Abstract:
Background: Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on
neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined
whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths
through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal
mortality (day 0–2) and later neonatal mortality (day 3–28).
Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a
prospective cohort study of pregnant women in rural communities in five low and lower middle income
countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health
Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal,
coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas
and biogas.
Results: We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG)
and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there
was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95
% confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds
ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality
(aOR 1.82, 95 % CI 1.47-2.22).
Conclusions: Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day
2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels
on global perinatal mortality may have previously been underestimated.
Trial registration: ClinicalTrials.gov NCT01073475
