美國環保署制定的總三鹵甲烷預期管制目標40 µg/L,應可充分保障民眾的健康。但仍需進一步研究以確認在多少濃度範圍內可能有影響,以利未來訂定更嚴格的法規。也需進一步探討是否其他毒性更強的消毒副產物才是主要造成生殖異常的原因。



Water chlorination has been the major disinfection process of drinking water in Taiwan. Disinfection by-products could be produced during the disinfection process, such as trihalomethanes (THMs) and haloacetic acids (HAAs). Concerns about the potential health effects from exposures to the disinfection by-products have been raised. Many toxicological and epidemiological studies have been conducted to investigate the possible associations between the maternal exposure to disinfection by-products and the adverse health effects such as cancers and adverse birth outcomes, but the results were inconsistent. The objective of this study was to examine the effects of maternal exposure to total THMs (TTHMs) in drinking water during the first and the third trimesters on the risks of adverse birth outcomes in Taiwan. The adverse birth outcomes investigated in this study included all congenital malformations, congenital heart disease, nervous system defects, orofacial cleft, stillbirth, term low birth weight, and small for gestational age.
We used the birth registration data to conduct a registry-based study between 2001 and 2009 in Taiwan. There were 1,126,714 live births and 10,337 stillbirths, and 1,148,308 live births included in the analysis of the first and the third trimesters, respectively. We obtained the TTHMs data routinely collected in distribution systems by Taiwan EPA from 2001 to 2005 and 2007 to 2009 as our exposure data, and used multiple regression models to estimated unavailable monthly average TTHMs concentrations. Adjusted ORs (95% CIs) were calculated by logistic regression, for the association between TTHMs exposure of the mothers averaged over the first and the third trimesters, and various adverse birth outcomes under two ways of classifying TTHMs exposure groups. Although we improved the previous exposure assessments and overcame the study limitation of low-level TTHMs in Taiwan, we still found no statistically significant positive associations between the TTHMs and the adverse birth outcomes, except stillbirth in the two classifying ways of the high exposure group of TTHMs, as well as treating complete exposure data as continuous (OR=1.077, 95%CI=1.01-1.49; OR=1.148, 95%CI=1.056-1.248; and OR=1.003, 95%CI=1.001-1.006, respectively). Weak evidence of a dose-response trend was found between TTHM exposure groups and TLBW and stillbirth.
We temporarily concluded that with low levels of average TTHMs concentrations (9.86 ± 10.05 µg/L) in Taiwan, we do not need to worry about the effects of TTHMs on adverse birth outcomes. If we strictly revise the MCL of TTHMs to 40µg/L in the future, the health of the people will be sufficiently protected. Further studies with individual water use and other exposure routes were needed to find the range above which TTHMs concentration would have an effect on adverse birth outcomes in order to set up stricter regulation to control the TTHMs to be within the safe range. Further studies of examining the relationship between other more toxic DBPs and adverse birth outcomes are also required.



