Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala

Archana B Patel, Sreelatha Meleth, Omrana Pasha, Shivaprasad S Goudar, Fabian Esamai, Ana L Garces, Elwyn Chomba, Elizabeth M McClure, Linda L Wright, Marion Koso-Thomas, Janet L Moore, Sarah Saleem, Edward A Liechty, Robert L Goldenberg, Richard J Derman, K Michael Hambidge, Waldemar A Carlo, Patricia L Hibberd, Archana B Patel, Sreelatha Meleth, Omrana Pasha, Shivaprasad S Goudar, Fabian Esamai, Ana L Garces, Elwyn Chomba, Elizabeth M McClure, Linda L Wright, Marion Koso-Thomas, Janet L Moore, Sarah Saleem, Edward A Liechty, Robert L Goldenberg, Richard J Derman, K Michael Hambidge, Waldemar A Carlo, Patricia L Hibberd

Abstract

Background: Consequences 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.

Results: We 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).

Conclusions: Perinatal 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 registration: ClinicalTrials.gov NCT01073475.

Keywords: Cooking fuels; Household air pollution; Mortality; Neonatal; Perinatal.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Pregnancy outcomes by global network site
Fig. 3
Fig. 3
Fuel use by global network site

References

    1. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet. 2010;375:1988–2008. doi: 10.1016/S0140-6736(10)60703-9.
    1. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, et al. Progress towards millennium development goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378:1139–1165. doi: 10.1016/S0140-6736(11)61337-8.
    1. Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet. 2009;107 Suppl 1: S5-18, S19. doi:10.1016/j.ijgo.2009.07.016.
    1. Liu L, Oza S, Hogan D, Perin J, Rudan I, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2014
    1. Goldenberg RL, McClure EM, Kodkany B, Wembodinga G, Pasha O, et al. A multi-country study of the "intrapartum stillbirth and early neonatal death indicator" in hospitals in low-resource settings. Int J Gynaecol Obstet. 2013;122:230–233. doi: 10.1016/j.ijgo.2013.04.008.
    1. Bang A, Bellad R, Gisore P, Hibberd P, Patel A, et al. Implementation and evaluation of the helping babies breathe curriculum in three resource limited settings: does helping babies breathe save lives? a study protocol. BMC Pregnancy Childbirth. 2014;14:116–1471. doi: 10.1186/1471-2393-14-116.
    1. Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med. 2014;2:823–860. doi: 10.1016/S2213-2600(14)70168-7.
    1. World Health Organization. Indoor Air Pollution and Health; 2011. .
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
    1. Bruce NG, Dherani MK, Das JK, Balakrishnan K, Adair-Rohani H, et al. Control of household air pollution for child survival: estimates for intervention impacts. BMC Public Health. 2013;13 Suppl 3:S8. doi:10.1186/1471-2458-13-S3-S8.
    1. Wylie BJ, Coull BA, Hamer DH, Singh MP, Jack D, et al. Impact of biomass fuels on pregnancy outcomes in central East India. Environ Health. 2014;13:1. doi:10.1186/1476-069X-13-1.
    1. Martin WJ, Glass RI, Araj H, Balbus J, Collins FS, et al. Household air pollution in low- and middle-income countries: health risks and research priorities. PLoS Med. 2013;10:e1001455. doi:10.1371/journal.pmed.1001455.
    1. Juarez SP, Merlo J. Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One. 2013;8:e61734. doi: 10.1371/journal.pone.0061734.
    1. Cnattingius S, Nordstrom ML. Maternal smoking and feto-infant mortality: biological pathways and public health significance. Acta Paediatr. 1996;85:1400–1402. doi: 10.1111/j.1651-2227.1996.tb13943.x.
    1. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2014;179:807–823. doi: 10.1093/aje/kwt334.
    1. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, et al. The maternal and newborn health registry study of the global network for Women's and Children's health research. Int J Gynaecol Obstet. 2012;118:190–193. doi: 10.1016/j.ijgo.2012.04.022.
