title: Association of Carbon Monoxide exposure with blood pressure among pregnant women in rural Ghana: Evidence from GRAPHS.
abstract: OBJECTIVE
  The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a community-level randomized-controlled trial of cookstove interventions for pregnant women and their newborns in rural Ghana. Given that household air pollution from biomass burning may be implicated in adverse cardiovascular outcomes, we sought to determine whether exposure to carbon monoxide (CO) from woodsmoke was associated with blood pressure (BP) among 817 adult women.
  
  
  METHODS
  Multivariate linear regression models were used to evaluate the association between CO exposure, determined with 72 hour personal monitoring at study enrollment, and BP, also measured at study enrollment. At the time of these assessments, women were in the first or second trimester of pregnancy.
  
  
  RESULTS
  A significant positive association was found between CO exposure and diastolic blood pressure (DBP): on average, each 1 ppm increase in exposure to CO was associated with 0.43 mmHg higher DBP [0.01, 0.86]. A non-significant positive trend was also observed for systolic blood pressure (SBP).
  
  
  CONCLUSIONS
  This study is one of very few to have examined the relationship between household air pollution and blood pressure among pregnant women, who are at particular risk for hypertensive complications. The results of this cross-sectional study suggest that household air pollution from wood-burning fires is associated with higher blood pressure, particularly DBP, in pregnant women at early to mid-gestation. The clinical implications of the observed association toward the eventual development of chronic hypertension and/or hypertensive complications of pregnancy remain uncertain, as few of the women were overtly hypertensive at this point in their pregnancies.
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: aquinn@columbia.edu.
authors.forename: Ashlinn K
authors.initials: AK
authors.lastname: Quinn
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Kenneth Ayuurebobi
authors.initials: KA
authors.lastname: Ae-Ngibise
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Darby W
authors.initials: DW
authors.lastname: Jack
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Ellen Abrafi
authors.initials: EA
authors.lastname: Boamah
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Yeetey
authors.initials: Y
authors.lastname: Enuameh
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Mohammed Nuhu
authors.initials: MN
authors.lastname: Mujtaba
authors.affiliation: Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Chillrud
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Wylie
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Kinney
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects*; D002248:Carbon Monoxide / Q000009:adverse effects* / Q000032:analysis; D003296:Cooking; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006798:Housing; D006801:Humans; D011247:Pregnancy; D012424:Rural Population; D012906:Smoke; D014934:Wood; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D012906:Smoke; D002248:Carbon Monoxide
keywords: Biomass; Blood pressure; Cardiovascular disease; Cookstoves; Household air pollution; Pregnancy