Ahmed Anisuddin, Rahman Ahmed Ehsanur, Ahmed Saifuddin, Rahman Fariya, Sujan Hasan Mahmud, Ahmmed Faisal, Hossain Aniqa Tasnim, Sayeed Abu, Hossain Shahed, Huq Nafisa Lira, Quaiyum Mohammad Abdul, Reichenbach Laura, El Arifeen Shams
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet Reg Health Southeast Asia. 2024 Jan 3;25:100342. doi: 10.1016/j.lansea.2023.100342. eCollection 2024 Jun.
Smoke from biomass fuels used for cooking in traditional cookstoves contains a variety of health-damaging pollutants. Inhalation of these pollutants by pregnant women has been linked to abnormal foetal development and adverse pregnancy outcomes, including low birthweight (LBW). There is a dearth of data on environmental interventions that have the potential to reduce exposure to biomass fuel during pregnancy and improve birth outcomes. International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) therefore, designed a low-cost kitchen with an improved cookstove and examined the impact of this intervention on the birthweight of neonates.
icddr,b conducted a cluster-randomised controlled trial of a 'low-cost kitchen with improved cookstove' intervention among 1,267 pregnant women who used traditional cookstoves in a rural sub-district of Bangladesh. All participants were enrolled during the first trimester of pregnancy among 104 randomly selected clusters after obtaining informed consent. The model kitchens were installed in 628 participants' households of the intervention group, and 639 participants continued to use traditional cookstoves as the control group. The primary outcome was the proportion of LBW neonates between the intervention and control groups. The study also examined if the intervention would reduce CO exposure, measured by the differences in maternal blood carbon monoxide saturation (SpCO) levels and prevalence of LBW in neonates. We performed a generalized structural equation model for jointly assessing the simultaneous relationships of biomass fuel exposure to LBW of neonates and the relationships of LBW of neonates to maternal blood SpCO level. This trial was registered with ClinicalTrials.gov (NCT02923882).
We found that in the intervention group using 'low-cost kitchen with improved cookstove', the risk of LBW reduced by 37% (adjusted risk ratio: 0.63, 95% CI [0.45, 0.89]). Between the second and third trimester, the mean maternal blood SpCO level was significantly reduced from 10.4% to 8.9% (p-value <0.01) in the intervention group but remained unchanged in the control group (11.6% and 11.5%). Of the total effects of the intervention on the risk of LBW, 48.3% was mediated through maternal blood SpCO level.
The risk of LBW among rural neonates was reduced in the intervention group using 'low-cost kitchen with improved cookstove', which may be attributed to the reduction in maternal blood SpCO level. Additional research is needed to identify other mechanisms through which biomass fuel exposure might lead to adverse pregnancy outcomes.
Grand Challenges Canada: Rising Stars in Global Health Programme.
传统炉灶中用于烹饪的生物质燃料产生的烟雾含有多种危害健康的污染物。孕妇吸入这些污染物与胎儿发育异常及不良妊娠结局有关，包括低出生体重（LBW）。关于有可能减少孕期生物质燃料暴露并改善出生结局的环境干预措施的数据匮乏。因此，孟加拉国腹泻病研究国际中心（icddr，b）设计了一种配备改良炉灶的低成本厨房，并研究了该干预措施对新生儿出生体重的影响。
icddr，b在孟加拉国一个农村分区的1267名使用传统炉灶的孕妇中进行了一项关于“配备改良炉灶的低成本厨房”干预措施的整群随机对照试验。所有参与者在获得知情同意后于妊娠早期在104个随机选择的群组中入组。在干预组的628名参与者家庭中安装了样板厨房，639名参与者继续使用传统炉灶作为对照组。主要结局是干预组和对照组中低出生体重新生儿的比例。该研究还通过母体血液一氧化碳饱和度（SpCO）水平差异和新生儿低出生体重患病率来检验该干预措施是否会降低一氧化碳暴露。我们进行了一个广义结构方程模型，以联合评估生物质燃料暴露与新生儿低出生体重之间的同时关系以及新生儿低出生体重与母体血液SpCO水平之间的关系。该试验已在ClinicalTrials.gov（NCT02923882）注册。
我们发现，在使用“配备改良炉灶的低成本厨房”的干预组中，低出生体重风险降低了37%（调整风险比：0.63，95%可信区间[0.45，0.89]）。在妊娠中期和晚期之间，干预组母体血液SpCO平均水平从10.4%显著降至8.9%（p值<0.01），而对照组保持不变（11.6%和11.5%）。干预措施对低出生体重风险的总效应中，48.3%是通过母体血液SpCO水平介导的。
使用“配备改良炉灶的低成本厨房”的干预组中农村新生儿低出生体重风险降低，这可能归因于母体血液SpCO水平的降低。需要进一步研究以确定生物质燃料暴露可能导致不良妊娠结局的其他机制。
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