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Toxic Tap Water & Pregnancy

Val Wilson, Annette Spaven, and Malithia Smith barely know each other, but the three women have two things in common. At one time, they all lived in Chesapeake, Virginia, and during that time, each had a series of unexplained miscarriages.

Val Wilson, 40, was pregnant four times between April 1994 and May 1997 with what would have been her first child. Only once did she make it beyond 12 weeks. "In November 1996, I was five months along and everything was fine," Wilson recalls. "One night, I woke up and my water had broken and I was in labor. The baby was stillborn a few hours later. I was crushed."

Annette Spaven, 40, thought her family was complete in early 1998; she had three children, the youngest of whom was five years old. When she discovered she was pregnant again, it was a surprise -- but she and her husband quickly warmed to the idea of having another child. Spaven miscarried at ten weeks. "We were really disappointed, and a few months later we tried again." By August she was pregnant, but she miscarried again at seven weeks.

Malithia Smith, 30, had had one successful pregnancy before suffering three miscarriages between May 1999 and May 2000. Each time, she began spotting at eight weeks, and each time, the doctor could not determine what had gone wrong. "The first time, I just thought, 'These things happen,'" Smith remembers. "The second time, it shook me up, and by the time I lost the third baby, I was really scared." Smith, Wilson, and Spaven had no idea what was causing their miscarriages. But ultimately, each of them gave birth to a healthy child after making one simple lifestyle change: They stopped drinking the tap water.

Chesapeake, population 200,000, is one of several growing communities along the Atlantic Intercoastal Highway that comprise Hampton Roads, Virginia. Chesapeake's architecture is a mix of the modern buildings, stately old homes, and newer track-home developments that symbolize growth and prosperity. It's hard to imagine that this well-to-do community might be plagued by unsafe drinking water -- the kind of problem you might expect to find in a developing country.

However, the issue has dogged Chesapeake and many of its residents for years. As a result, 214 women -- including Wilson, Spaven, and Smith -- have filed a lawsuit, alleging that the levels of chlorinated by-products in the water were sometimes seven times the levels permitted by the federal government. The suit, which is the first ever of its kind in this country, also alleges that the city failed to adequately warn residents of myriad health risks connected to drinking the water, including miscarriages and birth defects.

Chesapeake has a long history of water issues. When it became an independent city in 1963, it remained dependent on the surrounding cities for its water supply. In the mid-1970s, Chesapeake turned to the Northwest River as an alternative. Bordered by swampland and trees, the river water contains large amounts of organic materials such as leaves, twigs, and algae.

Like nearly every city in the country, Chesapeake adds chlorine to its water supply. Chlorine kills dangerous microbes that cause dysentery and cholera, but when chlorine mixes with organic materials, it also causes the formation of trihalomethanes (THMs), a toxic by-product that has been proven harmful at high levels. In 1979, the Environmental Protection Agency (EPA) attempted to balance the benefit with the risk by setting the amount of THMs allowed in public drinking-water supplies at 100 parts per billion (ppb). The Northwest River's high concentration of organic materials -- the levels fluctuate with the seasons and are especially high in the hotter months -- greatly increased the risk that the THMs in Chesapeake's water supply could spike above the EPA limit at different times throughout the year.

Problems started coming to light in 1998, when Chesapeake tore down two towers at its water-processing plant to make way for a new reverse-osmosis system. A construction proj-ect of this sort would more than likely cause a spike in THM levels, possibly beyond EPA limits, so the utility director asked the state's local health department to request a temporary waiver of EPA water-quality standards.

That was the first time Nancy Welch, M.D., the director of Chesapeake's health department, had ever heard of THMs. The utility director also gave Dr. Welch a copy of a study that had been published that year in the medical journal Epidemiology; it suggested a link between drinking tap water with a high level of THMs and an increased rate of miscarriage. The authors, California Department of Health Services researchers Shanna Swan, Ph.D., and Kirsten Waller, M.D., examined the records of 5,144 pregnant women and found that those in their first trimester who drank five or more glasses of tap water a day containing 75 ppb or more of THMs were 65 percent more likely to miscarry than women with low exposure. The EPA had been doing its own investigation into THM levels, and a year after the Swan-Waller study was released, it lowered the allowable amount from 100 ppb to 80 ppb.

After examining the records closely and speaking with colleagues, Dr. Welch was deeply concerned that the THM levels in Chesapeake's water were often above this limit, and she decided to go public. She sent an advisory -- to family practitioners, ob-gyns, internists, and the media -- suggesting that pregnant women should boil their tap water, install a tap filter, or drink bottled water. "It was a personal call, and I was focused on sharing information with the public," Dr. Welch says. "The idea of a lawsuit wasn't on my mind."

