Maternal and Child Health Benefits from Reducing Household Air Pollution

描述（由申请人提供）：由马萨诸塞州总医院和印度那格浦尔英迪拉甘地政府医学院组成的联盟，隶属于Lata医学研究基金会，在开展国际多中心合作临床试验/实施科学研究方面具有丰富的经验，致力于改善孕产妇和儿童健康。自2008年以来，该联盟作为一个研究单位参加了妇女和儿童健康研究全球网络，并正在申请继续在印度那格浦尔开展富有成效和成功的研究单位。RU的目标是继续制定和实施GN赞助的共同协议，产生证据和科学知识，以可持续地改善妇女和儿童的结果。MGH-Nagpur财团提议开展的研究是基于他们目前关于家庭空气污染（HAP）对妊娠和婴儿结局的不利影响的GN研究。他们的GN研究集中在这一领域，因为GN中有30亿人（约占世界人口的一半）和-80%的孕妇仍然使用传统的炉灶和固体燃料，这些炉灶和固体燃料产生高水平的家庭污染物，远远超过世界卫生组织（WHO）的室内空气质量准则。世卫组织估计，HAP每年造成200万人死亡（主要是妇女和儿童）。他们建议开展一项多中心随机临床试验，以评估在妊娠头三个月使用传统炉灶的孕妇家庭中，是否可以通过引进炉灶/燃料来减少HAP，从而改善妊娠和婴儿结局。主要结果是出生体重。次要结局是早产、围产期/新生儿死亡率、儿童肺炎/新生儿败血症和不良的儿童生长/发育。他们还建议在一个随机的家庭中测量妇女和儿童的HAP水平，以提高对HAP影响的生物学基础的认识——包括< 2.5微米的颗粒物、一氧化碳和生物标志物1-羟基芘、甲氧基酚和可替宁（烟草烟雾）。在资源有限的环境中，成功引进减少HAP的炉灶/燃料有可能持续改善妊娠结局和儿童健康。

DESCRIPTION (provided by applicant): The consortium between the Massachusetts General Hospital and the Indira Gandhi Government Medical College Nagpur, India, affiliated with Lata Medical Research Foundation, has extensive experience in conducting international multicenter collaborative clinical trials/implementation science research dedicated to improving maternal and child health. Since 2008, the consortium has participated as a Research Unit (RU) in the Global Network (GN) for Women's and Children's Health Research and is applying to continue the productive and successful RU in Nagpur, India. The RU's goal is to continue to develop and implement GN sponsored common protocols that generate evidence and scientific knowledge to sustainably improve outcomes for women and children. The research that the MGH-Nagpur consortium proposes to develop is based on their current GN studies on the adverse effects of Household Air Pollution (HAP) on pregnancy and infant outcomes. Their GN research is focused in this area because 3 billion people (~ half of the world's population) and -80% of pregnant women in the GN still use traditional cook stoves and solid fuels that generate high levels of household pollutants, far exceeding World Health Organization (WHO) indoor air quality guidelines. WHO estimates that HAP causes 2 million deaths annually (mostly in women and children). They propose to develop a multicenter randomized clinical trial to evaluate whether pregnancy and infant outcomes can be improved by introduction of cook stoves/fuel that reduce HAP in households where pregnant women, in their first trimester, are using traditional cook stoves. The primary outcome is birth weight. Secondary outcomes are preterm birth, perinatal/neonatal mortality, childhood pneumonia/neonatal sepsis and adverse child growth/development. They also propose to measure HAP levels in women and children in a random subset of households to improve knowledge about the biological basis of the effects of HAP - including particulate matter < 2.5 micrometers, carbon monoxide and biomarkers 1-hydroxypyrene, methoxyphenol and cotinine (tobacco smoke). Successful introduction of cook stoves/fuel that reduce HAP has the potential to sustainably improve pregnancy outcomes and child health in resource limited settings.