Effects of a liquefied petroleum gas stove and fuel intervention on head circumference and length at birth: A multi-country household air pollution intervention network (HAPIN) trial

Hina Raheel; Sheela Sinharoy; Anaité Diaz-Artiga; Sarada S Garg; Ajay Pillarisetti; Kalpana Balakrishnan; Marilu Chiang; Amy Lovvorn; Miles Kirby; Usha Ramakrishnan; Shirin Jabbarzadeh; Alexie Mukeshimana; Michael Johnson; John P McCracken; Luke P Naeher; Ghislaine Rosa; Jiantong Wang; Joshua Rosenthal; William Checkley; Thomas F Clasen; Jennifer L Peel; Lisa M Thompson; Household Air Pollution Intervention Network (HAPIN) investigators

doi:10.1016/j.envint.2024.109211

Effects of a liquefied petroleum gas stove and fuel intervention on head circumference and length at birth: A multi-country household air pollution intervention network (HAPIN) trial

Environ Int. 2024 Dec 24:195:109211. doi: 10.1016/j.envint.2024.109211. Online ahead of print.

Authors

Hina Raheel¹, Sheela Sinharoy², Anaité Diaz-Artiga³, Sarada S Garg⁴, Ajay Pillarisetti⁵, Kalpana Balakrishnan⁴, Marilu Chiang⁶, Amy Lovvorn⁷, Miles Kirby⁸, Usha Ramakrishnan², Shirin Jabbarzadeh⁹, Alexie Mukeshimana¹⁰, Michael Johnson¹¹, John P McCracken¹², Luke P Naeher¹², Ghislaine Rosa¹³, Jiantong Wang⁹, Joshua Rosenthal¹⁴, William Checkley¹⁵, Thomas F Clasen⁷, Jennifer L Peel¹⁶, Lisa M Thompson¹⁷; Household Air Pollution Intervention Network (HAPIN) investigators

Affiliations

¹ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. Electronic address: hraheel@emory.edu.
² Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
³ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁴ ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India.
⁵ Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, CA, USA.
⁶ Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.
⁷ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA.
⁸ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁹ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁰ Eagle Research Centre, Kigali, Rwanda.
¹¹ Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹² Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
¹³ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
¹⁴ Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
¹⁵ Division of Pulmonary and Critical Care, School of Medicine, 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 and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁷ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, CA, USA.

PMID: 39729872
DOI: 10.1016/j.envint.2024.109211

Abstract

Background: Air pollution may impair child growth and cognitive development, with potential markers including birth length and head circumference.

Methods: The Household Air Pollution Intervention Network (HAPIN) trial was an open label multi-country-randomized controlled trial, with 3200 pregnant women aged 18-34 years (9-19 weeks of gestation) randomly assigned in a 1:1 ratio to receive liquefied petroleum gas (LPG) stove intervention compared to women continuing to cook with solid fuels for 18 months. Particulate matter ≤ 2.5 μm (PM2.5), black carbon (BC) and carbon monoxide (CO) 24-hour personal exposures were measured three times during pregnancy. Head circumference and length were measured < 24 h of birth. We conducted intention-to-treat and exposure-response analyses to determine the intervention effects and associations between household air pollution (HAP) exposure during pregnancy and head circumference, head circumference-for-gestational age Z-score, length, and length-for-gestational age Z-scores at birth.

Clinicaltrials: gov.

Results: Between May 2018, and Feb 2020, 3200 pregnant women were randomly assigned to intervention (n = 1593) and control groups (n = 1607) with 3060 births included in the analysis. There was a 71.9 % reduction in PM2.5 in the intervention group with similar reductions for BC and CO. Intention-to-treat analysis showed that the intervention did not affect head circumference (β = -0.01 cm, 95 %CI -0.11, 0.09), head circumference-for-gestational age Z-score (β = -0.01, 95 %CI -0.08, 0.07), or birth length (β = 0.14 cm, 95 %CI -0.01, 0.29) but did increase birth length-for-gestational age Z-score (β = 0.09, 95 %CI 0.01, 0.16). After covariate adjustment, exposure-response analysis revealed that each log-unit increase in BC was associated with a decrease in birth length-for-gestational age Z-score (β = -0.07, 95 %CI -0.13, -0.005). There was no evidence of hypothesized associations with PM2.5 or CO.

Conclusion: An LPG intervention reduced HAP exposure during pregnancy but had minor effects on birth length-for-gestational age Z-score. Birth length-for-gestational age was only associated with BC.

Clinical trial registration: The study has been registered with ClinicalTrials.gov (Identifier NCT02944682).

Keywords: Birth length; Head circumference; Household air pollution; Intervention; LPG stove.

Associated data

ClinicalTrials.gov/NCT02944682