Contents
Chapter 1 Introduction....................................1
 1.1 Background..........................................1
 1.2 Objective...........................................2
Chapter 2 Literature review...............................4
 2.1 THMs in drinking water..............................4
  2.1.1 Formation, categories, and characteristics of DBPs ................................................4
  2.1.2 Exposure routes and pathways of THMs............5
  2.1.3 Regulations of THMs.............................7
 2.2 Studies of THMs and adverse health outcomes.........8
  2.2.1 Toxicological studies and possible mechanisms of
THMs and adverse birth outcomes.................8
  2.2.2 Epidemiological studies of THMs and adverse birth
outcomes.......................................11
  2.2.3 Gene-environment interaction...................17
  2.2.4 Exposure period................................18
Chapter 3 Materials and methods..........................20
 3.1 Study population...................................20
 3.2 Exposure data ......................................21
  3.2.1 Introduction of exposure data..................21
  3.2.2 Study region...................................22
  3.2.3 TTHM exposure..................................23
 3.3 Adverse birth outcomes.............................28
 3.4 Statistical methods................................29
Chapter 4 Results........................................30
 4.1 Distribution of TTHMs concentrations in Taiwan.....30
 4.2 Complete TTHMs exposure data.......................33
  4.2.1 Tests to determine equation curves for estimating
TTHMs exposure data............................34
  4.2.2 Combination of observed and estimated TTHMs data ...............................................36
 4.3 Characteristics of the study population............40
  4.3.1 The study population included in the analysis of
the first trimester............................40
  4.3.2 The study population included in the analysis of
the third trimester............................45
 4.4 Prevalence rates of various adverse birth outcomes.49
  4.4.1 Prevalence rates of various adverse birth
outcomes by TTHMs exposure groups..............49
  4.4.2 Congenital malformations and stillbirth........49
  4.4.3 Prevalence rates of various adverse birth
outcomes by potential risk factors.............52
  4.4.4 Prevalence rates of various adverse birth
outcomes by years..............................68
 4.5 Logistic Regression models on the occurrence of
congenital malformations...........................74
Chapter 5 Discussions....................................78
 5.1 Effects of TTHMs exposure on birth outcomes........78
 5.2 TTHMs exposure data................................82
 5.3 Registration and outcomes data.....................84
 5.4 Low levels of TTHMs in Taiwan......................87
 5.5 Limitations of study...............................90
Chapter 6 Conclusions and Suggestions....................91
References...............................................94
Appendixes..............................................109

List of Tables
Table 2.1 Summary of epidemiological studies on THMs and adverse birth outcomes in countries with low levels of THMs...................................................13
Table 4.1 Distribution of TTHMs concentrations (μg/L) in Taiwan, 2001-2009......................................31
Table 4.2 Results of F-test of two models performed separately for each of the seven regions...............36
Table 4.3 The characteristics of the total study population and four TTHMs exposure groups included in the analysis of the first trimester....................................43
Table 4.4 The characteristics of the total study population and three counties/cities included in the analysis of the first trimester........................................44
Table 4.5 The characteristics of the total study population and four TTHMs exposure groups included in the analysis of the third trimester ....................................47
Table 4.6 The characteristics of the total study population and three counties/cities included in the analysis of the third trimester........................................48
Table 4.7 Prevalence rates of various adverse birth outcomes by TTHMs exposure groups......................51
Table 4.8 The prevalence rates of congenital malformations among live births and stillbirths......................51
Table 4.9 Prevalence rates of congenital heart disease by potential risk factors.................................54
Table 4.10 Prevalence rates of nervous system defects by potential risk factors.................................56
Table 4.11 Prevalence rates of orofacial cleft by potential risk factors...........................................58
Table 4.12 Prevalence rates of all congenital malformations by potential risk factors..............................60
Table 4.13 Prevalence rates of stillbirth by potential risk factors................................................62
