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. 2025 Nov 15;285(Pt 1):122258.
doi: 10.1016/j.envres.2025.122258. Epub 2025 Jul 2.

Gestational and postnatal exposures to fine particulate matter (PM2.5) and their association with acute ear infections, diarrhea, respiratory symptoms, and mortality: A longitudinal study of infants in the multicountry Household Air Pollution Intervention Network (HAPIN) trial

Brandie Banner Shackelford  1 , Kyle Steenland  2 , Miles A Kirby  3 , Kalpana Balakrishnan  4 , Marilú Chiang  5 , Anaité Diaz-Artiga  6 , John P McCracken  7 , Lisa M Thompson  8 , Ghislaine Rosa  9 , Lance A Waller  10 , Shirin Jabbarzadeh  10 , Jiantong Wang  10 , Ajay Pillarisetti  11 , Michael A Johnson  12 , Jennifer L Peel  13 , William Checkley  14 , Thomas F Clasen  2 ; HAPIN Investigators
Collaborators, Affiliations

Gestational and postnatal exposures to fine particulate matter (PM2.5) and their association with acute ear infections, diarrhea, respiratory symptoms, and mortality: A longitudinal study of infants in the multicountry Household Air Pollution Intervention Network (HAPIN) trial

Brandie Banner Shackelford et al. Environ Res. .

Abstract

Exposure to household air pollution from cooking with biomass is a risk factor for infant morbidity and mortality. The Household Air Pollution Intervention Network (HAPIN) evaluated the effects of a liquefied petroleum gas (LPG) stove and fuel intervention on air pollutant exposure and health outcomes among 3195 pregnant women (nine to 19 weeks' gestation) and their infants in Guatemala, India, Peru, and Rwanda. We measured PM2.5 exposure among women before childbirth and infants in the postnatal period. Infant death was monitored for the entirety of the study, while data on acute ear infections, diarrhea, cough, and rapid and/or difficulty breathing were collected at four timepoints. Multivariable logistic regression models, adjusted for demographics and repeated measures within each child, estimated the odds of each health outcome based on exposures. We observed a modest but statistically significant association between an interquartile increase in gestational PM2.5 exposure and increased odds of acute ear infection (OR: 1.15; 95 % CI: 1.00, 1.33), but there was no association with other measured health outcomes. We found no statistically significant association between postnatal PM2.5 exposure and any of the measured health outcomes. Our findings underscore the need for further investigation into the environmental determinants of infant health.

Keywords: Gestational exposure; Household air pollution; Infant morbidity; Infant mortality; PM(2.5) exposure.

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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.

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