Abstract
BackgroundConsequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28).Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas.ResultsWe studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22).ConclusionsPerinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated.Trial registrationClinicalTrials.gov NCT01073475
Highlights
Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood
As progress continues to be made toward Millennium Development Goal #4 (MDG4), attention increasingly focuses on causes of childhood mortality that have been the most resistant to improvement – neonatal mortality [1,2,3,4]
A total of 54,082 (82 %) pregnancies occurred in households using polluting fuel and 11,830 (18 %) in households using clean fuels
Summary
Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. HAP is a recognized risk factor for childhood pneumonia [10] and preterm birth [11], but the role of exposure to HAP on other pregnancy and neonatal outcomes is less clear due to concerns about the quality of evidence in the available observational studies [10]. This information is important as international governments are rolling out improved cookstoves that continue to use solid fuels without evidence on potential perinatal and other health benefits [12]. While there is a biologic basis for the effects of HAP on the developing fetus, neonate and young infant based on the similar pollutants in tobacco smoke (active and passive smoke exposure) [13,14,15], it is unclear whether the effects of tobacco smoking and HAP are additive, synergistic or whether there is no interaction because the effect of one of the exposures (e.g., HAP) overwhelms the other (e.g., tobacco smoke)
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