WATER AND HEALTH (T WADE, SECTION EDITOR) Overview of Disinfection By-products and Associated Health Effects Cristina M. Villanueva & Sylvaine Cordier & Laia Font-Ribera & Lucas A. Salas & Patrick Levallois Published online: 22 January 2015 # Springer International Publishing AG 2015 Abstract The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal ab- sorption from drinking water and swimming pools. Epidemi- ological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insuffi- cient or mixed. Numerous studies have evaluated reproductive implications, including sperm quality, time to pregnancy, menstrual cycle, and pregnancy outcomes such as fetal loss, fetal growth, preterm delivery, and congenital malformation. The body of evidence suggests only minor effects from high exposure during pregnancy on fetal growth indices such as small for gestational age (SGA) at birth. Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers. The risk of asthma, wheezing, eczema, and other respiratory outcomes among children at- tending swimming pools has been the object of extensive research. Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association. Future research should develop methods to evaluate the effects of the DBP mixture and the interaction with personal characteristics (e.g., genetics, life- style), clarify the association between swimming pools and respiratory health, evaluate the occurrence of DBPs in low- and middle-income countries, and evaluate outcomes sug- gested by animal studies that have not been considered in epidemiological investigations. Keywords Disinfection by-products . Cancer . Exposure . Reproductive . Respiratory . Swimming pools This article is part of the Topical Collection on Water and Health C. M. Villanueva (*) : L. Font-Ribera : L. A. Salas Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader 88, 08003 Barcelona, Spain e-mail: cvillanueva@creal.cat C. M. Villanueva : L. Font-Ribera IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain C. M. Villanueva : L. Font-Ribera : L. A. Salas CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain C. M. Villanueva : L. Font-Ribera : L. A. Salas Universitat Pompeu Fabra (UPF), Barcelona, Spain S. Cordier Inserm U1085 – IRSET, University Rennes 1, Rennes, France P. Levallois Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du, Québec, QC, Canada P. Levallois Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada P. Levallois Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHUQ de Québec, Québec, QC, Canada Curr Envir Health Rpt (2015) 2:107–115 DOI 10.1007/s40572-014-0032-x