Table 4.14 Prevalence rates of TLBW by potential risk factors................................................64
Table 4.15 Prevalence rates of SGA by potential risk factors................................................66
Table 4.16 Prevalence rates of congenital heart disease by years..................................................70
Table 4.17 Prevalence rates of nervous system defects by years..................................................70
Table 4.18 Prevalence rates of orofacial cleft by years..71
Table 4.19 Prevalence rates of all congenital malformations by years.................................................71
Table 4.20 Prevalence rates of stillbirth by years.......72
Table 4.21 Prevalence rates of TLBW by years.............72
Table 4.22 Prevalence rates of SGA by years..............73
Table 4.23 The number of cases and adjusted ORs (95% CIs) for the association between maternal exposure to TTHMs averaged over the first trimester and various congenital malformations under two ways of classifying TTHMs exposure groups...................................................76
Table 4.24 The number of cases and adjusted ORs (95% CIs) for the association between maternal exposure to TTHMs averaged over the first trimester and stillbirth, and exposure to TTHMs averaged over the third trimester and TLBW and SGA under two ways of classifying TTHMs exposure groups...................................................77


List of Figures
Figure 4.1 Yearly average TTHMs concentrations (μg/L) by five areas in Taiwan, 2001-2005 and 2007-2009............32
Figure 4.2 Yearly average TTHMs concentrations (μg/L) by three counties/cities in Taiwan, 2001-2005 and 2007-2009..33
Figure 4.3 The complete monthly average TTHMs concentrations (μg/L) in Taipei City, 2001-2005 and 2007-2008.....................................................37
Figure 4.4 The complete monthly average TTHMs concentrations (μg/L) in Kaohsiung City, 2001-2005 and 2007-2008................................................37
Figure 4.5 The complete monthly average TTHMs concentrations (μg/L) in Kinmen County, 2005, 2007 and 2008.....................................................38
Figure 4.6 The complete monthly average TTHMs concentrations (μg/L) in north area, 2001-2005 and 2007-2008.....................................................38
Figure 4.7 The complete monthly average TTHMs concentrations (μg/L) in south area, 2001-2005 and 2007-2008.....................................................39
Figure 4.8 The complete monthly average TTHMs concentrations (μg/L) in east area, 2001-2005 and 2007-2008.....................................................39
Figure 4.9 The complete monthly average TTHMs concentrations (μg/L) in offshore islands, 2001-2005 and 2007-2008................................................40
Appendix A. Distribution of HAAs concentrations (μg/L) in Taiwan, 2006-2009.......................................109
Appendix B. Average concentrations (μg/L) of individual HAAs from 2006 to 2009 by five areas in Taiwan..........109
Appendix C. Average concentrations (μg/L) of HAA5, HAA6, and HAA9 from 2006-2009 by five areas in Taiwan.........110
Appendix D. Yearly average HAA9 concentrations (μg/L) by five areas in Taiwan, 2007-2009.........................110
Appendix E. Eurocat subgroups of congenitalmalformations.111






References
Aggazzotti G, Righi E, Fantuzzi G, Biasotti B, Ravera G, Kanitz S, Barbone F, Sansebastiano E, Battaglia MA, Leoni
V, Fabiani L, Triassi M, Sciacca S. Collaborative Group
for the Study of Chlorinated Drinking Water and Pregnancy. 2004. Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy. J Water Health 2:233-247.
Alston TA. 1991. Inhibition of vitamin B12-dependent methionine biosynthesis by chloroform and carbon tetrachloride. Biochem Pharmacol 42:R25-R28.
Beddowes EJ, Faux SP, Chipman JK. 2003. Chloroform, carbon tetrachloride and glutathione depletion induce secondary genotoxicity in liver cells via oxidative stress. Toxicology 187:101-115.
Borzelleca JF, Carchman RA. 1982. Effects of selected organic drinking water contaminants on male reproduction. Research Triangle Park, NC:US Environmental Protection Agency, (EPA 600/1-82-009; NTIS PB82-259847; Contract No R804290).
Botto LD, Yang Q. 2000. 5,10-Methyienetetrahydrofolate reductase gene variants and congenital anomalies: a HUGE review. Am J Epidemiol 151:862-877.
Bove FJ, Fulcomer MC, Klotz JB, Esmart J, Dufficy EM, Savrin JE. 1995. Public drinking water contamination and birth outcomes. Am J Epidemiol 141:850-862.
Brown-Woodman PD, Hayes LC, Huq F, Herlihy C, Picker K, Webster WS. 1998. In vitro assessment of the effect of halogenated hydrocarbons:chloroform, dichloromethane, and
dibromoethane on embryonic development of the rat. Teratology 57:321-333.
Cben ATL, Reidy JA, Sever LE. 1996. Public drinking water contamination and birth outcomes (Letter). Am J Epidemiol 143:1179-1180.
Cedergren MI, Selbing AJ, Lofman O, Källen B. 2002. Chlorination byproducts and nitrate in drinking water and risk of congenital cardiac defects. Environ Res 89(2):124-130.
