Women are exposed to drinking water with low arsenic concentrations (<10.0 μg/L) worldwide, yet little work has been done to assess the risk. To begin to address this data gap, we conducted an exploratory study of birth outcomes in Timis County, Romania. We prospectively followed 122 women with singleton deliveries, for whom we constructed individual exposure indicators using self-reported water consumption weighted by arsenic measured in drinking water sources. There were no overall confounder-adjusted effects for arsenic exposure on birth outcomes. Yet, higher average arsenic (10 μg/L) was associated with a −2.45 lower birth weight Z-score (P = 0.021) and a −1.17 shorter birth length Z-score (P = 0.029) among smokers. Higher average iAs (10 μg/L) was also associated with smaller ponderal index in boys (P = 0.023). Our results suggest smoking may potentiate an otherwise benign arsenic exposure. A larger, more definitive biomarker-based study is needed to investigate the potential risks in conjunction with smoking.

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