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Matern Health Neonatol Perinatol. 2015 Jul 21;1:18. doi: 10.1186/s40748-015-0019-0. eCollection 2015.

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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Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India.
RTI International, Research Triangle Park, North Carolina, 27709 USA.
Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan.
KLE University's JN Medical College, Belgaum, Karnataka India.
Moi University School of Medicine, Eldoret, Kenya.
IMSALUD, San Carlos University, Guatemala City, Guatemala.
University Teaching Hospital, Lusaka, Zambia.
Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA.
Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA.
Department of OB-GYN, Christiana Care, Newark, DE 19718 USA.
Department of Pediatrics, University of Colorado, Aurora, CO 80045 USA.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA.
Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA.



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.


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).


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.



Cooking fuels; Household air pollution; Mortality; Neonatal; Perinatal

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