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. 2025 Dec 19;45(1):26.
doi: 10.1186/s41043-025-01178-6.

Baseline exposure-response assessment of metals from dried blood spots and personal household air pollution concentrations among pregnant women in Rwanda: household air pollution intervention network trial

Adolphe Ndikubwimana  1 , William Checkley  2 , Yunyun Chen  3 , Thomas Clasen  4 , Carmen Lucía Contreras  5 , Anaite Diaz-Artiga  5 , Gloriose Bankundiye  6 , Ephrem Dusabimana  6 , Lisa de Las Fuentes  7 , Shirin Jabbarzadeh  3 , Michael Johnson  8 , Egide Kalisa  9 , Patrick Karakwende  10 , Miles A Kirby  11 , Amy E Lovvorn  4 , John P McCracken  5   12 , Florien Ndagijimana  6 , Theoneste Ntakirutimana  10 , Jean de Dieu Ntivuguruzwa  6 , Jennifer L Peel  13 , Ajay Pillarisetti  14 , Victor G Dávila-Román  7 , Ghislaine Rosa  15 , Sarada S Garg  16 , Lisa M Thompson  17 , Lance A Waller  3 , Jiantong Wang  3 , Maggie L Clark  13 , Dana Boyd-Barr  4 , Bonnie N Young  18 ; HAPIN investigators
Collaborators, Affiliations

Baseline exposure-response assessment of metals from dried blood spots and personal household air pollution concentrations among pregnant women in Rwanda: household air pollution intervention network trial

Adolphe Ndikubwimana et al. J Health Popul Nutr. .

Abstract

Background: Exposure to metals from the combustion of biomass via inhalation may result in negative health outcomes affecting a variety of organs and systems. Pregnant women cooking with biomass fuels may be exposed to metals, such as lead (Pb) and cadmium (Cd), and have unique risks for adverse health effects with potential impacts on the growing fetus. We assessed the associations between household air pollution and metals detected in dried blood spots from pregnant women at baseline in Rwanda.

Methods: We analyzed data from 781 pregnant women aged 18-35 years who resided in rural households using biomass fuel and who were enrolled in the Household Air Pollution Intervention Network (HAPIN) Trial in Rwanda. We explored associations between 24-h average natural log-transformed personal exposures to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO) and K + standardized Pb and Cd concentrations using linear regression models adjusted for potential confounders (i.e., age, body mass index, bicycle ownership, fish consumption, and food insecurity).

Results: The adjusted models showed positive but non-significant associations between air pollutant concentrations and metals detected in blood: PM₂.₅ and Pb (β coefficient: 0.06; 95% CI - 0.03-0.15), BC and Pb (0.11; 95% CI - 0.01-0.24), PM₂.₅ and Cd (0.04; 95% CI - 0.02-0.09), and BC with Cd (0.02; 95% CI - 0.05-0.09).

Conclusions: While associations were not statistically significant, the directionally consistent increases in blood Pb and Cd with increased PM₂.₅ and BC exposures align with existing evidence and underscore the need for continued research and policy action to reduce household air pollution exposures and protect maternal and fetal health.

Keywords: Biomass cookstove; Cadmium; Dried blood spots; Indoor air pollution; Lead; Rwanda.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ). The study protocol has been reviewed and approved by institutional review boards (IRBs) or Ethics Committees at Emory University (00089799), Johns Hopkins University (00007403), Sri Ramachandra Institute of Higher Education and Research (IEC-N1/16/JUL/54/49) and the Indian Council of Medical Research–Health Ministry Screening Committee (5/8/4-30/(Env)/Indo-US/2016-NCD-I), Universidad del Valle de Guatemala (146-08-2016/11-2016) and Guatemalan Ministry of Health National Ethics Committee (11-2016), A.B. PRISMA, the London School of Hygiene and Tropical Medicine (11664-5) and the Rwandan National Ethics Committee (No.357/RNEC/2018), and Washington University of St. Louis (201611159). The HAPIN trial has been registered with ClinicalTrials.gov (Identifier NCT029446282) on October 26, 2016. However, it is a randomized control trial (RCT) not a clinical trial. And all participants provided informed consent prior to participation in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot of adjusted model results for estimated associations between natural log-transformed (Ln) PM2.5 and other covariates on Ln Pb concentrations (n = 683). The red box highlights PM2.5’s estimated impact on Pb
Fig. 2
Fig. 2
Forest plot of adjusted model results for estimated associations between natural log-transformed (Ln) black carbon (BC) and other covariates on Ln Pb concentrations (n = 540). The red box highlights BC’s estimated impact on Pb
See this image and copyright information in PMC

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