Abstract
Available evidence concerning the association between indoor air pollution (IAP) from biomass and solid fuel combustion and preeclampsia/eclampsia is not available in developing countries. We investigated the association between exposure to IAP from biomass and solid fuel combustion and symptoms of preeclampsia/eclampsia in Indian women by analyzing cross-sectional data from India's third National Family Health Survey (NFHS-3, 2005–2006). Self-reported symptoms of preeclampsia/eclampsia during pregnancy such as convulsions (not from fever), swelling of legs, body or face, excessive fatigue or vision difficulty during daylight, were obtained from 39 657 women aged 15–49 years who had a live birth in the previous 5 years. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking on preeclampsia/eclampsia risk, were estimated using logistic regression after adjusting for various confounders. Results indicate that women living in households using biomass and solid fuels have two times higher likelihood of reporting preeclampsia/eclampsia symptoms than do those living in households using cleaner fuels (OR = 2.21; 95%: 1.26–3.87; P = 0.006), even after controlling for the effects of a number of potentially confounding factors. This study is the first to empirically estimate the associations of IAP from biomass and solid fuel combustion and reported symptoms suggestive of preeclampsia/eclampsia in a large nationally representative sample of Indian women and we observed increased risk. These findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiological research with detailed exposure assessments and clinical measures of preeclampsia/eclampsia is needed in a developing country setting to validate these findings.
Highlights
Preeclampsia is a pregnancy-induced hypertensive disorder characterized by high blood pressure and proteinuria after the 20th week of pregnancy (Sibai et al, 2005)
The findings from this study have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating, and have an additional burden of high maternal and infant mortality and morbidity, and preeclampsia/eclampsia is one of a major cause for this high burden
We aimed to examine the effect of exposure to cooking smoke from biomass and solid fuel combustion on the risk of preeclampsia/eclampsia using data from a largescale cross-sectional nationally representative sample of adult women in India
Summary
Preeclampsia is a pregnancy-induced hypertensive disorder characterized by high blood pressure and proteinuria after the 20th week of pregnancy (Sibai et al, 2005). Established risk factors for preeclampsia/eclampsia reported in high-income country settings include young and old maternal age, obesity prior to pregnancy, being unmarried, excessive weight gain during pregnancy, multiple gestation, nulliparity, chronic hypertension, low socioeconomic status, prolonged birth interval, lack of prenatal care, and current smoking (Ansari et al, 1995; Baeten et al, 2001; Chesley, 1984; Coghill et al, 2011; Douglas and Redman, 1994; Saftlas et al, 1990; Zwart et al, 2008). According to WHO (2014), an estimated 4.3 million people a year die prematurely from illness attributable to the household air pollution caused by the inefficient use of solid fuels (from 2012 data) Among these deaths, 12% are due to pneumonia, 34% from stroke, 26% from ischemic heart disease, 22% from chronic obstructive pulmonary disease (COPD), and 6% from lung cancer.
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