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)

• Type of Material: Article
• Authors: Ashley Younger, University of California San Francisco; Abbey Alkon, University of California San Francisco; Kristen Harknett, University of California San Francisco; Miles A. Kirby, Harvard University; Lisa Elon, Emory University; Amy E. Lovvorn, Emory University; Jiantong Wang, Emory University; Wenlu Ye, University of California Berkeley; Anaite Diaz-Artiga, Universidad del Valle de Guatemala; John P. McCracken, Universidad del Valle de Guatemala; Adly Castanaza Gonzalez, Universidad del Valle de Guatemala; Libny Monroy Alarcon, Universidad del Valle de Guatemala; Alexie Mukeshimana, Eagle Research Center; Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Marilu Chiang, Johns Hopkins University; Kalpana Balakrishnan, Deemed University; Sarada S. Garg, Deemed University; Ajay Pillarisetti, Emory University; Ricardo Piedrahita, Berkeley Air Monitoring Group; Michael Johnson, Berkeley Air Monitoring Group; Rachel Craik, University of Oxford; Aris T. Papageorghiou, University of Oxford; Ashley Toenjes, Washington University in St. Louis; Ashlinn Quinn, Berkeley Air Monitoring Group; Kendra N. Williams, Johns Hopkins University; Lindsay Underhill, Washington University in St. Louis; Howard Chang, Emory University; Luke P. Naeher, University of Georgia; Joshua Rosenthal, Fogarty International Center; William Checkley, Johns Hopkins University; Jennifer L. Peel, Colorado State University; Thomas Clasen, Emory University; Lisa Thompson, Emory University
• Language: English
• Date: 2023-08-01
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envint.2023.108059
• Title of Journal or Parent Work: ENVIRONMENT INTERNATIONAL
• Volume: 178
• Start Page: 108059
• End Page: 108059
• Keywords: Spontaneous abortion; Life Sciences & Biomedicine; Hypertensive disorders of pregnancy; mortality; Environmental Sciences; Postpartum hemorrhage and maternal; Household air pollution; RISK; BIOMASS; CARBON-MONOXIDE; Science & Technology; Low-and middle-income countries; Environmental Sciences & Ecology; BURDEN; Birth outcomes; Cooking fuel
• Research Categories: Health Sciences, Public Health; Environmental Sciences; Health Sciences, Obstetrics and Gynecology

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.