Looking back to move forward: Lessons learned from the RESPIRE trial applied to the NACER study

摘要

Background: Few studies have examined the association between household air pollution (HAP) and low birth weight (LBW). Only one study directly measured prenatal carbon monoxide exposures among women enrolled in the RESPIRE randomized stove intervention trial. Aims:The NACER pilot study builds off our earlier experience and aims to: 1) measure personal exposures to carbon monoxide (CO), particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs) during pregnancy and the first year of infant life; and 2) collect standardized measures of infant weight, length and head circumference, newborn gestational age and infant neurodevelopment. Methods: Guatemalan, indigenous women were recruited through a rural Ministry of Health clinic at ＜ 20 weeks gestation and received prenatal health exams at ＜ 20, 24-28, and 32-36 weeks. Home visits were made 3 times during pregnancy to monitor prenatal HAP. Home visits were made within 48 hours of birth and at 1, 3, 6, 9, and 12 months to assess infant anthropometry and neurodevelopment using a validated 27-item instrument (Rapid Neurodevelopmental Assessment (RNDA)). Personal CO and PM exposures were measured using real time monitors and 5 gas-phase PAHs were measured using passive diffusion badges worn over a 48-hour period. Results: 37 pregnant women were enrolled. Gestational age was confirmed by fetal ultrasound (mean: 15.2 weeks, range 7-20.1). Eleven percent of households used open fires for cooking; 89% used deteriorated vented chimney stoves. Maternal and neonatal exposures to CO, PM2.5 and PAHs will be presented. 29% of infants were low birth weight (＜ 2,500 grams) and 6% were preterm (＜ 37 weeks). Among neonates, moderate/severe neurodevelopmental impairment were: fine motor (13%), gross motor (32%), speech (16%), cognition (32%), behavior (13%), vision (45%), hearing (39%), primitive reflexes (23%), and seizures (0). Conclusions: Maternal PM and CO exposures were significantly greater than neonatal exposures. LBW and moderate/severe neurodevelopmental impairment were both high. In a future, larger study we will measure the impact of maternal and neonatal HAP exposures on LBW, preterm delivery and infant neurodevelopmental impairment.