Associations between Household Incense Burning and Motor Development of Preterm Infants: Results from the Taiwan Birth Cohort Study with Propensity Score Weighting Analysis

Abstract

Background: Household incense burning is a common ritual behavior in Taiwan, but was found to be associated with negative neurodevelopmental outcomes in term infants. We further examined the associations between exposure status and neurodevelopmental development among preterm infants. Methods: We extracted the information from structured questionnaires upon home interview during six and eighteen months of Taiwan Birth Cohort Study (TBCS) survey. We conducted multivariate Cox proportional hazards to model the association between household exposure status and the corrected age for infant neurodevelopmental milestone achievements and we further weighted the effect with multinomial propensity score (PS). The effect among late preterm infants (gestational age 34-36 weeks) were examined with stratified analysis. Results: In this study, 1062 preterm singletons were included, and 933 of them were late preterm. Household incense burning exposure was associated with increased hazards of delay in gross motor neurodevelopmental milestones (aHR=1⋅19, 95% CI=1⋅01-1⋅41 for walking steadily), and the effects were also observed after PS-weighting (Persistent exposure: aHR=1⋅20, 95% CI=1⋅01-1⋅42 for walking with support; aHR=1⋅25, 95% CI=1⋅05-1⋅48 for walking steadily). Similar effects in gross motor neurodevelopmental milestones were observed among late preterm infants, while the effects for other preterm infants were observed in fine motor neurodevelopmental milestones. Conclusions: This study shows negative associations between household incense burning and delayed motor neurodevelopmental milestone achievement. The effects were shown in different domains for late preterm infants and earlier preterm infants. Funding Statement: Bureau of Health Promotion, Department of Health, Ministry of Science and Technology and Ministry of Education, Taiwan. Declaration of Interests: No conflicts of interest have been declared. Ethical Approval Statement: All subjects in this study provided informed consent according to the protocol approved by the institutional Ethics Review Board of the College of Public Health, National Taiwan University and the Institutional Review Board of the Bureau of Health Promotion, Ministry of Health and Welfare, Executive Yuan, Taiwan, which was in comply with the principles of the Declaration of Helsinki.