液化石油气或生物质用于烹饪对出生体重的影响。
Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight.
机构信息
From Emory University, Atlanta (T.F.C., H.H.C., L.M.T., K.S., D.B.B., Y.C., S.J., A.E.L., U.R., S.S.S., L.A.W., J.W.), and the University of Georgia, Athens (J.P.M., L.P.N.) - both in Georgia; the Harvard T.H. Chan School of Public Health, Boston (M.A.K.); the Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., V.A., S.G., K.M., N.P., S.S., G.T.); Universidad del Valle de Guatemala, Guatemala City (A.D.-A., A.C., L.M.); the London School of Hygiene and Tropical Medicine, London (G.R.), and the University of Oxford, Oxford (A. Papageorghiou) - both in the United Kingdom; the University of California, San Francisco, San Francisco (A.Y.), and the Berkeley Air Monitoring Group (M.A.J., R.P., A.Q.) and the University of California, Berkeley (A. Pillarisetti), Berkeley - all in California; Asociación Benéfica PRISMA (M.C.) and Universidad Peruana Cayetano Heredia (S.H.) - both in Lima, Peru; Colorado State University, Fort Collins (M.L.C., J.L.P.); the National Institutes of Health, Bethesda (D.-Y.K., J.P.R.), and Johns Hopkins University, Baltimore (E.D.M., L.H.M., K.N.W., W.C.) - both in Maryland; the Eagle Research Center, Kigali, Rwanda (A.M., F.N.); and Washington University in St. Louis, St. Louis (L.J.U.).
出版信息
N Engl J Med. 2022 Nov 10;387(19):1735-1746. doi: 10.1056/NEJMoa2206734. Epub 2022 Oct 10.
BACKGROUND
Exposure during pregnancy to household air pollution caused by the burning of solid biomass fuel is associated with adverse health outcomes, including low birth weight. Whether the replacement of a biomass cookstove with a liquefied petroleum gas (LPG) cookstove would result in an increase in birth weight is unclear.
METHODS
We performed a randomized, controlled trial involving pregnant women (18 to <35 years of age and at 9 to <20 weeks' gestation as confirmed on ultrasonography) in Guatemala, India, Peru, and Rwanda. The women were assigned in a 1:1 ratio to use a free LPG cookstove and fuel (intervention group) or to continue using a biomass cookstove (control group). Birth weight, one of four prespecified primary outcomes, was the primary outcome for this report; data for the other three outcomes are not yet available. Birth weight was measured within 24 hours after birth. In addition, 24-hour personal exposures to fine particulate matter (particles with a diameter of ≤2.5 μm [PM]), black carbon, and carbon monoxide were measured at baseline and twice during pregnancy.
RESULTS
A total of 3200 women underwent randomization; 1593 were assigned to the intervention group, and 1607 to the control group. Uptake of the intervention was nearly complete, with traditional biomass cookstoves being used at a median rate of less than 1 day per month. After randomization, the median 24-hour personal exposure to fine particulate matter was 23.9 μg per cubic meter in the intervention group and 70.7 μg per cubic meter in the control group. Among 3061 live births, a valid birth weight was available for 94.9% of the infants born to women in the intervention group and for 92.7% of infants born to those in the control group. The mean (±SD) birth weight was 2921±474.3 g in the intervention group and 2898±467.9 g in the control group, for an adjusted mean difference of 19.6 g (95% confidence interval, -10.1 to 49.2).
CONCLUSIONS
The birth weight of infants did not differ significantly between those born to women who used LPG cookstoves and those born to women who used biomass cookstoves. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.).
背景
孕妇在怀孕期间暴露于燃烧固体生物质燃料造成的室内空气污染与不良健康后果有关，包括低出生体重。用液化石油气（LPG）炉具替代生物质炉具是否会导致出生体重增加尚不清楚。
方法
我们在危地马拉、印度、秘鲁和卢旺达进行了一项随机对照试验，涉及孕妇（年龄 18 岁至<35 岁，超声检查证实妊娠 9 周至<20 周）。这些妇女以 1:1 的比例被分配使用免费的 LPG 炉具和燃料（干预组）或继续使用生物质炉具（对照组）。出生体重是四项预设主要结局之一，是本报告的主要结局；其他三个结局的数据尚不可用。出生体重是在出生后 24 小时内测量的。此外，在基线和妊娠期间两次测量了 24 小时个人暴露于细颗粒物（直径≤2.5μm 的颗粒物[PM]）、黑碳和一氧化碳的情况。
结果
共有 3200 名妇女接受了随机分组；1593 名被分配到干预组，1607 名被分配到对照组。干预措施的使用率几乎达到 100%，传统生物质炉具的月平均使用天数不足 1 天。随机分组后，干预组中 24 小时个人细颗粒物暴露中位数为 23.9μg/立方米，对照组为 70.7μg/立方米。在 3061 例活产中，干预组中 94.9%的婴儿和对照组中 92.7%的婴儿出生体重有效。干预组的平均（±SD）出生体重为 2921±474.3g，对照组为 2898±467.9g，调整后的平均差异为 19.6g（95%置信区间，-10.1 至 49.2）。
结论
使用 LPG 炉具的妇女所生婴儿的出生体重与使用生物质炉具的妇女所生婴儿的出生体重无显著差异。（由美国国立卫生研究院和比尔及梅琳达·盖茨基金会资助；HAPIN 临床试验。 gov 编号，NCT02944682。）
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