    1. USAID. DHS Program; 2014. .
    1. Pope DP, Mishra V, Thompson L, Siddiqui AR, Rehfuess EA, et al. Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries. Epidemiol Rev. 2010;32:70–81. doi: 10.1093/epirev/mxq005.
    1. VanderWeele TJ, Mumford SL, Schisterman EF. Conditioning on intermediates in perinatal epidemiology. Epidemiology. 2012;23:1–9. doi: 10.1097/EDE.0b013e31823aca5d.
    1. Wilcox AJ, Weinberg CR, Basso O. On the pitfalls of adjusting for gestational age at birth. Am J Epidemiol. 2011;174:1062–1068. doi: 10.1093/aje/kwr230.
    1. Hernandez-Diaz S, Schisterman EF, Hernan MA. The birth weight "paradox" uncovered? Am J Epidemiol. 2006;164:1115–1120. doi: 10.1093/aje/kwj275.
    1. De RM, Worku HM. A warning concerning the estimation of multinomial logistic models with correlated responses in SAS. Comput Methods Programs Biomed. 2012;107:341–346. doi: 10.1016/j.cmpb.2012.01.008.
    1. Kadir MM, McClure EM, Goudar SS, Garces AL, Moore J, et al. Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries. Acta Obstet Gynecol Scand. 2010;89:540–548. doi: 10.3109/00016340903473566.
    1. Epstein MB, Bates MN, Arora NK, Balakrishnan K, Jack DW, et al. Household fuels, low birth weight, and neonatal death in India: the separate impacts of biomass, kerosene, and coal. Int J Hyg Environ Health. 2013;216:523–532. doi: 10.1016/j.ijheh.2012.12.006.
    1. Lakshmi PV, Virdi NK, Sharma A, Tripathy JP, Smith KR, et al. Household air pollution and stillbirths in India: analysis of the DLHS-II National Survey. Environ Res. 2013;121:17–22. doi: 10.1016/j.envres.2012.12.004.
    1. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, et al. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009;87:130–138. doi: 10.2471/BLT.08.050963.
    1. Tielsch JM, Katz J, Thulasiraj RD, Coles CL, Sheeladevi S, et al. Exposure to indoor biomass fuel and tobacco smoke and risk of adverse reproductive outcomes, mortality, respiratory morbidity and growth among newborn infants in south India. Int J Epidemiol. 2009;38:1351–1363. doi: 10.1093/ije/dyp286.
    1. Boy E, Bruce N, Delgado H. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ Health Perspect. 2002;110:109–114. doi: 10.1289/ehp.02110109.
    1. Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term low birthweight in Ahmedabad, India. Int J Epidemiol. 1992;21:263–272. doi: 10.1093/ije/21.2.263.
    1. Mishra V, Dai X, Smith KR, Mika L. Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe. Ann Epidemiol. 2004;14:740–747. doi: 10.1016/j.annepidem.2004.01.009.
    1. Siddiqui AR, Gold EB, Yang X, Lee K, Brown KH, et al. Prenatal exposure to wood fuel smoke and low birth weight. Environ Health Perspect. 2008;116:543–549. doi: 10.1289/ehp.10782.
    1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384:189–205. doi: 10.1016/S0140-6736(14)60496-7.
    1. Madhavan ND, Naidu KA. Polycyclic aromatic hydrocarbons in placenta, maternal blood, umbilical cord blood and milk of Indian women. Hum Exp Toxicol. 1995;14:503–506. doi: 10.1177/096032719501400607.
    1. Rossner P, Jr, Milcova A, Libalova H, Novakova Z, Topinka J, et al. Biomarkers of exposure to tobacco smoke and environmental pollutants in mothers and their transplacental transfer to the foetus. Part II. Oxidative damage. Mutat Res. 2009;669:20–26. doi: 10.1016/j.mrfmmm.2009.04.010.
    1. Sram RJ, Beskid O, Rossnerova A, Rossner P, Lnenickova Z, et al. Environmental exposure to carcinogenic polycyclic aromatic hydrocarbons--the interpretation of cytogenetic analysis by FISH. Toxicol Lett. 2007;172:12–20. doi: 10.1016/j.toxlet.2007.05.019.
    1. Topinka J, Milcova A, Libalova H, Novakova Z, Rossner P, Jr, et al. Biomarkers of exposure to tobacco smoke and environmental pollutants in mothers and their transplacental transfer to the foetus. Part I: bulky DNA adducts. Mutat Res. 2009;669:13–19. doi: 10.1016/j.mrfmmm.2009.04.011.
