Table 2.

Summary of case control studies on the association between dioxin-related toxicants except Agent Orange and adverse pregnancy outcome

First author year(country) studyperiod	Exposed	Unexposed	Exposed level	Exposed defini-tion/data sourceand measurement	Caseascertainment	Results
Dimich-ward H,1996 (Canada)1952-1988(32)	4302 cases oflow birth weight,prematurity,stillbirths, orneonatal deaths.And 942 otherbirth defect cases	5 referentsmatched percase accordingto year of birthand gender	Cumulative hours ofexposure tochlorophenates	Paternal exposure: occupational exposures(worked forsawmills wherechlorophenatewood preserva-tives had beenused)/, based onpersonal records	All types ofbirth defects byself-reports andexaminations	No associations werefound for lowbirth weight,prematurity,stillbirths, orneonataldeaths. expo-sure increasedthe risk fordevelopingcongenitalanomalies ofthe eye andanencephalyor spina bifidaandcongenitalanomalies ofgenital organs
Orr M,2002 (US)1983-1988(33)	13938 minority infants withmajor structuralbirth defectswhose mothersresided in se-lected countiesat the time ofdelivery	14463 minorityinfants withoutbirth defectwho were ran-domly selectedfrom the samebirth cohortas the casesubjects	No specificvalues	Maternal exposure: environmental pollution(shared thesame tract as thehazardous wastesites during thetime of delivery)/exposures basedon the data listedin EPA’s comput-erized database	All types ofbirth defectsby CBDMP’srecords	Potentialexpose tolow vola-tile organiccompounds as-sociated withanencephaly
Eskenazi B,*2003 (US)1996-1998(17)	Spontaneousabortions, andsmall for gestational age in 888total pregnancies	Not spontaneous abortions,and not smallfor gestationalage in 888 totalpregnancies	MaternalSerum TCDDlevels: median(IQR) 46.6 ppt(24.3–104.0)	Maternal exposure: Chemicalfactory explosion/exposuresbased on formerstudy’s records	Spontaneousabortions, birthweight, andsmall for gestational age byself-reports andmedical reports	There was no association of log10 TCDDwith SAB,with birthweight, orwith SGA
Kuehn CM,2007 (US)1997-2001(34)	63006 infantswith malformations occurrencesin WashingtonState	315030 infantsrandomlySelectedwithout malformations inWashingtonState during thesame years	No specificvalues	Maternal exposure: Distancebetween maternal residenceand nearesthazardouswaste site wasmeasured usingGIS software. /exposues basedon CSCS Reportconducted by theWADOE	All types ofmalformationsby hospital discharged reportsoffered by theBERD	Relative to living >5 milesfrom a site,living <5 mileswas associatedwith increasedrisk of anymalformationsin offspring
Vinceti M,2009 (Italy)1998-2006(35)	228 births and induced abortions with diagnosis of congenital anomalies in a community resides in the city of Reggio Emilia (Italy), in which a municipal solid waste incinerator with a capacity of . 70,000 tons/y is located	A randomly selected living birth without diagnosis of malformations during the same year to women residing in the Reggio Emilia municipality , referred to the same hospital and born in the same year of the matched "case" mother	0.5~1.0 ug/m³	Maternal exposure: exposure to the emissions from a municipal solid waste incinerator/exposures based on estimation with the support of GIS data	All types of malformations by records form RMER and the Eurocat program	Do not lend support to the hypothesis that the environmental contamination occurring around an incineration plant may induce major teratogenic effects
Cordier S,*2010 (France)2001-2003(36)	304 infants with urinary tract birth defects diagnosed in the Rhône-Alpes region	A random sample of 226 population controls frequency-matched for infant sex and year and district of birth.	Median exposures were 3.0×10-3 pg/m³ and1.7×10-5 pg/m³, respectively	Maternal exposure: Exposure to dioxin in early pregnancy at the place of residence,/exposures based on records of the operator or a public body, during the relevant time period, yet on a global metal emission score assignned by an expert group	All types of urinary tract birth defects by self-reports	Risk was increased for mothers exposed to dioxin above the median (OR 2.95, 95% CI:1.47 to 5.92)

*; Study was not used in meta-analysis because of no available data (Dimich-ward et al. (32), Eskenazi et al. (17)) or limitation in special birth defects (Cordier et al. (36)). CBDMP; California birth defects monitoring program, GIS; Geographic information systems, CSCS; Confirmed and suspected contaminated sites report, WADOE; Washington state department of ecology, BERD; Birth events records database, RMER; Registry of congenital malformations of the Emilia-Romagna Region, EPA; Environmental Protection Agency, TCDD; Tetrachlorodibenzo-p-dioxin, SAB; Spontaneous abortion and SGA; Small for gestational age.