Prenatal Exposure to Solid Fuel Smoke and Birth Outcomes in Sri Lanka

描述(申请人提供)：在通风不良地区的低效炉灶中燃烧固体燃料会导致孕妇大量接触一氧化碳(CO)和细颗粒物(PM2.5)，这两种物质都已知会导致胎儿缺氧。然而，将室内吸烟与不良妊娠结局联系起来的证据是有限的，有时甚至是相互矛盾的；而且将室内吸烟与婴儿神经发育联系起来的证据也不存在。许多研究使用间接的烟雾暴露测量和报告的健康结果测量，并没有充分考虑混淆和相互作用。世界卫生组织建议，需要更多高质量的研究来确认风险估计，重点是对暴露和胎龄的准确评估。在这项拟议的研究中，我们计划评估居住在斯里兰卡甘帕哈地区的半城市人口中固体燃料使用与出生结局和婴儿神经发育之间的关系。其目的是衡量使用固体燃料问卷信息作为室内PM2.5和CO测量水平的替代指标的准确性，并评估产前暴露于固体燃料烟雾暴露与胎儿生长(低出生体重、头围和身长)以及固体燃料烟雾与出生时神经发育之间的关系。我们将通过实时连续监测测量PM2.5和CO，并通过超声评估孕周。这项印美合作将增加关于使用固体燃料作为出生结局和婴儿神经发育风险因素的知识，并作为开发基于社区的干预措施以降低相关疾病负担的第一步。 公共卫生相关性：燃烧烹饪用固体燃料造成的室内空气污染已被确定为造成全球疾病负担的十大最重要风险因素之一。这项研究将增加关于固体燃料使用作为出生结局和婴儿神经发育风险因素的知识，并受益于具有不同和补充背景的研究人员之间建立的良好的印美合作，同时促进两个伙伴机构之间的技术转让。

DESCRIPTION (provided by applicant): Solid fuel combustion in inefficient cooking stoves in poorly ventilated areas causes heavy maternal exposure to carbon monoxide (CO) and to fine particulate matter (PM2.5), both known to cause fetal anoxia. However, the evidence linking indoor smoke to and adverse pregnancy outcomes is limited and sometimes conflicting; and evidence linking indoor smoke to infant neurodevelopment is nonexistent. Many studies use indirect measures of smoke exposure and reported measures of health outcomes, and do not adequately account for confounding and interactions. The WHO recommends that additional, high quality studies are required to confirm the risk estimates, with an emphasis on accurate assessments of exposure and gestational age. In the proposed research, we plan to evaluate the relationship between solid fuel use and birth outcomes and infant neurodevelopment among a semi-urban population residing in Gampaha district, Sri Lanka. The aims are to measure the accuracy of questionnaire information on solid fuel use as a surrogate for measured levels of indoor PM2.5 and CO, and to evaluate the relationship between prenatal exposure to solid fuel smoke exposure and fetal growth (low birth weight, head circumference and length) and between solid fuel smoke and neurodevelopment at birth. We will measure PM2.5 and CO by real-time continuous monitoring and assess gestational age by ultrasound. This Indo-US collaboration will add to the body of knowledge on solid fuel use as a risk factor for birth outcome and infant neurodevelopment and serve as a first step for development of community-based interventions to lower associated disease burden. PUBLIC HEALTH RELEVANCE: Indoor air pollution from combustion of solid fuels for cooking has been identified as one of the ten most important risk factors in global burden of disease. This study will add to the body of knowledge on solid fuel use as a risk factor for birth outcome and infant neurodevelopment, and benefit from a well-established Indo- US collaboration among investigators with diverse and supplementary backgrounds while at the same time fostering technology transfer between the two partner institutions.