title: Impact of reduced maternal exposures to wood smoke from an introduced chimney stove on newborn birth weight in rural Guatemala.
abstract: BACKGROUND
  A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes, such as low birth weight (LBW), in resource-poor countries.
  
  
  OBJECTIVE
  We examined the effect of reduced wood smoke exposure in pregnancy on LBW of Guatemalan infants in RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects).
  
  
  METHODS
  Pregnant women (n = 266) either received a chimney stove (intervention) or continued to cook over an open fire (control). Between October 2002 and December 2004 we weighed 174 eligible infants (69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy) within 48 hr of birth. Multivariate linear regression and adjusted odds ratios (ORs) were used to estimate differences in birth weight and LBW (< 2,500 g) associated with chimney-stove versus open-fire use during pregnancy.
  
  
  RESULTS
  Pregnant women using chimney stoves had a 39% reduction in mean exposure to carbon monoxide compared with those using open fires. LBW prevalence was high at 22.4%. On average, infants born to mothers who used a stove weighed 89 g more [95% confidence interval (CI), -27 to 204 g] than infants whose mothers used open fires after adjusting for maternal height, diastolic blood pressure, gravidity, and season of birth. The adjusted OR for LBW was 0.74 (95% CI, 0.33-1.66) among infants of stove users compared with open-fire users. Average birth weight was 296 g higher (95% CI, 109-482 g) in infants born during the cold season (after harvest) than in other infants; this unanticipated finding may reflect the role of maternal nutrition on birth weight in an impoverished region.
  
  
  CONCLUSIONS
  A chimney stove reduced wood smoke exposures and was associated with reduced LBW occurrence. Although not statistically significant, the estimated effect was consistent with previous studies.
authors.affiliation: Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, USA. lisa.thompson@nursing.ucsf.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Thompson
authors.forename: Nigel
authors.initials: N
authors.lastname: Bruce
authors.forename: Brenda
authors.initials: B
authors.lastname: Eskenazi
authors.forename: Anaite
authors.initials: A
authors.lastname: Diaz
authors.forename: Daniel
authors.initials: D
authors.lastname: Pope
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects; D001724:Birth Weight / Q000187:drug effects*; D002248:Carbon Monoxide / Q000633:toxicity; D003296:Cooking; D005260:Female; D006166:Guatemala; D006801:Humans; D007231:Infant, Newborn; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy; D012906:Smoke / Q000009:adverse effects*; D014934:Wood; D055815:Young Adult
chemical_list: D012906:Smoke; D002248:Carbon Monoxide