Maternal fever, multivitamin use, and selected birth defects: evidence of interaction?

BACKGROUND: Multivitamin use has been associated with lower risks for some birth defects. We evaluated whether multivitamin use modified birth defect risks associated with febrile illness, a common and possibly teratogenic exposure. METHODS: From the population-based Atlanta Birth Defects Case-Control Study (1968-1980) we selected seven defects (neural tube defects, cleft lip and palate, cardiac outflow tract defects, ventricular septal defects, atrial septal defects, omphalocele, and limb deficiencies) because of their inverse relation with multivitamin supplement use documented in previous analyses. We defined four exposure categories from combinations of multivitamin use (periconceptional use compared with no use) and febrile illness (early pregnancy compared with no illness). The reference category was no multivitamin use and no illness. RESULTS: Febrile illness with no multivitamin use was associated with generally increased risk for the seven defects and the combined group (odds ratio = 2.1, 1.7, 1.5, 1.9, 2.9, 4.4, 3.3, and 2.3, respectively). With multivitamin use, however, the risk estimates associated with febrile illness were generally lower (odds ratio = 0.6, 1.1, 0.0, 1.5, 0.0, 0.8, 0.0, and 0.8, respectively). Some of the associated 95% confidence intervals included one. CONCLUSIONS: The pattern of findings suggests that multivitamin use might decrease the risk associated with febrile illness.

Comparison of trihalomethanes in tap water and blood.

Trihalomethane (THM) concentrations in blood and tap water were measured for 50 women living in two locations with different bromide concentrations and disinfectant types. Blood samples were taken from each woman early in the morning prior to any major water-use activity and again immediately after showering. Each residence was sampled for THMs in tap water prior to the woman's shower. Cobb County, GA, tap water exhibited high THM concentrations composed primarily of chloroform. Corpus Christi, TX, tap water exhibited lower THM concentrations with significant proportions of brominated THMs. THMs in tap water and blood were compared using mole fraction speciation, extent of bromine incorporation, and correlation analysis. Results indicated that THMs in the blood rose significantly as a result of showering, that showering shifted the THM distribution in the blood toward that found in the corresponding tap water, and that THMs measured in the blood of women living in the two locations reflected species and concentration differences in their respective tap waters. In general, blood concentrations were not significantly correlated with tap water concentrations. This finding suggests that other factors, in addition to tap water concentrations, may be important in determining THM concentrations in the blood.