Chen J, Thirkill TL, Lohstroh PN, Bielmeier SR, Narotsky MG, Best DS, Harrison RA, Natarajan K, Pegram RA, Overstreet JW, Lasley BL, Douglas GC. 2004. Bromodichloromethane inhibits human placental trophoblast differentiation. Toxicol Sci 78:166-174.
Chen J, Douglas GC, Thirkill TL, Lohstroh PN, Bielmeier SR, Narotsky MG, Best DS, Harrison RA, Natarajan K, Pegram RA, Overstreet JW, Lasley BL. 2003. Effect of bromodichloromethane on chorionic gonadotrophin secretion by human placental trophoblast cultures. Toxicol Sci 76:75-82.
Chinery RL, Gleason AK. 1993. A compartmental model for the prediction of breath concentration and absorbed dose of chloroform after exposure while showering. Risk Anal 13:51-62.
Delaney JC, Wolfe GW, Kaiser LL, Klinefelter G, Hunter ES, Chapin RE. 1997. Short term reproductive and developmental effects of chlorodibromomethane in S-D rats when administered in drinking water. Toxicologist 36:257.
Dodds L, King W, Woolcott C, Pole J. 1999. Trihalomethanes in public water supplies and adverse birth outcomes. Epidemiology 10:233-237.
Dodds L, King W, Allen AC, Armson A, Fell DB, Nimrod C. 2004. Trihalomethanes in public water supplies and risk of stillbirth. Epidemiology 15:179-186.
Gallagher MD, Nuckols JR, Stallones L, Savitz DA. 1998. Exposure to trihalomethanes and adverse pregnancy outcomes. Epidemiology 9:484-489
Gemma S, Vittozzi L., Testai E. 2003. Metabolism of chloroform in the human liver and identification of the competent P450s. Drug Metab Dispos 31:266-274.
Gorden SM, Wallace L, Challaghan P, Kenny D, Brinkman M. 1998. Effect of water temperature on dermal exposure to chloroform. Environ Health Perspect 106:337-345.
Grazuleviciene R, Nieuwenhuijsen MJ, Vencloviene J, Kostopoulou-Karadanelli M, Krasner SW, Danileviciute A, Balcius G, Kapustinskiene V. 2011. Individual exposures to drinking water trihalomethanes, low birth weight and small for gestational age risk:a prospective Kaunas cihort study. Environmental Health 10:32 (19 April 2011).
Gulati DK, Hope E, Barnes LH. 1989. Bromoform:reproductive and fertility assessment in Swiss CD-1 mice when administered by gavage. Research Triangle Park, NC:National Institute for Environmental Health Sciences,(NTIS PB89-169254.)
Hertz-Picciotto I, Pastore LM, Beaumont JJ. 1996. Timing and patterns of exposures during pregnancy and their implications for study methods. Am J Epidemiol 143:597-607.
Hinckley AF, Bachand AM, Nuckols JR, Reif JS. 2005. Identifying public water facilities with low spatial variability of disinfection by-products for epidemiologic investigations. Occup Environ Med 62:494-499.
Hoffman CS, Mendola P, Savitz DA, Herring AH, Loomis D, Hartmann KE, Singer PC, Weinberg HS, Olshan AW. 2008a. Drinking water disinfection by-product exposure and fetal growth. Epidemiology 19:729-737.
Hoffman CS, Mendola P, Savitz DA, Herring, AH, Loomis D, Hartmann KE, Singer, PC, Weinberg, HS, Olshan AW. 2008b. Drinking water disinfection by-product exposure and duration of gestation. Epidemiology 19:738-746.
Hwang BF, Magnus P, Jaakkola JJK. 2002. Risk of specific birth defects in relation to chlorination and the amount of natural organic matter in the water supply. Am J Epidemiol 156:374-382.
Hwang BF, Jaakkola JJF, Guo HR. 2008. Water disinfection by-products and the risk of specific birth defects:a population-based cross-sectional study in Taiwan. Environ Health 7:23.
