title: Impact of biomass fuels on pregnancy outcomes in central East India.
abstract: BACKGROUND
  Smoke from biomass burning has been linked to reduced birth weight; association with other birth outcomes is poorly understood. Our objective was to evaluate effects of exposure to biomass smoke on birth weight, preterm birth and stillbirth.
  
  
  METHODS
  Information on household cooking fuel was available for secondary analysis from two cohorts of pregnant women enrolled at delivery in India (n = 1744). Birth weight was measured and the modified Ballard performed to assess gestational age. Linear and logistic regression models were used to explore associations between fuel and birth outcomes. Effect sizes were adjusted in multivariate models for socio-demographic characteristics using propensity score techniques and for medical/obstetric covariates.
  
  
  RESULTS
  Compared to women who use gas (n = 265), women cooking with wood (n = 1306) delivered infants that were on average 112 grams lighter (95% CI -170.1, -54.6) and more likely to be preterm (OR 3.11, 95% CI 2.12, 4.59). Stillbirths were also more common in the wood group (4% versus 0%, p < 0.001). In adjusted models, the association between wood use and birth weight was no longer significant (14 g reduction; 95% CI -93, 66); however, the increased odds for preterm birth persisted (aOR 2.29; 95% CI 1.24, 4.21). Wood fuel use did not increase the risk of delivering either a low birth weight or small for gestational age infant.
  
  
  CONCLUSIONS
  The association between wood fuel use and reduced birth weight was insignificant in multivariate models using propensity score techniques to account for socio-demographic differences. In contrast, we demonstrated a persistent adverse impact of wood fuel use on preterm delivery. If prematurity is confirmed as a consequence of antenatal exposure to household air pollution, perinatal morbidity and mortality from household air pollution may be higher than previously appreciated.
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, USA. bwylie@partners.org.
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Wylie
authors.forename: Brent A
authors.initials: BA
authors.lastname: Coull
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Mrigendra P
authors.initials: MP
authors.lastname: Singh
authors.forename: Darby
authors.initials: D
authors.lastname: Jack
authors.forename: Kojo
authors.initials: K
authors.lastname: Yeboah-Antwi
authors.forename: Lora
authors.initials: L
authors.lastname: Sabin
authors.forename: Neeru
authors.initials: N
authors.lastname: Singh
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D018533:Biomass; D001724:Birth Weight; D003296:Cooking / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D012044:Regression Analysis; D012906:Smoke / Q000009:adverse effects*; D014934:Wood; D055815:Young Adult
chemical_list: D012906:Smoke