Examining the Relationship Between Safe Drinking Water Violations and Adverse Birth Outcomes in Virginia

The Safe Drinking Water Act (SDWA) was established to protect consumers from potential exposure to over 90 water contaminants. Each contaminant is assigned a health-based standard meant to reflect the maximum level at which an adverse human health outcome is unlikely; measurements beyond that level have greater potential to result in an adverse health outcome. While extensive research has been done on the human health implications of water contaminants, few studies have specifically examined the risk to fetal health under real world monitoring conditions. Therefore, the objective of this study is to assess whether drinking water violations are related to fetal health in the Commonwealth of Virginia, by examining the association between SDWA violations and preterm birth (PTB), low birth weight (LBW), and term-low birth weight (tLBW). Singleton births (n=665,984) occurring between 2007 and 2015 in Virginia were geocoded and assigned to their corresponding water service area. Health-based (HB) and monitoring and reporting (MR) violations for 12 contaminants were acquired from the USEPA Safe Drinking Water System, and exposure to contaminants was defined at the service area level to limit exposure misclassification. A logistic regression model for each birth outcome was performed to evaluate potential relationships with water contaminants. When examining the relationship between individual monitoring and reporting violations and PTB, Nitrate-Nitrite and Disinfectant Byproducts Stage 2 violations were both positively associated with the birth outcome. When examining the relationship between health-based violations and birth outcomes, the total coliform rule was negatively associated with tLBW. These findings indicate that monitoring and reporting requirements may need to be more stringent to reduce MR violation occurrence.