Effect of Drinking Water Quality on Birth Outcomes: A Systematic Review

This review aimed to analyze the effects of drinking water contaminants during pregnancy on birth outcomes, focusing on chemical contaminants, including heavy metals, nitrates, and disinfection byproducts.

A literature search was conducted using SCOPUS, EBSCO, PubMed, Cochrane, and Google Scholar databases. The review included English-language prospective cohort studies and clinical trials published between 2007-2022 that focused on healthy pregnant women and measured birth outcomes. From 269 articles identified, 30 met the inclusion criteria.

Analysis of 30 studies encompassing over 4 million births demonstrated significant associations between water contaminants and adverse birth outcomes. Arsenic exposure below 10 μg/L was associated with an increased risk of very low birth weight (AOR 1.14) and preterm birth (AOR 1.10). Nitrate concentrations of 5-10 mg/L were linked to higher rates of spontaneous preterm birth. Combined exposure to multiple contaminants demonstrated stronger effects than individual exposures, particularly during the second trimester.

Evidence demonstrates that exposure to water pollutants during pregnancy, even at levels below current regulatory guidelines, has a significant impact on birth outcomes. Recommendations include increased monitoring during pregnancy, particularly for private well users, reviewing regulatory standards, and implementing tailored treatments for vulnerable populations.