Effects of a liquefied petroleum gas stove intervention on stillbirth, congenital anomalies and neonatal mortality: A multi-country household air pollution intervention network trial

Ashley Younger; Wenlu Ye; Abbey Alkon; Kristen Harknett; Miles A Kirby; Lisa Elon; Amy E Lovvorn; Jiantong Wang; Anaité Diaz-Artiga; John P McCracken; Adly Castañaza Gonzalez; Libny Monroy Alarcon; Alexie Mukeshimana; Ghislaine Rosa; Marilu Chiang; Kalpana Balakrishnan; Sarada S Garg; Ajay Pillarisetti; Ricardo Piedrahita; Michael A Johnson; Rachel Craik; Aris T Papageorghiou; Ashley Toenjes; Kendra N Williams; Lindsay J Underhill; Stella M Hartinger; Laura Nicolaou; Howard H Chang; Luke P Naeher; Joshua Rosenthal; William Checkley; Jennifer L Peel; Thomas F Clasen; Lisa M Thompson; Household Air Pollution Intervention Network (HAPIN) Investigators

doi:10.1016/j.envpol.2024.123414

Effects of a liquefied petroleum gas stove intervention on stillbirth, congenital anomalies and neonatal mortality: A multi-country household air pollution intervention network trial

Environ Pollut. 2024 Mar 15:345:123414. doi: 10.1016/j.envpol.2024.123414. Epub 2024 Jan 27.

Authors

Ashley Younger¹, Wenlu Ye², Abbey Alkon³, Kristen Harknett³, Miles A Kirby⁴, Lisa Elon⁵, Amy E Lovvorn⁶, Jiantong Wang⁵, Anaité Diaz-Artiga⁷, John P McCracken⁸, Adly Castañaza Gonzalez⁷, Libny Monroy Alarcon⁷, Alexie Mukeshimana⁹, Ghislaine Rosa¹⁰, Marilu Chiang¹¹, Kalpana Balakrishnan¹², Sarada S Garg¹², Ajay Pillarisetti², Ricardo Piedrahita¹³, Michael A Johnson¹³, Rachel Craik¹⁴, Aris T Papageorghiou¹⁴, Ashley Toenjes¹⁵, Kendra N Williams¹⁶, Lindsay J Underhill¹⁵, Stella M Hartinger¹⁷, Laura Nicolaou¹⁶, Howard H Chang⁵, Luke P Naeher¹⁸, Joshua Rosenthal¹⁹, William Checkley¹⁶, Jennifer L Peel²⁰, Thomas F Clasen⁶, Lisa M Thompson²¹; Household Air Pollution Intervention Network (HAPIN) Investigators

Affiliations

¹ School of Nursing, University of California, San Francisco, CA, USA. Electronic address: ashley.younger@wrh.ox.ac.uk.
² Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
³ School of Nursing, University of California, San Francisco, CA, USA.
⁴ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁵ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁶ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁸ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala; Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
⁹ Eagle Research Centre, Kigali, Rwanda.
¹⁰ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
¹¹ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹² Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹³ Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹⁴ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁵ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
¹⁶ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Latin American Center of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁸ Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
¹⁹ Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
²⁰ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
²¹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.

PMID: 38286258
DOI: 10.1016/j.envpol.2024.123414

Abstract

Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM_2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to <35 years of age; gestation confirmed by ultrasound at 9 to <20 weeks) were randomly assigned to intervention or control arms. We monitored these fetal and neonatal outcomes and personal exposure to PM_2.5, BC and CO three times during pregnancy, we conducted intention-to-treat (ITT) and exposure-response (E-R) analyses to determine if the HAPIN intervention and corresponding HAP exposure was associated with the risk of fetal/neonatal outcomes. A total of 3200 women (mean age 25.4 ± 4.4 years, mean gestational age at randomization 15.4 ± 3.1 weeks) were included in this analysis. Relative risks for stillbirth, congenital anomaly and neonatal mortality were 0.99 (0.60, 1.66), 0.92 (95 % CI 0.52, 1.61), and 0.99 (0.54, 1.85), respectively, among women in the intervention arm compared to controls in an ITT analysis. Higher mean personal exposures to PM_2.5, CO and BC during pregnancy were associated with a higher, but statistically non-significant, incidence of adverse outcomes. The LPG stove and fuel intervention did not reduce the risk of these outcomes nor did we find evidence supporting an association between personal exposures to HAP and stillbirth, congenital anomalies and neonatal mortality.

Keywords: Birth outcomes; Congenital anomaly; Cooking fuel; Low- and middle-income countries; Neonatal mortality; Stillbirth.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Air Pollution*
Air Pollution, Indoor* / analysis
Cooking
Female
Humans
Infant Mortality
Infant, Newborn
Particulate Matter / analysis
Petroleum* / toxicity
Pregnancy
Soot
Stillbirth / epidemiology
Young Adult

Substances

Particulate Matter
Petroleum
Soot

Grants and funding

T42 OH008429/OH/NIOSH CDC HHS/United States