We conducted a retrospective cohort study with a semi-ecologic study design examining the type of disinfection and source water in relation to birth outcomes. Consistent with previous studies of preterm delivery (PTD), increased risks were noted for chlorinated water use relative to
untreated water (odds ratio (OR)=1.16; 95% confidence intervals (CI): 1.01, 1.33). We also found fairly consistent increased ORs of PTD (range: 1.09 to 1.19) for chlorinated surface water, chlorinated ground water, chloraminated water and all other types of disinfected drinking water relative
to untreated ground water. Small increased risks of small for gestational age (SGA) consistent in magnitude (OR range: 1.08 to 1.11) were detected for exposure to chlorinated surface water, chloraminated water, and other water disinfectants relative to untreated ground water. We also found
a reduction in mean birth weight for users of chlorinated surface water, chloraminated water, and other water disinfectants (range: 19 to 37 grams) relative to untreated ground water. This is the first study to compare risk of adverse fetal growth indices and PTD among residents using chlorinated,
chloraminated and other types of disinfected drinking water. Although we saw small differences for mean birth weight (≤16 grams) among chlorinated surface water users relative to chloraminated surface water users, relative risks for SGA and PTD were fairly comparable. These data suggest
that although there may be differences relative to untreated ground water users, risk of adverse birth outcomes among consumers of different types of disinfected drinking water appears to be minimal. Future analyses will focus on examining risk of fetal growth retardation, fetal loss, and
birth defects in relation to DBP concentrations independent of type of water source and disinfection practices.
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