Pregnancy outcomes and ethanol cook stove intervention: A randomized-controlled trial in Ibadan, Nigeria
Pregnancy outcomes and ethanol cook stove intervention: A randomized-controlled trial in Ibadan, Nigeria
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DOI：
10.1016/j.envint.2017.11.021
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发表时间：
2018-02-01
影响因子：
11.8
通讯作者：
Olopade, Christopher O.
中科院分区：
文献类型：
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作者：
Alexander, Donee A.;Northcross, Amanda;Olopade, Christopher O.
背景：家庭空气污染（HAP）暴露与不良妊娠结局有关。目的：在尼日利亚伊巴丹进行了一项随机对照试验，以确定用乙醇烹饪对妊娠结局的影响。方法：将324名孕妇随机分为对照组（继续使用煤油/柴薪灶，n = 162）和干预组（使用乙醇灶，n = 162）。主要结局变量为出生体重、早产、宫内生长受限（IUGR）和流产/死产的发生。结果：乙醇组和对照组的平均出生体重分别为3076和2988 g；差异为88 g(95%可信区间：- 18 g至194 g)，无统计学意义（p = 0.10）。调整协变量后，差异达到显著性（p = 0.020）。乙醇组早产率为6.7%，对照组早产率为11.0%，差异有统计学意义（p = 0.22）。流产数为1例（乙醇组）vs. 4例（对照组），死产数为3例（乙醇组）vs. 7例（对照组）（均无统计学意义）。酒精使用者的平均胎龄（39.2周）明显高于对照组（38.2周）（p = 0.015）。对照组的围产期死亡率（死产和新生儿死亡）是乙醇使用者的两倍（7.9%对3.9%；协变量校正后p = 0.045）。我们没有发现两个治疗组的暴露水平有显著差异，可能是由于较大的季节性影响和较高的环境空气污染水平。结论：从传统的生物质/煤油燃料过渡到乙醇减少了不良妊娠结局。然而，只有在协变量调整后，出生体重的差异才有统计学意义，其他显著差异是在第三终点。我们的研究结果提示了使用乙醇的有益效果。需要更大规模的试验来验证这些发现。
Background: Household air pollution (HAP) exposure has been linked to adverse pregnancy outcomes. Objectives: A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with ethanol on pregnancy outcomes.Methods: Three-hundred-twenty-four pregnant women were randomized to either the control (continued cooking using kerosene/firewood stove, n = 162) or intervention group (received ethanol stove, n = 162). Primary outcome variables were birthweight, preterm delivery, intrauterine growth restriction (IUGR), and occurrence of miscarriage/stillbirth.Results: Mean birthweights for ethanol and controls were 3076 and 2988 g, respectively; the difference, 88 g, (95% confidence interval: - 18 g to 194 g), was not statistically significant (p = 0.10). After adjusting for covariates, the difference reached significance (p = 0.020). Rates of preterm delivery were 6.7% (ethanol) and 11.0% (control), (p = 0.22). Number of miscarriages was 1(ethanol) vs. 4 (control) and stillbirths was 3 (ethanol) vs. 7 (control) (both non-significant). Average gestational age at delivery was significantly (p = 0.015) higher in ethanol-users (39.2 weeks) compared to controls (38.2 weeks). Perinatal mortality (stillbirths and neonatal deaths) was twice as high in controls compared to ethanol-users (7.9% vs. 3.9%; p = 0.045, after adjustment for covariates). We did not detect significant differences in exposure levels between the two treatment arms, perhaps due to large seasonal effects and high ambient air pollution levels.Conclusions: Transition from traditional biomass/kerosene fuel to ethanol reduced adverse pregnancy outcomes. However, the difference in birthweight was statistically significant only after covariate adjustment and the other significant differences were in tertiary endpoints. Our results are suggestive of a beneficial effect of ethanol use. Larger trials are required to validate these findings.