Are there excess fetal deaths attributable to waterborne lead exposure during the Flint Water Crisis? Evidence from bio-kinetic model predictions and Vital Records

Background Flint, Michigan had elevated water lead (Pb) levels during the 2014-15 Flint Water Crisis (FWC) and reports claim the exposures caused excess fetal deaths. Objective To model the likelihood of excess fetal deaths occurring from FWC lead exposure and compare results to Vital Records. Methods We used an established bio-kinetic model to predict relative blood lead trends in pregnant women from characteristic exposure to 90th percentile water lead levels (WLLs), and another established model to then estimate characteristic miscarriage (<20 gestation weeks) odds ratios (OR) in Flint (2011-17). For comparison, we made similar predictions for exposures during (1) Washington DC's worst water lead crisis year (2001), (2) Flint Resident Zero home with anomalously high WLLs, and (3) 19th century lead-based abortifacients. Data on stillbirths (>= 20 gestation weeks) and total fertility rates were obtained from the State of Michigan. Results The models predicted that pregnant women drinking water with representative 90th percentile WLLs had a miscarriage OR during the worst FWC period (June-August 2014) of 1.21 (95% CI = 1.02,1.60), versus 1.66 (95% CI = 1.07, 3.56) during a time of high water lead 3 years before the FWC and 1.00 (95% CI = 1.00, 1.01) post-FWC. The corresponding predicted OR in late-2001 for Washington D.C. when higher fetal death rates were statistically associated with very high WLLs was 3.01 (95% CI = 1.16, 16.23). No apparent differences were revealed in overall and race-specific stillbirth rates before, during, or after the FWC. Total fertility rates dropped 6.8% during the FWC (April 2014-October 2015 versus April 2012-October 2013), but this is now revealed to be within the normal annual variation (-9.4% to +15%) observed post-FWC when residents were protected from water lead exposure. Significance Neither model simulations nor Vital Records data are consistent with the hypothesis that there was an uptick in fetal deaths or decreased fertility attributable to water lead exposure during the FWC.

Automated summary

Using established bio-kinetic models, the study investigated the likelihood of fetal deaths in pregnant women exposed to high water lead levels, with results showing a slight increase in miscarriage odds during the FWC period but no significant changes before or after the water crisis.