Infante-Rivard C, Amre D, Sinnett D. 2002. GSTTI and CYP2E1 polymorpbisms and trihalomethanes in drinking water:effect on cbildbood leukemia. Environ Health Perspect 110:591-593.
Infante-Rivard C. 2004. Drinking water contaminants, gene polymorphisms and fetal growth. Environ Health Perspect 112:1213-1216.
Jaakkola JJK, Magnus P, Skrondal A, Hwang BF, Becher G, Dybing E. 2001. Fetal growth and duration of gestation relative to water chlorination. Occup Environ Med 58:437-442.
Jo WK, Weisel CP, Lioy PJ. 1990. Routes of chloroform exposure and body burden from showering with chlorinated tap water. Risk Anal 10:575-580.
Källen BAJ, Robert E. 2000. Drinking water chlorination and delivery outcome-a registry-based study in Sweden. Reprod Toxicol 14:303-309.
Kanitz S, Franco Y, Patrone V, Caltabellotta M, Raffo E, Riggi C, Timitilli D, Ravera G. 1996. Association between drinking water disinfection and somatic parameters at birth. Environ. Health Perspect 104:516-520.
Kramer MD, Lynch CF, Isacson P, Hanson JW. 1992. The association of waterborne chloroform with intrauterine growth retardation. Epidemiology 3:407-413.
Kim H, Haltmeier P, Klotz JB, Weisel CP. 1999. Evaluation of biomarkers of environmental exposures:urinary HAAs associated with ingestion of chlorinated drinking water. Environ Res 80:185-195.
KimYJ, Hong YC, Lee KH, Park HJ, Park EA, Moon HS, Ha EH. 2005. Oxidative stress in pregnant women and birth weight reduction. Reprod Toxicol 19:487-492.
King WD, Dodds L, Allen AC. 2000. Relation between stillbirth and specific chlorination by-products in public water supplies. Environ Health Perspect 108:883-886.
King WD, Dodds L, Allen AC, Armson BA, Fell D, Nimrod C. 2005. Haloacetic acids in drinking water and risk for stillbirth. Occup Environ Med 62:124-12.
Kline J, Stein Z, Susser M. 1989. Conception to Birth: The Epidemiology of Prenatal Development. New York: Oxford University Press.
Klinefelter GR, Suarez JD, Roberts NL, Deangelo AB. 1995. Preliminary screening for the potential of drinking water disinfection by-products to alter male reproduction. Reprod Toxicol 9:571-578.
Klotz JB, Pyrch LA. 1999. Neural tube defects and drinking water disinfection by-products. Epidemiology 10:383-90.
Kuo HW, Chiang TF, Lo II, Lai JS, Chan CC, Wang JD. 1997. VOC concentration in Taiwan’s household drinking water. The Science of the Total Environment 208:41-47.
Levesque B, Ayotte P, LeBlanc A, Dewally E, Prud Homme D, Lavoie R, Allaire S, Levallois. 1994. Evaluation of dermal and respiratory chloroform exposure in humans. Environ Health Perspect 102:1082-1087.
Lewis C, Suffet IH, Ritz B. 2006. Estimated effects of disinfection by-products on birth weight in a population served by a single water utility. Am J Epidemiol 163:38-47.
Lin TF, Hoang SW. 2000. Inhalation exposure to THMs from drinking water in south Taiwan. The Science of the Total Environment 246:41-49.
Lindstorm AB, Pleil JD, Beerkoff DC. 1997. Alveolar breath sampling and analysis to assess trihalomethane exposures during competitive swimming training. Environ Health Perspect 105(6):636-642.
Luben TJ, Nuckols JR, Mosley BS, Hobbs, C, Reif JS. 2008. Maternal exposure to water disinfection by-products during gestation and risk of hypospadias. Occup Environ Med 65:420-429.
