title: Effect of a clean stove intervention on inflammatory biomarkers in pregnant women in Ibadan, Nigeria: A randomized controlled study.
abstract: Exposure to household air pollution (HAP) has been linked to systemic inflammation. We determined the impact of transition from traditional firewood/kerosene stove to bioethanol-burning stove on inflammatory biomarkers in pregnant Nigerian women.
  
  
  
  Women (n=324), cooking with kerosene/firewood, were recruited during their first trimester of pregnancy from June 2013-October 2015 and were randomly allocated to either control (n=162) or intervention (n=162) group using web-based randomization. Controls continued to use their own firewood/kerosene stove, while intervention participants received bioethanol CleanCook stoves. Serum concentrations of retinol-binding protein (RBP), malondialdehyde (MDA), tumor necrosis factor alpha (TNF)-α, interleukin (IL)-6, and IL-8 were measured by ELISA.
  
  
  
  After excluding 53 women (loss of follow-up, untimely biomarker assessments, incorrect dates of enrollment), data from 271 women were included in analysis. Mean (SD) change in RBP, MDA, TNF-α, IL-6, and IL-8 between baseline and third trimester was -2.16 (4.47), -19.6 (46.4), 3.72 (37.2), 0.51 (14.4), and 13.2 (197), respectively, in intervention and -2.25 (4.30), -24.6 (43.6), 7.17 (32.6), -1.79, (11.4), and 31.3 (296) in control groups. None of these changes differed significantly between the two treatment arms. However, changes from baseline in TNF-α levels were significantly different between intervention and control groups in subset of women (n=99) using firewood before trial (-7.03 [32.9] vs. +12.4 [33.6]; 95% CI for group difference: -35.4 to -3.4, p=0.018).
  
  
  
  Decrease in TNF-α concentration from baseline to third trimesters in intervention group women could indicate reduced cardiovascular stress and prothrombotic effects from decreased HAP. Our findings suggest that ethanol-burning stoves may mitigate cardiovascular health risks.
authors.affiliation: Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6076, Chicago, IL 60637, USA. Electronic address: solopade@bsd.uchicago.edu.
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Olopade
authors.affiliation: Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Frank
authors.affiliation: Pritzker School of Medicine, University of Chicago, 924 East 57th Street, Suite 104, Chicago, IL 60637, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Bartlett
authors.affiliation: Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA.
authors.forename: Donee
authors.initials: D
authors.lastname: Alexander
authors.affiliation: Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6076, Chicago, IL 60637, USA.
authors.forename: Anindita
authors.initials: A
authors.lastname: Dutta
authors.affiliation: Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria.
authors.forename: Tope
authors.initials: T
authors.lastname: Ibigbami
authors.affiliation: Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria.
authors.forename: Damilola
authors.initials: D
authors.lastname: Adu
authors.affiliation: Healthy Life for All Foundation, House 38, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria.
authors.forename: John
authors.initials: J
authors.lastname: Olamijulo
authors.affiliation: College of Medicine, University College Hospital, Ibadan, Nigeria.
authors.forename: Ganiyu
authors.initials: G
authors.lastname: Arinola
authors.affiliation: Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC2000, Chicago, IL 60637, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Karrison
authors.affiliation: Department of Obstetrics and Gynecology, University College Hospital Campus, University of Ibadan, Oyo State, Ibadan, Nigeria.
authors.forename: Oladosu
authors.initials: O
authors.lastname: Ojengbede
mesh_terms: D000293:Adolescent; D000328:Adult; D000397:Air Pollution; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000517:prevention & control*; D056804:Biofuels; D015415:Biomarkers / Q000097:blood*; D003296:Cooking / Q000295:instrumentation*; D000431:Ethanol; D005260:Female; D006794:Household Articles; D006795:Household Products; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology; D015850:Interleukin-6; D007648:Kerosene; D009549:Nigeria; D018384:Oxidative Stress; D011247:Pregnancy; D037841:Pregnant People / Q000208:ethnology; D055815:Young Adult
chemical_list: D056804:Biofuels; D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D007648:Kerosene; D000431:Ethanol
keywords: Bio-ethanol; Cleancook stove; Cytokines; Nigeria; Pregnant women; Systemic inflammation