    1. Hatch MC, Warburton D, Santella RM. Polycyclic aromatic hydrocarbon-DNA adducts in spontaneously aborted fetal tissue. Carcinogenesis. 1990;11:1673–1675. doi: 10.1093/carcin/11.9.1673.
    1. Sanyal MK, Mercan D, Belanger K, Santella RM. DNA adducts in human placenta exposed to ambient environment and passive cigarette smoke during pregnancy. Defects Res A Clin Mol Teratol. 2007;79:289–294. doi: 10.1002/bdra.20346.
    1. Singh VK, Singh J, Anand M, Kumar P, Patel DK, et al. Comparison of polycyclic aromatic hydrocarbon levels in placental tissues of Indian women with full- and preterm deliveries. Int J Hyg Environ Health. 2008;211:639–647. doi: 10.1016/j.ijheh.2007.11.004.
    1. Huel G, Girard F, Nessmann C, Godin J, Blot P, et al. Placental aryl hydrocarbon hydroxylase activity and placental calcifications. Toxicology. 1992;71:257–266. doi: 10.1016/0300-483X(92)90028-D.
    1. Huel G, Godin J, Frery N, Girard F, Moreau T, et al. Aryl hydrocarbon hydroxylase activity in human placenta and threatened preterm delivery. J Expo Anal Environ Epidemiol. 1993;3(Suppl 1):187–199.
    1. Huel G, Godin J, Moreau T, Girard F, Sahuquillo J, et al. Aryl hydrocarbon hydroxylase activity in human placenta of passive smokers. Environ Res. 1989;50:173–183. doi: 10.1016/S0013-9351(89)80056-8.
    1. Arnould JP, Verhoest P, Bach V, Libert JP, Belegaud J. Detection of benzo[a]pyrene-DNA adducts in human placenta and umbilical cord blood. Hum Exp Toxicol. 1997;16:716–721. doi: 10.1177/096032719701601204.
    1. Dejmek J, Selevan SG, Benes I, Solansky I, Sram RJ. Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect. 1999;107:475–480. doi: 10.1289/ehp.99107475.
    1. Dejmek J, Solansky I, Benes I, Lenicek J, Sram RJ. The impact of polycyclic aromatic hydrocarbons and fine particles on pregnancy outcome. Environ Health Perspect. 2000;108:1159–1164. doi: 10.1289/ehp.001081159.
    1. Perera FP, Rauh V, Tsai WY, Kinney P, Camann D, et al. Effects of transplacental exposure to environmental pollutants on birth outcomes in a multiethnic population. Environ Health Perspect. 2003;111:201–205. doi: 10.1289/ehp.5742.
    1. Perera FP, Whyatt RM, Jedrychowski W, Rauh V, Manchester D, et al. Recent developments in molecular epidemiology: a study of the effects of environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland. Am J Epidemiol. 1998;147:309–314. doi: 10.1093/oxfordjournals.aje.a009451.
    1. Sioutas C, Delfino RJ, Singh M. Exposure assessment for atmospheric ultrafine particles (UFPs) and implications in epidemiologic research. Environ Health Perspect. 2005;113:947–955. doi: 10.1289/ehp.7939.
    1. Nel AE, Diaz-Sanchez D, Li N. The role of particulate pollutants in pulmonary inflammation and asthma: evidence for the involvement of organic chemicals and oxidative stress. Curr Opin Pulm Med. 2001;7:20–26. doi: 10.1097/00063198-200101000-00004.
    1. Li N, Sioutas C, Cho A, Schmitz D, Misra C, et al. Ultrafine particulate pollutants induce oxidative stress and mitochondrial damage. Environ Health Perspect. 2003;111:455–460. doi: 10.1289/ehp.6000.
    1. Engel SA, Erichsen HC, Savitz DA, Thorp J, Chanock SJ, et al. Risk of spontaneous preterm birth is associated with common proinflammatory cytokine polymorphisms. Epidemiology. 2005;16:469–477. doi: 10.1097/01.ede.0000164539.09250.31.
    1. Keelan JA, Blumenstein M, Helliwell RJ, Sato TA, Marvin KW, et al. Cytokines, prostaglandins and parturition--a review. Placenta. 2003;24 Suppl A:S33-S46.
    1. Wei SQ, Fraser W, Luo ZC. Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review. Obstet Gynecol. 2010;116:393–401. doi: 10.1097/AOG.0b013e3181e6dbc0.
    1. Gomez C, Berlin I, Marquis P, Delcroix M. Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth. Prev Med. 2005;40:10–15. doi: 10.1016/j.ypmed.2004.04.049.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi