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Meta-analysis and Mendelian randomization study on the association between exposure to chlorinated disinfection byproducts and preterm birth risk

Journal of Perinatology volume 45, pages 438–447 (2025)Cite this article

Subjects

Abstract

Objective

This study aims to investigate the correlation between exposure to disinfection byproducts of chlorination and preterm birth (PTB) through evidence-based medicine Meta-analysis and Mendelian randomization (MR) analysis.

Study design

Meta-analysis was conducted on 17 studies involving 1,251,426 neonates, revealing a higher risk of PTB with exposure to total trihalomethanes (TTHMs) and chloroform. Mendelian randomization (MR) analysis confirmed a causal relationship between chlorides and PTB.

Results

TTHMs and chloroform were associated with increased PTB risk, while haloacetic acids showed no significant association. TTHMs were linked to small gestational age. Ethnicity and study design influenced heterogeneity.

Conclusions

Exposure to chlorination byproducts, particularly TTHMs and chloroform, poses a significant risk for PTB. MR analysis supports a causal relationship between chlorides and PTB, highlighting the importance of water disinfection byproduct control in preventing PTB.

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Fig. 1: Meta-analysis of PTB-related risk factors.
Fig. 2: Meta-analysis of SGA-related risk factors.
Fig. 3: Meta-analysis of LBW-related risk factors.
Fig. 4: MR analysis of the association between chloride levels and birth weight using two samples.
Fig. 5: Data analysis process and key findings of this study.

Data availability

All data can be provided as needed.

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Funding

This study was supported by Jilin Science and Technology Development Program Project (20210204145YY).

Author information

Author notes

  1. These authors contributed equally: Changxia Cheng, Yanling Pei.

Authors and Affiliations

  1. China-Japan Union Hospital of Jilin University Operating Room, Changchun, China

    Changxia Cheng

  2. China-Japan Union Hospital of Jilin University Nursing Department, Changchun, China

    Yanling Pei

  3. Department of Beihu Campus, China-Japan Union Hospital of Jilin University Emergency, Changchun, China

    Guangyu Shan

  4. China-Japan Union Hospital of Jilin University Central Sterile Supply Department, Changchun, China

    Yutao Liu

Authors
  1. Changxia Cheng
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  2. Yanling Pei
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  3. Guangyu Shan
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  4. Yutao Liu
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Contributions

CC and YP contributed equally as co-first authors conceptualized the study, conducted the meta-analysis, and interpreted the results. GS and YL contributed to the data collection, conducted the Mendelian randomization analysis, and assisted in drafting the manuscript. YL supervised the study. All authors contributed to the critical revision of the manuscript and approved the final version for submission.

Corresponding author

Correspondence to Yutao Liu.

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Competing interests

The author declares no competing interests.

Ethics approval and consent to participate

This study is a meta-analysis and Mendelian randomization study based on publicly available datasets and previously published research. Therefore, ethics approval and consent to participate were not applicable.

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Cite this article

Cheng, C., Pei, Y., Shan, G. et al. Meta-analysis and Mendelian randomization study on the association between exposure to chlorinated disinfection byproducts and preterm birth risk. J Perinatol 45, 438–447 (2025). https://doi.org/10.1038/s41372-024-02195-9

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  • DOI: https://doi.org/10.1038/s41372-024-02195-9

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