The Birth Outcomes and Water (BOW) Study

Portrait of Martha Rhoades
Childhood Health Impacts Adult Health

The Birth Outcomes and Water (BOW) Study

Understanding Water Quality Impacts on Health in Women and Children

Portrait of Author Morgan Leefers
Interview with Martha Rhoades Morgan Leefers

Water quality plays a crucial role in public health, but it may be something most people do not consider until it adversely affects them. The Birth Outcomes and Water (BOW) study was created to learn more about water quality and potential negative impacts to women and their children. Specifically, the BOW study evaluates the relationships between harmful birth outcomes and maternal exposure to nitrate and other agrichemicals in drinking water.


Martha Rhoades, research manager in the School of Natural Resources at the University of Nebraska–Lincoln is the project leader for this study.


“Understanding the relationship between drinking water quality and pregnancy outcomes will help us prevent birth defects and improve quality of life for future generations,” Rhoades said.


One in every 33 infants in the United States is born with a birth defect, according to Rhoades. Yet, in the state of Nebraska, two out of every 33 infants born has a birth defect.


The BOW study connects Nebraska researchers with families across the state to find the cause of this increased rate.


Drinking Water Impacts Health

Drinking water plays a critical role in one’s health. Therefore, Rhoades said additional research on water quality is needed.


“The key benefit of water quality research is to establish if there are connections between environmental factors (protective or otherwise), drinking water quality, and the impact on public health,” Rhoades said.


The BOW study takes a deeper look at water quality in Nebraska. Following the model of the National Birth Defects Prevention Study, the BOW project serves as a pilot study for the state as it assesses the feasibility of exploring maternal exposures to chemicals in drinking water and the impact on birth outcomes. 


“We do translational science,” Rhoades said. “The BOW study does both benchtop science (laboratory science) and population science, or what we consider the epidemiology side,” Rhoades said.


Sometimes contaminants occur in drinking water and can form toxic nitrosated compounds (such as nitrosamines) over time. One important factor within the study is the ability for a water specialist to determine the groundwater age and test for nitrate and nitrosatable compounds.


Using drinking water, blood and saliva testing, along with examining environmental factors and health history, researchers create a more complete picture and determine connections between drinking water quality and human health.


Environmental Factors Impacts Health

In additional to examining drinking water quality, the BOW study also examines environmental factors and how they influence risk for birth defects.


Specifically, Rhoades and her team uncover women’s health and environmental factors that are related to the health of their children.


“We are interested most in drinking water quality and its impacts on health, but we also have to control for other environmental factors such as lifestyle, smoking, diet, and family history,” Rhoades said.


People are interested in how their environment affects all aspects of their lives, Rhoades said. There may be simple things that people can do to prevent birth defects and the BOW study is working to find these answers.


Getting Involved

Researchers involved with the BOW study work directly with the Nebraska Department of Health & Human Services to reach eligible participants via mailed letter.


Women who are interested in taking part in the study complete a questionnaire and provide samples of saliva, blood, and water for testing.


Women are given incentives throughout the process as they complete the questionnaire and provide each of the samples. Once the initial portion of the study is complete, women are asked to be interviewed to understand the motivators and barriers impacting a decision to participate in the study.


For more information, visit