Luben TJ, Olshan AF, Herring AH, Jeffay S, Strader L, Buus RM, Chan RL, Savitz DA, Singer PC, Weinberg HS, Perreault SD. 2007. The healthy men study: an evaluation of exposure to disinfection by-products in tap water and sperm quality.
Environ Health Perspect 115:1169-1176.
MacLehose RF, Savitz DA, Herring AH, Hartmann KE, Singer PC, Weinberg HS. 2008. Drinking water disinfection by-products and time to pregnancy. Epidemiology 19:451-458.
Magnus P, Jaakkola JJK, Skrondal A, Alexander J, Becher G, Krogh T, Dybing E. 1999. Water chlorination and birth defects. Epidemiology 10:513-517.
Maxwell NI, Burmaster DE, Ozonoff D. 1993. Trihalomethanes and maximum contaminant levels:the significance of inhalation and dermal exposures to chloroform in household water. Regul Toxicol Pharmacol 14:297-312.
McKone T. 1993. Linking a PBPK model for chloroform with measured breath concentrations in showers:Implications for dermal exposure models. J Exposure Anal Environ Epidemiol 3:339-365.
Meek ME, Beauchamp R, Long G, Moir D, Turner L, Walker M. 2002. Chloroform: exposure estimation, hazard characterization, and exposure-response analysis. J Toxicol Environ Health B Crit Rev 5:283-334.
Min J, Park H, Park B, Kim YJ, Park J, Lee H, Ha E, Park E, Hong YC. 2006. Paraoxonase gene polymorphism and vitamin levels during pregnancy: relationship with maternal oxidative stress and neonatal birth weights. Reprod Toxicol
22:418-424.
Murray FJ, Schwetz BA, McBride JF, Staples RE. 1979. Toxicity of inhaled chloroform in pregnant mice and their offspring. Toxicol Appl Pharmacol 50:515-22.
Myatt L, Cui X. 2004. Oxidative stress in the placenta. Histochem Cell Biol 122:369-382.
Narotsky MG, Pegram RA, Kavlock RJ. 1997. Effect of dosing vehicle on the developmental toxicity of bromodichloromethane and carbon tetrachloride in rats.
Fundam Appl Toxicol 40:30-36.
National toxicology program. 1999. Short term reproductive and development toxicity of bromodichloromethane administered in drinking water to Sprague-Dawley rats.
Research Triangle Park, NC:NTP, (NTIS/PB99-111262.)
Nieuwenhuijsen MJ, Martinez D, Grellier J, Bennett J, Best N, Iszatt N, Vrijheid M, Toledano MB. 2009a. Chlorination disinfection by-products in drinking water and
congenital anomalies:review and meta-analyses. Environ Health Perspect 117:1486-1493.
Nieuwenhuijsen MJ, Grellier J, Smith R, Iszatt N, Bennett J, Best N, Toledano M. 2009b. The epidemiology and possible mechanisms of disinfection by-products in drinking water. Philos Transact A Math Phys Eng Sci 367:4043-4076.
Nieuwenhuijsen MJ, Smith R, Golfinopoulos S, Best N, Bennett J, Aggazzotti G, Righi E, Fantuzzi G, Bucchini L, Cordier S, Villanueva CM, Moreno V, La Vecchia C, Bosetti C, Vartiainen T, Rautiu R, Toledano M, Iszatt N, Grazuleviciene R, Kogevinas M. 2009c. Health impacts of long-term exposure to disinfection by-products in drinking water in Europe:HIWATE. Water Health 7:185-207.
Nieuwenhuijsen MJ, Toledano MB, Elliott P. 2000a. Uptake of chlorination disinfection by-products; a review and a discussion of its implications for epidemiological studies. J Expos Anal Environ Epidemiol 10:586-599.
Nieuwenhuijsen MJ, Toledano MB, Eaton NE, Elliott P, Fawell J. 2000b. Chlorination disinfection by-products in water and their association with adverse reproductive outcomes: a review. Occup Environ Med 57:73-85.
