Household air pollution, ultrasound measurement, fetal biometric parameters and intrauterine growth restriction

Anindita Dutta,John Olamijulo,Samuel Adekunle,Oludare Morhasson-Bello,Babatunde Adedokun,Omolola Akinwunmi,Donee Alexander,Oladosu Ojengbede,Dayo Adepoju,Oluwafunmilade Deji-Abiodun,Theodore Karrison,Christopher O Olopade,Oluniyi S Afolabi,Briseis Aschebrook-Kilfoy,Tope Ibigbami,Omolola Mojisola Atalabi,Nathaniel Wilson,Damilola Adu

doi:10.1186/s12940-021-00756-5

Abstract

BackgroundLow birthweight, intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution. However, intervention studies that use ultrasound measurements to assess the effects of household air pollution (HAP) on fetal biometric parameters (FBP) are rare. We investigated the effect of a cookstove intervention on FBP and IUGR in a randomized controlled trial (RCT) cohort of HAP-exposed pregnant Nigerian women.MethodsWe recruited 324 women early in the second trimester of pregnancy. Between 16 and 18 weeks, we randomized them to either continue cooking with firewood/kerosene (control group) or receive a CleanCook stove and ethanol fuel (intervention group). We measured fetal biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and ultrasound-estimated fetal weight (U-EFW) in the second and third trimesters. The women were clinically followed up at six regular time points during their pregnancies. Once during the women’s second trimester and once during the third, we made 72-h continuous measurements of their personal exposures to particulate matter having aerodynamic diameter < 2.5 μm (PM2.5). We adopted a modified intent-to-treat approach for the analysis. Differences between the intervention and control groups on impact of HAP on fetal growth trajectories were analyzed using mixed effects regression models.ResultsThere were no significant differences in fetal growth trajectories between the intervention and control groups.ConclusionsLarger studies in a setting of low ambient air pollution are required to further investigate the effect of transitioning to a cleaner fuel such as ethanol on intrauterine growth.Trial registrationClinicalTrials.gov NCT02394574; September 2012

Highlights

Low birthweight, intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution
Participant recruitment and eligibility criteria In earlier publications we have detailed the processes of participant recruitment and randomization and the eligibility criteria for this randomized controlled trial (RCT) [13,14,15], which was conducted in Ibadan, Nigeria between June 2013 and October 2015
The baseline clinical and demographic characteristics were similar between the study groups and have been reported in our previous publications [13, 14]

Summary

Introduction

Intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution. Intervention studies that use ultrasound measurements to assess the effects of household air pollution (HAP) on fetal biometric parameters (FBP) are rare. It is necessary to assess fetal health and ultimate birth outcomes among pregnant women exposed to HAP from using biomass, kerosene and coal for cooking. The method has been used to examine the impacts of early-life exposure to air pollution on fetal growth. Most such studies have concerned the impact of exposure to ambient air pollution [2, 8,9,10,11]. No studies have used ultrasound serially to measure fetal biometric parameters in cook stove intervention trials

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Discussion

Conclusion