Drinking water contaminants and fetal loss in Northern California

PROJECT SUMMARY/ABSTRACT The objective of this R03 proposal is to characterize the rates of miscarriage and stillbirth by gestational week in a Northern California population, and to evaluate whether climate change-sensitive drinking water contaminants increase rates of miscarriage and stillbirth. We also aim to estimate the effects of a hypothetical intervention of reducing water contaminant levels on risk of fetal loss. The relationships between drinking water contaminants and risks of miscarriage and stillbirth have not been investigated in California since the early 1980s. As climate change threatens the quality of drinking water in the state, it is important to better understand how climate-sensitive drinking water contaminants affect reproductive health. There is a significant gap in research on environmental determinants of fetal loss at a population level. This is likely due to the challenges in studying early fetal loss, as existing data sources have difficulty capturing miscarriage. However, electronic health record data can help us improve our knowledge of fetal loss between 10 and 20 weeks of gestation, when many pregnant people have received a prenatal care visit but whose pregnancies would not be captured in birth records. We propose to use Sutter Health’s electronic medical records to identify pregnancies, and link participants to community water system boundaries using residential address at each clinic visit. We will then assign water contaminant levels based on the annual average contaminant levels collected from public water monitoring information at the water system level in California. The goals of this project are to 1) characterize the rate of fetal loss in a diverse California cohort, 2) evaluate the individual and mixture effects of climate-sensitive water contaminants on rates of fetal loss, and 3) assess whether reducing all water contaminants to their 50th percentiles observed in the study cohort reduces the risk of fetal loss. The research plan is supported by a strong team of investigators from UCSF, Sutter Health, UC Berkeley, and Columbia University. The investigators have a strong history of collaboration and experience working with electronic health records. They bring significant expertise in reproductive health, drinking water contaminants, climate change, and environmental justice. This research addresses a significant gap in the literature and aligns with both NIEHS’s goal to generate evidence that can be used by policymakers to improve population health, and NICHD’s goals to understand contributors to pregnancy loss and to help identify targets for effective prevention of health disparities.