Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial

• Authors: Wenlu Ye, Emory University; Kyle Steenland, Emory University; Ashlinn Quinn, Emory University; Jiawen Liao, Emory University; Kalpana Balakrishnan, Sri Ramachandra Institute for Higher Education and Research (Deemed University); Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Florien Ndagijimana, Eagle Research Centre Limited, Kigali; Jean de Dieu Ntivuguruzwa, Eagle Research Centre Limited, Kigali; Lisa Thompson, Emory University; John P McCracken, University of Georgia; Anaité Díaz-Artiga, Universidad del Valle de Guatemala; Joshua P Rosenthal, Emory University; Aris Papageorghiou, University of Oxford; Victor G Davila-Roman, Washington University in St. Louis; Ajay Pillarisetti, Emory University; Michael Johnson, Emory University; Jiantong Wang, Emory University; Laura Nicolaou, Johns Hopkins University; William Checkley, Johns Hopkins University; Jennifer L Peel, Colorado State University; Thomas Clasen, Emory University
• Journal Title: HYPERTENSION
• Volume: Volume 79, Number 8
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2022-08-01, Pages 1887-1898
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/HYPERTENSIONAHA.122.19362
• Subjects: Environmental Sciences; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Peripheral Vascular Disease; Cardiovascular System & Cardiology; blood pressure; cardiovascular diseases; inflammation; morbidity; pregnant women; AIR-POLLUTION; CARDIOVASCULAR-DISEASE; COOKSTOVE INTERVENTION; SCIENTIFIC STATEMENT; CARBON-MONOXIDE; BASE-LINE; ASSOCIATION; WOMEN; METAANALYSIS; HYPERTENSION

Abstract

Background: Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies. Methods: We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP. Results: Median 24-hour PM2.5dropped from 84 to 24 μg/m3after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03-1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05-1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance. Conclusions: In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP.