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      A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes Translated title: Revisão sobre nitratos na água potável: exposição materna e reações adversas ao desenvolvimento reprodutivo

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          Abstract

          In this review, we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects.

          Translated abstract

          Nesta revisão, apresentamos um estudo sobre exposição materna aos nitratos na água potável e possíveis reações adversas ao desenvolvimento reprodutivo, no caso dos Estados Unidos. O padrão de uso de nitratos na água potável é baseado em estudos retrospectivos e leva em conta níveis que protegem os bebês contra a metemoglobinemia. Mas nenhum fator de segurança foi construído a partir desse padrão, sendo que os níveis atuais foram construídos e exigidos apenas para os sistemas públicos de distribuição de água. Estudos com animais encontraram efeitos reprodutivos adversos e advindos das altas doses de nitrato ou nitrito na água. A evidência epidemiológica sobre a relação de exposição-resposta direta entre o nível de nitratos na água potável e efeitos adversos não está clara. No entanto, algumas notificações sugerem associação entre exposição a nitratos na água potável e abortos espontâneos, restrições ao crescimento intrauterino e vários defeitos de nascença. As incertezas nos estudos epidemiológicos incluem a falta de avaliação da exposição individual que excluiria confundir a exposição com outros fatores. Concluimos que a literatura atual não provê suficiente evidência de uma relação causal entre exposição a nitratos na água potável e efeitos reprodutivos adversos.

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          Genotoxicity of pesticides: a review of human biomonitoring studies.

          Pesticides constitute a heterogeneous category of chemicals specifically designed for the control of pests, weeds or plant diseases. Pesticides have been considered potential chemical mutagens: experimental data revealed that various agrochemical ingredients possess mutagenic properties inducing mutations, chromosomal alterations or DNA damage. Biological monitoring provides a useful tool to estimate the genetic risk deriving from an integrated exposure to a complex mixture of chemicals. Studies available in scientific literature have essentially focused on cytogenetic end-points to evaluate the potential genotoxicity of pesticides in occupationally exposed populations, including pesticide manufacturing workers, pesticide applicators, floriculturists and farm workers. A positive association between occupational exposure to complex pesticide mixtures and the presence of chromosomal aberrations (CA), sister-chromatid exchanges (SCE) and micronuclei (MN) has been detected in the majority of the studies, although a number of these failed to detect cytogenetic damage. Conflicting results from cytogenetic studies reflect the heterogeneity of the groups studied with regard to chemicals used and exposure conditions. Genetic damage associated with pesticides occurs in human populations subject to high exposure levels due to intensive use, misuse or failure of control measures. The majority of studies on cytogenetic biomarkers in pesticide-exposed workers have indicated some dose-dependent effects, with increasing duration or intensity of exposure. Chromosomal damage induced by pesticides appears to have been transient in acute or discontinuous exposure, but cumulative in continuous exposure to complex agrochemical mixtures. Data available at present on the effect of genetic polymorphism on susceptibility to pesticides does not allow any conclusion.
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            Blue babies and nitrate-contaminated well water.

            The use of nitrate-contaminated drinking water to prepare infant formula is a well-known risk factor for infant methemoglobinemia. Affected infants develop a peculiar blue-gray skin color and may become irritable or lethargic, depending on the severity of their condition. The condition can progress rapidly to cause coma and death if it is not recognized and treated appropriately. Two cases of blue baby syndrome were recently investigated. Both cases involved infants who became ill after being fed formula that was reconstituted with water from private wells. Water samples collected from these wells during the infants' illnesses contained nitrate-nitrogen concentrations of 22.9 and 27.4 mg/L.
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              Health implications of nitrate and nitrite in drinking water: an update on methemoglobinemia occurrence and reproductive and developmental toxicity.

              In 1987, an evaluation of the nitrate drinking water standard was performed with a primary focus on the effects of nitrate on methemoglobinemia and reproductive/developmental effects (Fan et al. (1987). Regul. Toxicol. Pharmacol. 7, 135-148). The present review presents an updated overview and evaluation of the available information on the same health effects of nitrate and nitrite with an emphasis on data not included in the previous review, which should be used as a compendium to this report. Recent epidemiologic data have suggested an association between developmental effects in offspring and the maternal ingestion of nitrate from drinking water, but a definite conclusion on the cause and effect relationship cannot be drawn. Animal experimental data have shown reproductive toxicity associated with high exposure levels to nitrate or nitrite, which are not likely to be encountered in drinking water. No teratogenic effects were observed in rats, mice, rabbits, and hamsters tested. Several cases of methemoglobinemia have been reported in infants in the United States using water containing nitrate at levels higher than the current maximum contaminant level (MCL) of 45 ppm (mg/liter) nitrate (NO3) or 10 ppm nitrate-nitrogen (nitrate-N), but none at or lower than the MCL. The uncertainties in the data base are discussed, noting that no uncertainty factor was applied in deriving the MCL in order to account for the uncertainties that exist in the data base.
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                Author and article information

                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                March 2007
                : 12
                : 1
                : 153-163
                Affiliations
                [01] Chamblee GA orgnameHealth Studies Branch orgdiv1EHHE orgdiv2NCEH USA dmanassaram@ 123456cdc.gov
                Article
                S1413-81232007000100018 S1413-8123(07)01200118
                10.1590/S1413-81232007000100018
                17680066
                fdb7550f-8504-4d8f-af09-d5e913f047af

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 July 2006
                : 03 November 2005
                : 16 June 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 64, Pages: 11
                Product

                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Review

                Nitrite,Saúde reprodutiva,Nitrate,Developmental outcomes,Água potável,Drinking water,Maternal exposure,Reproductive health,Desenvolvimento fetal,Exposição materna,Nitrato,nitrito

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