Nieuwenhuijsen MJ, Toledano MB, Benneft J, Best N, Hambly P, de Hoogh C, Wellesley D, Boyd PA, Abramsky L, Dattani N, Fawell J, Briggs D, Jarup L, Elliott P. 2008. The relationship between disinfection byproducts in drinking water and congenital anomalies in England and Wales. Environ Health Perspect 116:216-222.
Porter CK, Putnam SD, Hunting KL, Riddle MR. 2005. The effect of trihalomethane and haloacetic acid exposure on fetal growth in Maryland county. Am J Epidemiol
162:334-344.
Potter CL, Chang LW, DeAngelo AB, Daniel FB. 1996. Effects of four trihalomethanes on DNA strand breaks, renal hyaline droplet formation and serum testosterone in male F-344 rats. Cancer Lett 106:235-242.
Rook JJ. 1974. Formation of haloforms during chlorination of natural waters. J Soc Water Treat Exam 23:234-243.
Ruddick JA, Villeneuve DC, Chi I, Valli VE. 1983. A teratological assessment of four trihalomethanes in the rat. J Environ Sci Health B18:333-349.
Savitz DA, Andrews KW, Pastore LM. 1995. Drinking water and pregnancy outcome in central North Carolina:source, amount, and trihalomethane levels. Environ Health Perspect 103:592-596.
Savitz DA, Singer PC, Herring AH, Hartmann KE, Howard S, Weinberg HS, Makarushka C. 2006. Exposure to drinking water disinfection by-products and pregnancy loss. Am. J Epidemiol 164:1043-1051.
Scholl TO, Stein TP. 2001. Oxidant damage to DNA and pregnancy outcome. J Matern Fetal Med. 10:182-185.
Schwetz BA, Leong BKJ, Gehring PJ. 1974. Embryo and fetotoxicity of inhaled chloroform in rats. Toxicol Appl Pharmacol 28:442-51.
Shaw GM, Ranatunga D, Quach T, Neri E, Correa A, Neutra R. 2003. Trihalomethane exposures from municipal water supplies and selected congenital malformations.
Epidemiology 14:191-199.
Thompson DJ, Warner SD, Robinson VB. 1974. Teratology studies on orally administered chloroform in the rat and the rabbit. Toxicol Appl Pharmacol 29:348-57.
Toledano MB, Nieuwenhuijsen MJ, Best N, Whitaker H, Hambly P, de Hoogh C, Fawell J, Jarup L, Elliott P. 2005. Relation of trihalomethane concentrations in public water supplies to stillbirth and birth weight in three water regions in England. Environ Health Perspect 113(2):225-32.
Tomasi A, Albano E, Biasi F, Slater T, Vannini V, Dianzani MU. 1985. Activation of chloroform and related trihalomethanes to free radical intermediates in isolated
hepatocytes and in the rat in vivo as detected by the ESP-spin trapping technique. Chem Biol Interact 55:303-316.
U.S. EPA. Stage 1 Disinfectant and Disinfection Byproduct Rule. 1998. Available at
http://water.epa.gov/lawsregs/rulesregs/sdwa/stage1/index.cfm. and http://water.epa.gov/lawsregs/rulesregs/sdwa/mdbp/upload/2001_05_23_mdbp_qrg_st1.pdf. Accessed July 27, 2011.
U.S. EPA. Stage 2 Disinfectant and Disinfection Byproduct Rule. 2006. Available at
http://water.epa.gov/lawsregs/rulesregs/sdwa/stage2/compliance.cfm.
http://www.epa.gov/ogwdw/disinfection/stage2/pdfs/qrg_stage_2_dbpr_qrg_sch4_final.pdf. Accessed July 27, 2011.
Villanueva CM, Cantor KP, Grimalt JO, Malats N, Sliverman D, Tardon A, Garcia-Closas R, Serra C, Carrato A, Castaño-Vinyals G, Marcos R, Rothman N, Real FX, Dosemeci M, Kogevinas M, 2007. Bladder cancer and exposure to water
disinfection by-products through ingestion, bathing, showering and swimming in pools. Am J Epidemiol 165:148-156.
