Abstract：
Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to <35 years of age; gestation confirmed by ultrasound at 9 to <20 weeks) were randomly assigned to intervention or control arms. We monitored these fetal and neonatal outcomes and personal exposure to PM2.5, BC and CO three times during pregnancy, we conducted intention-to-treat (ITT) and exposure-response (E-R) analyses to determine if the HAPIN intervention and corresponding HAP exposure was associated with the risk of fetal/neonatal outcomes. A total of 3200 women (mean age 25.4 ± 4.4 years, mean gestational age at randomization 15.4 ± 3.1 weeks) were included in this analysis. Relative risks for stillbirth, congenital anomaly and neonatal mortality were 0.99 (0.60, 1.66), 0.92 (95 % CI 0.52, 1.61), and 0.99 (0.54, 1.85), respectively, among women in the intervention arm compared to controls in an ITT analysis. Higher mean personal exposures to PM2.5, CO and BC during pregnancy were associated with a higher, but statistically non-significant, incidence of adverse outcomes. The LPG stove and fuel intervention did not reduce the risk of these outcomes nor did we find evidence supporting an association between personal exposures to HAP and stillbirth, congenital anomalies and neonatal mortality.
摘要：
怀孕期间使用固体燃料烹饪造成的家庭空气污染（HAP）与不良妊娠结局有关。家庭空气污染干预网络（HAPIN）试验是一项随机对照试验，评估了液化石油气（LPG）炉和燃料干预对危地马拉健康的影响。印度,秘鲁,卢旺达。在这里，我们调查了液化石油气炉和燃料干预对死产的影响，先天性异常和新生儿死亡率以及个人暴露于细颗粒物（PM2.5）之间的特征性暴露-反应关系，黑碳(BC)和一氧化碳(CO)以及这些结果。孕妇（年龄18至<35岁；在9至<20周时通过超声确认妊娠）被随机分配到干预或控制组。我们在怀孕期间对这些胎儿和新生儿的结局以及个人暴露于PM2.5，BC和CO的情况进行了3次监测，我们进行了意向治疗(ITT)和暴露反应(E-R)分析,以确定HAPIN干预和相应的HAP暴露是否与胎儿/新生儿结局风险相关.共有3200名妇女（平均年龄25.4±4.4岁，随机分组时的平均胎龄15.4±3.1周)纳入本分析.死产的相对风险，先天性异常和新生儿死亡率分别为0.99(0.60,1.66),0.92（95%CI0.52，1.61），和0.99（0.54，1.85），分别,在ITT分析中，干预组女性与对照组相比。怀孕期间较高的平均个人暴露于PM2.5，CO和BC与较高的水平相关，但统计上不显着，不良结局的发生率。LPG炉和燃料干预并没有降低这些结果的风险，我们也没有发现证据支持个人暴露于HAP和死产之间的关联。先天性异常和新生儿死亡率。
