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Randomized Controlled Trial
. 2022 Nov 10;387(19):1735-1746.
doi: 10.1056/NEJMoa2206734. Epub 2022 Oct 10.

Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight

Thomas F Clasen  1 , Howard H Chang  1 , Lisa M Thompson  1 , Miles A Kirby  1 , Kalpana Balakrishnan  1 , Anaité Díaz-Artiga  1 , John P McCracken  1 , Ghislaine Rosa  1 , Kyle Steenland  1 , Ashley Younger  1 , Vigneswari Aravindalochanan  1 , Dana B Barr  1 , Adly Castañaza  1 , Yunyun Chen  1 , Marilú Chiang  1 , Maggie L Clark  1 , Sarada Garg  1 , Stella Hartinger  1 , Shirin Jabbarzadeh  1 , Michael A Johnson  1 , Dong-Yun Kim  1 , Amy E Lovvorn  1 , Eric D McCollum  1 , Libny Monroy  1 , Lawrence H Moulton  1 , Alexie Mukeshimana  1 , Krishnendu Mukhopadhyay  1 , Luke P Naeher  1 , Florien Ndagijimana  1 , Aris Papageorghiou  1 , Ricardo Piedrahita  1 , Ajay Pillarisetti  1 , Naveen Puttaswamy  1 , Ashlinn Quinn  1 , Usha Ramakrishnan  1 , Sankar Sambandam  1 , Sheela S Sinharoy  1 , Gurusamy Thangavel  1 , Lindsay J Underhill  1 , Lance A Waller  1 , Jiantong Wang  1 , Kendra N Williams  1 , Joshua P Rosenthal  1 , William Checkley  1 , Jennifer L Peel  1 ; HAPIN Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Liquefied Petroleum Gas or Biomass for Cooking and Effects on Birth Weight

Thomas F Clasen et al. N Engl J Med. .

Abstract

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 [PM2.5]), 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.).

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Figures

Figure 1.
Figure 1.. Screening, Randomization, and Follow-up.
The women were randomly assigned in a 1:1 ratio to use a free liquefied petroleum gas (LPG) cookstove and fuel (intervention group) or to continue using a biomass cookstove (control group). The reasons for exclusion from the trial before randomization were not mutually exclusive. HAPIN denotes Household Air Pollution Intervention Network.
Figure 2.
Figure 2.. Overall and Subgroup Analyses of the Difference in Birth Weight between the Intervention Group and Control Group.
Shown is a forest plot of the between-group differences in birth weight. All analyses were adjusted for the randomization strata (the trial sites within each country). The actual birth weights are provided in Table S3.
See this image and copyright information in PMC

References

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