title: Does smoke from biomass fuel contribute to anemia in pregnant women in Nagpur, India? A cross-sectional study.
abstract: BACKGROUND
  Anemia affects upwards of 50% of pregnant women in developing countries and is associated with adverse outcomes for mother and child. We hypothesized that exposure to smoke from biomass fuel--which is widely used for household energy needs in resource-limited settings--could exacerbate anemia in pregnancy, possibly as a result of systemic inflammation.
  
  
  OBJECTIVE
  To evaluate whether exposure to smoke from biomass fuel (wood, straw, crop residues, or dung) as opposed to clean fuel (electricity, liquefied petroleum gas, natural gas, or biogas) is an independent risk factor for anemia in pregnancy, classified by severity.
  
  
  METHODS
  A secondary analysis was performed using data collected from a rural pregnancy cohort (N = 12,782) in Nagpur, India in 2011-2013 as part of the NIH-funded Maternal and Newborn Health Registry Study. Multinomial logistic regression was used to estimate the effect of biomass fuel vs. clean fuel use on anemia in pregnancy, controlling for maternal age, body mass index, education level, exposure to household tobacco smoke, parity, trimester when hemoglobin was measured, and receipt of prenatal iron and folate supplements.
  
  
  RESULTS
  The prevalence of any anemia (hemoglobin < 11 g/dl) was 93% in biomass fuel users and 88% in clean fuel users. Moderate-to-severe anemia (hemoglobin < 10 g/dl) occurred in 53% and 40% of the women, respectively. Multinomial logistic regression showed higher relative risks of mild anemia in pregnancy (hemoglobin 10-11 g/dl; RRR = 1.38, 95% CI = 1.19-1.61) and of moderate-to-severe anemia in pregnancy (RRR = 1.79, 95% CI = 1.53-2.09) in biomass fuel vs. clean fuel users, after adjusting for covariates.
  
  
  CONCLUSIONS
  In our study population, exposure to biomass smoke was associated with higher risks of mild and moderate-to-severe anemia in pregnancy, independent of covariates.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT 01073475.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Page
authors.affiliation: Lata Medical Research Foundation, Nagpur, Maharashtra, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America; Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, United States of America.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D000328:Adult; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D018533:Biomass; D003296:Cooking; D003430:Cross-Sectional Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007194:India / Q000453:epidemiology; D015999:Multivariate Analysis; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D012906:Smoke / Q000009:adverse effects*; D014934:Wood; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D012906:Smoke