Environment International (Aug 2023)
Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)
- Ashley Younger,
- Abbey Alkon,
- Kristen Harknett,
- Miles A. Kirby,
- Lisa Elon,
- Amy E. Lovvorn,
- Jiantong Wang,
- Wenlu Ye,
- Anaité Diaz-Artiga,
- John P. McCracken,
- Adly Castañaza Gonzalez,
- Libny Monroy Alarcon,
- Alexie Mukeshimana,
- Ghislaine Rosa,
- Marilu Chiang,
- Kalpana Balakrishnan,
- Sarada S. Garg,
- Ajay Pillarisetti,
- Ricardo Piedrahita,
- Michael Johnson,
- Rachel Craik,
- Aris T. Papageorghiou,
- Ashley Toenjes,
- Ashlinn Quinn,
- Kendra N. Williams,
- Lindsay Underhill,
- Howard H. Chang,
- Luke P. Naeher,
- Joshua Rosenthal,
- William Checkley,
- Jennifer L. Peel,
- Thomas F. Clasen,
- Lisa M. Thompson
Affiliations
- Ashley Younger
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Abbey Alkon
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Kristen Harknett
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Miles A. Kirby
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Lisa Elon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Amy E. Lovvorn
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Wenlu Ye
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Anaité Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala; Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
- Adly Castañaza Gonzalez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Libny Monroy Alarcon
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Alexie Mukeshimana
- Eagle Research Centre, Kigali, Rwanda
- Ghislaine Rosa
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Marilu Chiang
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA
- Kalpana Balakrishnan
- Department 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
- Sarada S. Garg
- Department 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
- Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Ricardo Piedrahita
- Berkeley Air Monitoring Group, Berkeley, CA, USA
- Michael Johnson
- Berkeley Air Monitoring Group, Berkeley, CA, USA
- Rachel Craik
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Aris T. Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Ashley Toenjes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, CA, USA
- Kendra N. Williams
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA
- Lindsay Underhill
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Luke P. Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
- Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA
- Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Lisa M. Thompson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; Corresponding author at: 1520 Clifton Road, NE Atlanta, GA, USA.
- Journal volume & issue
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Vol. 178
p. 108059
Abstract
Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels. Pregnant women (18–34 years of age; gestation confirmed by ultrasound at 9–19 weeks) were randomly assigned to an intervention (n = 1593) or control (n = 1607) arm. Intention-to-treat analyses compared outcomes between the two arms using log-binomial models. Among the 3195 pregnant women in the study, there were 10 spontaneous abortions (7 intervention, 3 control), 93 hypertensive disorders of pregnancy (47 intervention, 46 control), 11 post postpartum hemorrhage (5 intervention, 6 control) and 4 maternal deaths (3 intervention, 1 control). Compared to the control arm, the relative risk of spontaneous abortion among women randomized to the intervention was 2.32 (95% confidence interval (CI): 0.60, 8.96), hypertensive disorders of pregnancy 1.02 (95% CI: 0.68, 1.52), postpartum hemorrhage 0.83 (95% CI: 0.25, 2.71) and 2.98 (95% CI: 0.31, 28.66) for maternal mortality. In this study, we found that adverse maternal outcomes did not differ based on randomized stove type across four country research sites.
