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; HAPIN investigators

doi:10.1016/j.envint.2023.108059

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)

Environ Int. 2023 Aug:178:108059. doi: 10.1016/j.envint.2023.108059. Epub 2023 Jun 28.

Authors

Ashley Younger¹, Abbey Alkon¹, Kristen Harknett¹, Miles A Kirby², Lisa Elon³, Amy E Lovvorn⁴, Jiantong Wang³, Wenlu Ye⁵, Anaité Diaz-Artiga⁶, John P McCracken⁷, Adly Castañaza Gonzalez⁶, Libny Monroy Alarcon⁶, Alexie Mukeshimana⁸, Ghislaine Rosa⁹, Marilu Chiang¹⁰, Kalpana Balakrishnan¹¹, Sarada S Garg¹¹, Ajay Pillarisetti⁵, Ricardo Piedrahita¹², Michael Johnson¹², Rachel Craik¹³, Aris T Papageorghiou¹³, Ashley Toenjes¹⁴, Ashlinn Quinn¹², Kendra N Williams¹⁵, Lindsay Underhill¹⁴, Howard H Chang³, Luke P Naeher¹⁶, Joshua Rosenthal¹⁷, William Checkley¹⁵, Jennifer L Peel¹⁸, Thomas F Clasen⁴, Lisa M Thompson¹⁹; HAPIN investigators

Affiliations

¹ School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
² Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
³ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
⁶ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁷ 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.
⁸ Eagle Research Centre, Kigali, Rwanda.
⁹ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
¹⁰ Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA.
¹¹ 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.
¹² Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹³ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁴ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
¹⁵ Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹⁶ Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
¹⁷ 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.
¹⁸ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁹ 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. Electronic address: Lisa.thompson@emory.edu.

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.

Keywords: Birth outcomes; Cooking fuel; Household air pollution; Hypertensive disorders of pregnancy; Low- and middle-income countries; Postpartum hemorrhage and maternal mortality; Spontaneous abortion.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Spontaneous* / chemically induced
Abortion, Spontaneous* / etiology
Air Pollution*
Air Pollution, Indoor* / adverse effects
Air Pollution, Indoor* / analysis
Cooking
Female
Humans
Hypertension, Pregnancy-Induced*
Infant
Petroleum*
Postpartum Hemorrhage* / chemically induced
Postpartum Hemorrhage* / prevention & control
Pregnancy

Substances

Petroleum

Abstract

Publication types

MeSH terms

Substances

Grants and funding