Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala.
Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala.
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DOI：
10.1186/s40748-015-0019-0
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发表时间：
2015-01-01
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影响因子：
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通讯作者：
Hibberd, Patricia L
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文献类型：
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作者：
Patel, Archana B;Meleth, Sreelatha;Hibberd, Patricia L
背景技术背景：暴露于用于烹饪的生物质燃料的家庭空气污染（HAP）对新生儿死亡和死产的影响知之甚少。在一项大型多国观察性研究中，我们检查了HAP暴露是否与围产期死亡率（从妊娠20周开始的死产和出生后7天的死亡）以及死亡发生时间（浸渍、非浸渍死产、极早期新生儿死亡率（0-2天）和后期新生儿死亡率（3-28天））相关。在对参与全球妇幼健康网络孕产妇和新生儿健康登记处的五个低收入和中低收入国家农村社区孕妇进行的前瞻性队列研究中，在怀孕、分娩和新生儿随访时询问了有关家庭燃料使用的问题。该研究于2011年5月至2012年10月进行。造成污染的燃料包括煤油、木炭、煤、木材、稻草、作物废料和粪便。清洁燃料包括电力、液化石油气（LPG）、天然气和沼气。结果：我们研究了65,912例单胎妊娠的结局，18%来自使用清洁燃料的家庭（59%为LPG），82%来自使用污染燃料的家庭（86%为木材）。与使用清洁燃料做饭的家庭相比，使用污染燃料的家庭围产期死亡风险增加（调整后的相对风险（aRR）1.44，95%置信区间（CI）1.30-1.61）。接触HAP会增加浸渍死胎的风险（校正比值比（aOR）1.66，95%CI 1.23-2.25），非浸渍死胎（aOR 1.43，95% CI 1.15-1.85）和极早期新生儿死亡率结论：围产期死亡率与从妊娠第20周到出生后第2天暴露于HAP有关。由于分娩前的妊娠损失很难追踪，接触污染燃料对全球围产期死亡率的影响以前可能被低估了。ClinicalTrials.gov
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.