This notification prompted women who had had miscarriages -- whether they had initially considered suing or not -- to revisit a question that had troubled them for years: Could their reproductive problems be caused by something in the water? It seemed almost unthinkable, but it also seemed plausible; Chesapeake residents had regularly complained about the bad taste and smell of the tap water.

A Virginia Beach plaintiff's attorney named Mike Joynes was unaware of the health department advisory. However, for nearly two years, he had heard random accounts from clients of women who had repeated miscarriages and gave birth to children with chromosomal abnormalities, cleft palates, and other congenital malformations -- even though they had had healthy children previously. Joynes considered these to be isolated incidents until he noticed a pattern: Many of the women said the problems began when they moved to Chesapeake.

Nationally, about one in six pregnancies results in miscarriage, according to federal statistics. No comprehensive study of Chesapeake's miscarriage or birth-defect rates has ever been done, so it is impossible to draw a comparison between the period when the THMs were spiking and when they were not.

Nonetheless, Joynes was convinced there was sufficient reason to move ahead. Using the Freedom of Information Act, he obtained city records indicating that the Chesapeake utility regulators knew about high levels of THMs -- at various times exceeding 100 ppb, 200 ppb, 300 ppb, and 700 ppb -- as far back as 1983 and took specific measures to keep residents in the dark by withholding information that should have been public. In July 2000, the law firm ran TV and radio ads seeking women who had lived in Chesapeake between 1980 and 2000 and had suffered miscarriages or had children with birth defects.

"I didn't say what we were investigating," Joynes says. "I never mentioned the water in the ads, but the city told the local newspaper, 'They're talking about the THMs in the water.' My question was, 'Why did they immediately think of water?'"

The ads forced Spaven to relive the pain of the miscarriages she had tried so hard to forget. She and her family had moved to Virginia Beach two months after she lost the second baby, and a year later, she gave birth to a healthy little girl. When she learned that her miscarriages might have been prevented if she'd used bottled water, her pain turned to anger. "I went online and found out that the THMs should be a certain level and that ours were sometimes way over that," she recalls. "And in back issues of the newspaper, I read that the city knew but didn't tell. How many other women wouldn't have had to go through what I did if the city had been up-front with us?"

Joynes got thousands of calls and talked to hundreds of women, some of whom had lost up to five pregnancies. In August 2001, he filed suit in Circuit Court on behalf of 25 women who had miscarried in the mid- to late 1990s. An additional 189 cases were filed for women who had suffered miscarriages dating back to the 1980s. The lawsuits allege that the city failed to warn residents that THM levels sometimes exceeded seven times the EPA standards and posed a significant health risk.

A possible link has been established between THMs and cancers of the bladder and colon. However, chemical and water-industry officials maintain that the scientific evidence linking THMs to miscarriage and birth defects is inconclusive. Still, many researchers in the field contend that at the very least there is cause for serious concern.

"The evidence we have today is enough to prompt us to look at the issue closely," says Diane Regas, deputy assistant administrator for water at the EPA. Robert Morris, M.D., Ph.D., an adjunct professor of environmental engineering at Washington State University, in Pullman, who has researched extensively on THMs and cancer, adds, "The best study to date has found a link between chlorination by-products and miscarriage, and the research on cancer suggests that this link is plausible. Cancer occurs when cells aren't reproducing properly. And errors in the reproduction of cells in the embryo usually lead to serious malformations or even a nonviable embryo. When that happens, the rate of miscarriage rises dramatically."

On the other hand, Michele Lynberg, Ph.D., an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, says she's not convinced. "It's too early to make a direct association between chlorination by-products and a significant health risk to a pregnancy," she says. "We don't think that the evidence is compelling."

The debate over the health risk of THMs is likely to become more heated as the Chesapeake lawsuit proceeds; at press time, no trial date had been set. Residents of other communities who feel their water is responsible for a host of health problems, such as cancer, are eagerly awaiting the outcome. They're likely to have a long wait as the case winds its way through a justice system that often moves at a snail's pace. In the meantime, Joynes remains convinced of the merits of the case.

"To have high levels of a possible carcinogen in the water so closely related to miscarriages and to not tell pregnant women -- it's a sin," he says. "These women could have chosen to drink bottled water, buy a filter, or move out of Chesapeake. Even if we don't get a penny, we've already won because we've exposed this." Whatever the outcome, Spaven, Smith, and Wilson have reached their own conclusions based on their experiences. Spaven stopped drinking the water in December 1998; her daughter was born in November 1999. Smith gave up on Chesapeake water in 2000; her daughter was born in 2001. Wilson stopped drinking the water in 1999; she gave birth to healthy boys in 2000 and 2002. They all ask the same question: If the water wasn't the problem, then what else could it have been?

Copyright © 2003 Melba Newsome. Reprinted with permission from the July 2003 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.