PDF(Pubmed)
Abstract：
BACKGROUND: Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth.
METHODS: The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18-34 years (9-19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24-28 weeks of gestation (the first pregnancy visit), and 32-36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure-response analyses to identify associations between household air pollutants and fetal size. This trial is registered with ClinicalTrials.gov (NCT02944682).
RESULTS: Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0-1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 μm (PM2·5; 35·0 [SD 37·2] μg/m3vs 103·3 [97·9] μg/m3) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 vs 0·39; p=0·04), abdominal circumference (0·38 vs 0·39; p=0·99), femur length (0·44 vs 0·45; p=0·73), and estimated fetal weight or birthweight (-0·13 vs -0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size.
CONCLUSIONS: Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking.
BACKGROUND: US National Institutes of Health and Bill & Melinda Gates Foundation.
UNASSIGNED: For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.
METHODS: The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18-34 years (9-19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24-28 weeks of gestation (the first pregnancy visit), and 32-36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure-response analyses to identify associations between household air pollutants and fetal size. This trial is registered with ClinicalTrials.gov (NCT02944682).
RESULTS: Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0-1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 μm (PM2·5; 35·0 [SD 37·2] μg/m3vs 103·3 [97·9] μg/m3) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 vs 0·39; p=0·04), abdominal circumference (0·38 vs 0·39; p=0·99), femur length (0·44 vs 0·45; p=0·73), and estimated fetal weight or birthweight (-0·13 vs -0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size.
CONCLUSIONS: Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking.
BACKGROUND: US National Institutes of Health and Bill & Melinda Gates Foundation.
UNASSIGNED: For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.
摘要：
背景：家庭空气污染可能导致怀孕期间胎儿生长受限。我们旨在调查液化石油气（LPG）干预措施以减少怀孕期间个人暴露于家庭空气污染是否会改变胎儿的生长。
方法：家庭空气污染干预网络（HAPIN）试验是一项开放标签的随机对照试验，在危地马拉10个资源有限的环境中进行，印度,秘鲁,卢旺达。18-34岁（妊娠9-19周）的孕妇以1：1的比例随机分配接受LPG炉，连续燃料输送,和行为信息或继续用生物质烹饪18个月。我们在基线时进行了超声评估，妊娠24-28周（第一次妊娠访问），妊娠32-36周（第二次妊娠访问），测量胎儿的大小;我们监测了24小时的个人暴露于家庭空气污染物在这些访问;我们称孩子出生时。我们进行了意向治疗分析，以估计干预组和对照组之间胎儿大小的差异，和暴露反应分析，以确定家庭空气污染物和胎儿大小之间的关联。本试验在ClinicalTrials.gov(NCT02944682)注册。
结果：在2018年5月7日至2020年2月29日之间，我们随机分配了3200名孕妇（干预组1593名，对照组1607名）。平均胎龄为14·5（SD3·0）周，平均产妇年龄为25·6（4·5）岁。我们在基线时对3147名(98·3%)女性进行了超声评估，3052名（95·4%）妇女在第一次怀孕就诊时，和2962（92·6%）在第二次怀孕访问，至2020年8月25日。干预依从性高(使用生物质炉的天数比例中位数为0·0%，IQR0·0-1·6）和干预组的孕妇对直径小于2·5μm（PM2·5;35·0[SD37·2]μg/m3vs103·3[97·9]μg/m3）的颗粒物的平均暴露量低于对照组。我们没有发现头围随机后平均Z评分的差异（0·30对0·39；p=0·04），腹围（0·38vs0·39；p=0·99），股骨长度（0·44对0·45；p=0·73），干预组和对照组之间的估计胎儿体重或出生体重（-0·13vs-0·12；p=0·70）。个人暴露于家用空气污染物与胎儿大小无关。
结论：尽管LPG烹饪干预成功地减少了怀孕期间的个人空气污染暴露，不影响胎儿大小.我们的发现不支持使用不通风的液化石油气炉灶作为增加环境中胎儿生长的策略，因为生物质燃料主要用于烹饪。
背景：美国国立卫生研究院和比尔及梅琳达·盖茨基金会。
■对于基尼亚卢旺达人，摘要的西班牙语和泰米尔语翻译见补充材料部分。
方法：家庭空气污染干预网络（HAPIN）试验是一项开放标签的随机对照试验，在危地马拉10个资源有限的环境中进行，印度,秘鲁,卢旺达。18-34岁（妊娠9-19周）的孕妇以1：1的比例随机分配接受LPG炉，连续燃料输送,和行为信息或继续用生物质烹饪18个月。我们在基线时进行了超声评估，妊娠24-28周（第一次妊娠访问），妊娠32-36周（第二次妊娠访问），测量胎儿的大小;我们监测了24小时的个人暴露于家庭空气污染物在这些访问;我们称孩子出生时。我们进行了意向治疗分析，以估计干预组和对照组之间胎儿大小的差异，和暴露反应分析，以确定家庭空气污染物和胎儿大小之间的关联。本试验在ClinicalTrials.gov(NCT02944682)注册。
结果：在2018年5月7日至2020年2月29日之间，我们随机分配了3200名孕妇（干预组1593名，对照组1607名）。平均胎龄为14·5（SD3·0）周，平均产妇年龄为25·6（4·5）岁。我们在基线时对3147名(98·3%)女性进行了超声评估，3052名（95·4%）妇女在第一次怀孕就诊时，和2962（92·6%）在第二次怀孕访问，至2020年8月25日。干预依从性高(使用生物质炉的天数比例中位数为0·0%，IQR0·0-1·6）和干预组的孕妇对直径小于2·5μm（PM2·5;35·0[SD37·2]μg/m3vs103·3[97·9]μg/m3）的颗粒物的平均暴露量低于对照组。我们没有发现头围随机后平均Z评分的差异（0·30对0·39；p=0·04），腹围（0·38vs0·39；p=0·99），股骨长度（0·44对0·45；p=0·73），干预组和对照组之间的估计胎儿体重或出生体重（-0·13vs-0·12；p=0·70）。个人暴露于家用空气污染物与胎儿大小无关。
结论：尽管LPG烹饪干预成功地减少了怀孕期间的个人空气污染暴露，不影响胎儿大小.我们的发现不支持使用不通风的液化石油气炉灶作为增加环境中胎儿生长的策略，因为生物质燃料主要用于烹饪。
背景：美国国立卫生研究院和比尔及梅琳达·盖茨基金会。
■对于基尼亚卢旺达人，摘要的西班牙语和泰米尔语翻译见补充材料部分。
