Exposure–response relationships for personal exposure to fine particulate matter (PM 2·5 ), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial The Lancet. Planetary Health
Abstract Methods Birthweight outcome measurements Results Data sharing Declaration of interests Summary Background Household air pollution (HAP) from solid fuel use is associated with adverse birth outcomes, but data for exposure–response relationships are scarce. We examined associations between HAP exposures and birthweight in rural Guatemala, India, Peru, and Rwanda during the Household Air Pollution Intervention Network (HAPIN) trial. Methods The HAPIN trial recruited pregnant women (9–<20 weeks of gestation) in rural Guatemala, India, Peru, and Rwanda and randomly allocated them to receive a liquefied petroleum gas stove or not (ie, and continue to use biomass fuel). The primary outcomes were birthweight, length-for-age, severe pneumonia, and maternal systolic blood pressure. In this exposure–response subanalysis, we measured 24-h personal exposures to PM 2·5 , carbon monoxide, and black carbon once pre-intervention (baseline) and twice post-intervention (at 24–28 weeks and 32–36 weeks of gestation), as well as birthweight within 24 h of birth. We examined the relationship between the average prenatal exposure and birthweight or weight-for-gestational age Z scores using multivariate-regression models, controlling for the mother's age, nulliparity, diet diversity, food insecurity, BMI, the mother's education, neonate sex, haemoglobin, second-hand smoke, and geographical indicator for randomisation strata. Findings Between March, 2018, and February, 2020, 3200 pregnant women were recruited. An interquartile increase in the average prenatal exposure to PM 2·5 (74·5 μg/m 3 ) was associated with a reduction in birthweight and gestational age Z scores (birthweight: –14·8 g [95% CI –28·7 to –0·8]; gestational age Z scores: –0·03 [–0·06 to 0·00]), as was an interquartile increase in black carbon (7·3 μg/m 3 ; –21·9 g [–37·7 to –6·1]; –0·05 [–0·08 to –0·01]). Carbon monoxide exposure was not associated with these outcomes (1·7; –3·1 [–12·1 to 5·8]; –0·003 [–0·023 to 0·017]). Interpretation Continuing efforts are needed to reduce HAP exposure alongside other drivers of low birthweight in low-income and middle-income countries. Funding US National Institutes of Health (1UM1HL134590) and the Bill & Melinda Gates Foundation (OPP1131279).
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Kalpana Balakrishnan, Kyle Steenland, Thomas Clasen et al.. Exposure–response relationships for personal exposure to fine particulate matter (PM2·5), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial. The Lancet. Planetary Health. (2023). https://doi.org/10.1016/S2542-5196(23)00052-9 Kalpana Balakrishnan, Kyle Steenland, Thomas Clasen, Howard Chang, Michael Johnson, Ajay Pillarisetti, Wenlu Ye, Luke P Naeher, Anaite Diaz-Artiga, John P McCracken, Lisa M Thompson, Ghislaine Rosa, Miles A Kirby, Gurusamy Thangavel, Sankar Sambandam, Krishnendu Mukhopadhyay, Naveen Puttaswamy, Vigneswari Aravindalochanan, Sarada Garg, Florien Ndagijimana, Stella Hartinger, Lindsay J Underhill, Katherine A Kearns, Devan Campbell, Jacob Kremer, Lance Waller, Shirin Jabbarzadeh, Jiantong Wang, Yunyun Chen, Joshua Rosenthal, Ashlinn Quinn, Aris T Papageorghiou, Usha Ramakrishnan, Penelope P Howards, William Checkley, Jennifer L Peel
aDepartment of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India bGangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA cDepartment of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA dHubert Department of Global Health, Emory University, Atlanta, GA, USA eDepartment of Epidemiology, Emory University, Atlanta, GA, USA fRollins School of Public Health and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA gBerkeley Air Monitoring Group, Berkeley, CA, USA hDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA iDepartment of Environmental Health Sciences, University of Georgia, Athens, GA, USA jCenter for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala kDepartment of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK lDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA mEagle Research Centre, Kigali, Rwanda nDivision of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA oCardiovascular Division, Washington University School of Medicine, St Louis, MO, USA pDivision of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA qNuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK rDepartment of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA 