title: Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence.
abstract: BACKGROUND
  About 41% of households globally, mainly in developing countries rely on solid fuels for cooking with consequences for fetal growth and development. Previous reviews were limited in scope, assessing only two outcomes (birth weight, stillbirth). With important evidence accumulating, there is a need to improve the previous estimates and assess additional outcomes. We conducted a systematic review and meta-analysis to evaluate the quality and strength of available evidence on household air pollution (HAP) and the whole range of adverse pregnancy outcomes.
  
  
  METHODS
  PubMed, Ovid Medline, Scopus and CINAHL were searched from their inception to the end of April 2013. All epidemiological study designs were eligible for inclusion in the review. The random-effects model was applied in computing the summary-effect estimates (EE) and their corresponding 95% confidence interval (CI).
  
  
  RESULTS
  Of 1505 studies screened, 19 studies satisfied the inclusion criteria. Household combustion of solid fuels resulted in an 86.43 g (95% CI: 55.49, 117.37) reduction in birth weight, and a 35% (EE = 1.35, 95% CI: 1.23, 1.48) and 29% (EE = 1.29, 95% CI: 1.18, 1.41) increased risk of LBW and stillbirth respectively.
  
  
  CONCLUSIONS
  Combustion of solid fuels at home increases the risk of a wide range of adverse pregnancy outcomes. Access to clean household energy solutions is the surest way to combat HAP and mitigate their adverse effects.
authors.affiliation: Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Public Health, Department of Biomedical and Forensic Sciences, University of Cape Coast, Cape Coast, Ghana.
authors.forename: Adeladza K
authors.initials: AK
authors.lastname: Amegah
authors.affiliation: Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Reginald
authors.initials: R
authors.lastname: Quansah
authors.affiliation: Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Respiratory Medicine Unit, Oulu University Hospital, Oulu, Finland.
authors.forename: Jouni J K
authors.initials: JJ
authors.lastname: Jaakkola
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects*; D001724:Birth Weight; D036262:Empirical Research; D005260:Female; D005579:Fossil Fuels / Q000009:adverse effects*; D006801:Humans; D007230:Infant, Low Birth Weight; D011247:Pregnancy; D011256:Pregnancy Outcome; D017594:Publication Bias; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology
chemical_list: D005579:Fossil Fuels