Waller K, Swan SH, DeLorenze G, Hopkins B. 1998. Trihalomethanes in drinking water and spontaneous abortion. Epidemiology 9:134-40.
Wang G-S, Deng Y-C, Lin T-F. 2007. Cancer risk assessment from trihalomethanes in drinking water. Science of the Total Environment 387:86-95.
Weisel CP, Jo WK. 1996. Ingestion, inhalation and dermal exposure to chloroform and trichloroethane from tap water. Environ Health Perspect 104:48-51.
Weisel CP, Kim H, Haltmeier P, Klotz JB. 1999. Exposure estimates to disinfection by-products of chlorinated drinking water. Environ Health Perspect 107:103-110.
WHO. Guidelines for Drinking-water Quality, fourth edition. 2011. Available at
http://www.who.int/water_sanitation_health/publications/2011/dwq_guidelines/en/index.html. and
http://www.who.int/water_sanitation_health/publications/2011/9789241548151_ch12.pdf. Accessed July 27, 2011.
Wright JM, Schwartz J, Dockery DW. 2003. Effect of trihalomethane exposure on fetal development. Occup Environ Med 60:173-180.
Wright JM, Schwartz J, Dockery DW. 2004. The effect of disinfection by-products and mutagenic activity on birth weight and gestational duration. Environ Health
Perspect 112:920-925.
Yang C-Y, Cheng B-H, Tsai S-S, Wu T-N, Lin M-C, Lin K-C. 2000. Association between chlorination of drinking water and adverse pregnancy outcome in Taiwan. Environ Health Perspect 108:765-768.
Yang CY. 2004. Drinking water chlorination and adverse birth outcomes in Taiwan. Toxicology 198:249-254.
Yang C-Y, Xiao Z-P, Ho S-C, Wu T-N, Tsai S-S. 2007. Association between trihalomethane concentrations in drinking water and adverse pregnancy outcome in
Taiwan. Environ Res 104:390-395.
Yuan J, Wu XJ, Lu WQ, Cheng XL, Chen D, Li XY, Liu AL, Wu JJ, Xie H, Stahl T, Mersch-Sundermann V. 2005. Chlorinated river and lake water extract caused oxidative damage, DNA migration and cytotoxicity in human cells. Int J Hyg Environ Health 208:481-488.
飲用水水質標準。中華民國八十七年二月四日行政院環境保護署(87)環署毒字
第00四四二八號令訂定發布全文九條。
全民健康保險預防保健實施辦法。中華民國八十四年一月二十七日行政院衛生署(84)衛署健保字第八四○○八八五九號令發布。
行政院衛生署國民健康局(2010)。台灣菸害防制年報。台北縣:行政院衛生署國民健康局。
吳慧娜、歐名哲、張永生、黃禮偉、林陳立(2006)。臺北市立聯合醫院出生通報資料分析。北市醫學雜誌,3(4),385-396。
林宜平、黎雅如、沈佩瑩、廖玫涵(2006)。台灣婚姻移民的人口學特性與公共衛生需求初探。台灣衛誌,25(6),482-493。
紀玉臨、周孟嫻、謝雨生(2009)。台灣外籍新娘之空間分析。人口學刊,38,67-113。
郭義興(2003)。台灣母血唐氏症篩檢對唐氏症出生趨勢之影響(已出版之碩士論文)。國立台灣大學,台北市。
詹惠如(2009)。臺灣婦女產前檢查對生產健康的影響(未出版之碩士論文)。國立政治大學,台北市。
劉乃維(2005)。妊娠婦女產前檢查對新生兒健康的影響(已出版之碩士論文)。國立中央大學,桃園縣。
蕭慶華(2006年2月)。迎接第一孕期唐氏症篩檢的來臨。中華民國周產期會訊,120。




QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