Title: Prenatal and Postnatal Household Air Pollution Exposures and Pneumonia Risk: Evidence From the Ghana Randomized Air Pollution and Health Study.

Authors: Kinney, Patrick L; Asante, Kwaku-Poku; Lee, Alison G; Ae-Ngibise, Kenneth A; Burkart, Katrin; Boamah-Kaali, Ellen; Twumasi, Mieks; Gyaase, Stephaney; Quinn, Ashlinn; Oppong, Felix B; Wylie, Blair J; Kaali, Seyram; Chillrud, Steven; Yawson, Abena; Jack, Darby W; Owusu-Agyei, Seth

Published In Chest, (2021 11)

Abstract: BACKGROUND: Nearly 40% of the world's population is exposed daily to household air pollution. The relative impact of prenatal and postnatal household air pollution exposure on early childhood pneumonia, a leading cause of mortality, is unknown. RESEARCH QUESTION: Are prenatal or postnatal household air pollution, or both, associated with pneumonia risk in the first year of life? STUDY DESIGN AND METHODS: The Ghana Randomized Air Pollution and Health Study enrolled 1,414 nonsmoking, pregnant women before 24 weeks' gestation with prospective follow-up to the child's age of 1 year. We measured 72-h personal household air pollution exposures, indexed by carbon monoxide (CO), four times prenatally and three times postnatally. Weekly fieldworker surveillance identified ill-appearing children for physician pneumonia assessment. We used quasi-Poisson models to examine associations between prenatal and postnatal CO and physician-diagnosed pneumonia and severe pneumonia. Sex-specific effects were examined. RESULTS: Of the 1,306 live births, 1,141 infants were followed up with 55,605 child-weeks of fieldworker surveillance. The estimated risk for pneumonia and severe pneumonia in the first year of life increased by 10% (relative risk [RR], 1.10; 95% CI, 1.04-1.16) and 15% (RR, 1.15; 95% CI, 1.03-1.28), respectively, per 1-part per million (ppm) increase in average prenatal CO exposure and by 6% (RR, 1.06; 95% CI, 0.99-1.13) per 1-ppm increase in average postnatal CO exposure. Sex-stratified analyses suggest that in girls, higher prenatal CO exposure was associated with pneumonia risk, while no association was seen in boys. INTERPRETATION: Prenatal household air pollution exposure increased risk of pneumonia and severe pneumonia in the first year of life. Clean-burning interventions may be most effective when begun prenatally. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01335490; URL: www.clinicaltrials.gov.

PubMed ID: 34298005

MeSH Terms: Air Pollution, Indoor*/adverse effects; Air Pollution, Indoor*/analysis; Air Pollution, Indoor*/prevention & control; Carbon Monoxide/analysis*; Environmental Exposure*/adverse effects; Environmental Exposure*/analysis; Environmental Exposure*/prevention & control; Female; Ghana; Household Articles/standards*; Humans; Infant; Infant Health*/standards; Infant Health*/statistics & numerical data; Male; Needs Assessment; Particulate Matter/analysis; Perinatal Care/methods; Perinatal Care/statistics & numerical data; Pneumonia*/diagnosis; Pneumonia*/epidemiology; Pneumonia*/prevention & control; Pregnancy; Preventive Health Services/methods; Preventive Health Services/organization & administration; Risk Assessment; Rural Health