Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)

Ashley Younger¹, Abbey Alkon¹, Kristen Harknett¹, Miles A Kirby², Lisa Elon³, Amy E Lovvorn⁴, Jiantong Wang³, Wenlu Ye⁵, Anaité Diaz-Artiga⁶, John P McCracken⁷, Adly Castañaza Gonzalez⁶, Libny Monroy Alarcon⁶, Alexie Mukeshimana⁸, Ghislaine Rosa⁹, Marilu Chiang¹⁰, Kalpana Balakrishnan¹¹, Sarada S Garg¹¹, Ajay Pillarisetti⁵, Ricardo Piedrahita¹², Michael Johnson¹², Rachel Craik¹³, Aris T Papageorghiou¹³, Ashley Toenjes¹⁴, Ashlinn Quinn¹², Kendra N Williams¹⁵, Lindsay Underhill¹⁴, Howard H Chang³, Luke P Naeher¹⁶, Joshua Rosenthal¹⁷, William Checkley¹⁵, Jennifer L Peel¹⁸, Thomas F Clasen⁴, Lisa M Thompson¹⁹; HAPIN investigators

Affiliations

¹ School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
² Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
³ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
⁶ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala; Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
⁸ Eagle Research Centre, Kigali, Rwanda.
⁹ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
¹⁰ Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA.
¹¹ Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹² Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹³ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁴ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
¹⁵ Center for Global Non-Communicable Disease Research and Training, 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 Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
¹⁷ Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. Electronic address: Lisa.thompson@emory.edu.

PMID: 37413928
PMCID: PMC10445187
DOI: 10.1016/j.envint.2023.108059

Randomized Controlled Trial

Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)

Ashley Younger et al. Environ Int. 2023 Aug.

. 2023 Aug:178:108059.

doi: 10.1016/j.envint.2023.108059. Epub 2023 Jun 28.

Authors

Affiliations

¹ School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
² Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
³ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
⁶ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala; Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
⁸ Eagle Research Centre, Kigali, Rwanda.
⁹ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
¹⁰ Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore MD, USA.
¹¹ Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹² Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹³ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁴ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
¹⁵ Center for Global Non-Communicable Disease Research and Training, 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 Health Science, College of Public Health, University of Georgia, Athens, GA, USA.
¹⁷ Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. Electronic address: Lisa.thompson@emory.edu.

PMID: 37413928
PMCID: PMC10445187
DOI: 10.1016/j.envint.2023.108059

Abstract

Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels. Pregnant women (18-34 years of age; gestation confirmed by ultrasound at 9-19 weeks) were randomly assigned to an intervention (n = 1593) or control (n = 1607) arm. Intention-to-treat analyses compared outcomes between the two arms using log-binomial models. Among the 3195 pregnant women in the study, there were 10 spontaneous abortions (7 intervention, 3 control), 93 hypertensive disorders of pregnancy (47 intervention, 46 control), 11 post postpartum hemorrhage (5 intervention, 6 control) and 4 maternal deaths (3 intervention, 1 control). Compared to the control arm, the relative risk of spontaneous abortion among women randomized to the intervention was 2.32 (95% confidence interval (CI): 0.60, 8.96), hypertensive disorders of pregnancy 1.02 (95% CI: 0.68, 1.52), postpartum hemorrhage 0.83 (95% CI: 0.25, 2.71) and 2.98 (95% CI: 0.31, 28.66) for maternal mortality. In this study, we found that adverse maternal outcomes did not differ based on randomized stove type across four country research sites.

Keywords: Birth outcomes; Cooking fuel; Household air pollution; Hypertensive disorders of pregnancy; Low- and middle-income countries; Postpartum hemorrhage and maternal mortality; Spontaneous abortion.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 2**
Effects of the intervention on adverse maternal outcomes. Note: Y axis range is limited to10% of participants in order to visualize the results.

See this image and copyright information in PMC

References

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Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)

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Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)

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Abstract

Conflict of interest statement

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