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

描述（由申请人提供）：在通风不良的地区，在低效的炉灶中燃烧固体燃料会导致母亲大量暴露于一氧化碳（CO）和细颗粒物（PM2.5）中，这两种物质都会导致胎儿缺氧。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；而且没有证据表明室内吸烟与婴儿神经发育有关。许多研究使用烟雾暴露的间接测量方法和报告的健康结果测量方法，没有充分考虑混杂和相互作用。世卫组织建议，需要进行额外的高质量研究来确认风险估计，重点是对暴露和胎龄进行准确评估。在拟议的研究中，我们计划评估居住在斯里兰卡Gampaha地区的半城市人口中固体燃料使用与出生结果和婴儿神经发育之间的关系。目的是衡量问卷中固体燃料使用信息的准确性，以替代室内PM2.5和CO的测量水平，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）之间的关系，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，并通过超声评估胎龄。这种印美合作将增加关于固体燃料使用是出生结果和婴儿神经发育的风险因素的知识体系，并作为开发以社区为基础的干预措施以降低相关疾病负担的第一步。

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.