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Christensen GM, Marcus M, Vanker A, Eick SM, Malcolm-Smith S, Smith ADAC, Dunn EC, Suglia SF, Chang HH, Zar HJ, Stein DJ, Hüls A. Sensitive periods for exposure to indoor air pollutants and psychosocial factors in association with symptoms of psychopathology at school-age in a South African birth cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.08.23293825. [PMID: 37609236 PMCID: PMC10441486 DOI: 10.1101/2023.08.08.23293825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Gestation and the first few months of life are important periods for brain development. During these periods, exposure to environmental toxicants and psychosocial stressors are particularly harmful and may impact brain development. Specifically, exposure to indoor air pollutants (IAP) and psychosocial factors (PF) during these sensitive periods has been shown to predict childhood psychopathology. Objectives This study aims to investigate sensitive periods for the individual and joint effects of IAP and PF on childhood psychopathology at 6.5 years. Methods We analyzed data from the Drakenstein Child Health Study (N=599), a South African birth cohort. Exposure to IAP and PF was measured during the second trimester of pregnancy and 4 months postpartum. The outcome of childhood psychopathology was assessed at 6.5 years old using the Childhood Behavior Checklist (CBCL). We investigated individual effects of either pre-or postnatal exposure to IAP and PF on CBCL scores using adjusted linear regression models, and joint effects of these exposures using quantile g-computation and self-organizing maps (SOM). To identify possible sensitive periods, we used a structured life course modeling approach (SLCMA) as well as exposure mixture methods (quantile g-computation and SOM). Results Prenatal exposure to IAP or PFs, as well as the total prenatal mixture assessed using quantile g-computation, were associated with increased psychopathology. SLCMA and SOM models also indicated that the prenatal period is a sensitive period for IAP exposure on childhood psychopathology. Depression and alcohol were associated in both the pre-and postnatal period, while CO was associated with the postnatal period. Discussion Pregnancy may be a sensitive period for the effect of indoor air pollution on childhood psychopathology. Exposure to maternal depression and alcohol in both periods was also associated with psychopathology. Determining sensitive periods of exposure is vital to ensure effective interventions to reduce childhood psychopathology.
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Christensen GM, Marcus M, Vanker A, Eick SM, Malcolm-Smith S, Suglia SF, Chang HH, Zar HJ, Stein DJ, Hüls A. Joint Effects of Indoor Air Pollution and Maternal Psychosocial Factors During Pregnancy on Trajectories of Early Childhood Psychopathology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.07.23288289. [PMID: 37066323 PMCID: PMC10104216 DOI: 10.1101/2023.04.07.23288289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Prenatal indoor air pollution and maternal psychosocial factors have been associated with adverse psychopathology. We used environmental exposure mixture methodology to investigate joint effects of both exposure classes on child behavior trajectories. Methods For 360 children from the South African Drakenstein Child Health Study, we created trajectories of Child Behavior Checklist scores (24, 42, 60 months) using latent class linear mixed effects models. Indoor air pollutants and psychosocial factors were measured during pregnancy (2 nd trimester). After adjusting for confounding, single-exposure effects (per natural log-1 unit increase) were assessed using polytomous logistic regression models; joint effects using self-organizing maps (SOM), and principal component (PC) analysis. Results High externalizing trajectory was associated with increased particulate matter (PM 10 ) exposure (OR [95%-CI]: 1.25 [1.01,1.55]) and SOM exposure profile most associated with smoking (2.67 [1.14,6.27]). Medium internalizing trajectory was associated with increased emotional intimate partner violence (2.66 [1.17,5.57]), increasing trajectory with increased benzene (1.24 [1.02,1.51]) and toluene (1.21 [1.02,1.44]) and the PC most correlated with benzene and toluene (1.25 [1.02, 1.54]). Conclusions Prenatal exposure to environmental pollutants and psychosocial factors was associated with internalizing and externalizing child behavior trajectories. Understanding joint effects of adverse exposure mixtures will facilitate targeted interventions to prevent childhood psychopathology.
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Luo M, Liu T, Ma C, Fang J, Zhao Z, Wen Y, Xia Y, Zhao Y, Ji C. Household polluting cooking fuels and adverse birth outcomes: An updated systematic review and meta-analysis. Front Public Health 2023; 11:978556. [PMID: 36935726 PMCID: PMC10020710 DOI: 10.3389/fpubh.2023.978556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background and aim The current study aimed to clarify the association between household polluting cooking fuels and adverse birth outcomes using previously published articles. Methods In this systematic review and meta-analysis, a systematic literature search in PubMed, Embase, Web of Science, and Scopus databases were undertaken for relevant studies that had been published from inception to 16 January 2023. We calculated the overall odds ratio (OR) and 95% confidence interval (CI) for adverse birth outcomes [low birth weight (LBW), small for gestational age (SGA), stillbirth, and preterm birth (PTB)] associated with polluting cooking fuels (biomass, coal, and kerosene). Subgroup analysis and meta-regression were also conducted. Results We included 16 cross-sectional, five case-control, and 11 cohort studies in the review. Polluting cooking fuels were found to be associated with LBW (OR: 1.37, 95% CI: 1.24, 1.52), SGA (OR: 1.48, 95% CI: 1.13, 1.94), stillbirth (OR: 1.38, 95% CI: 1.23, 1.55), and PTB (OR: 1.27, 95% CI: 1.19, 1.36). The results of most of the subgroup analyses were consistent with the main results. In the meta-regression of LBW, study design (cohort study: P < 0.01; cross-sectional study: P < 0.01) and sample size (≥ 1000: P < 0.01) were the covariates associated with heterogeneity. Cooking fuel types (mixed fuel: P < 0.05) were the potentially heterogeneous source in the SGA analysis. Conclusion The use of household polluting cooking fuels could be associated with LBW, SGA, stillbirth, and PTB. The limited literature, observational study design, exposure and outcome assessment, and residual confounding suggest that further strong epidemiological evidence with improved and standardized data was required to assess health risks from particular fuels and technologies utilized.
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Affiliation(s)
- Mengrui Luo
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tiancong Liu
- Department of Otorhinolaryngology - Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Changcheng Ma
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianwei Fang
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhiying Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Wen
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yuhong Zhao
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Chao Ji
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Wu M, Williams GJ, Chen G, Zhang L, Hu C, Dai X, Du W, Hua J. Prenatal second-hand smoke exposure and the risk of suspected developmental coordination disorder in preschoolers: A nationwide retrospective cohort study in China. Front Public Health 2022; 10:993471. [PMID: 36438244 PMCID: PMC9686837 DOI: 10.3389/fpubh.2022.993471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Prenatal exposure to second-hand smoke (SHS) is associated with increased neurodevelopmental problems in children, however, its impact on the risk of developmental coordination disorder (DCD) in preschoolers have not been studied thoroughly. Herein, we probed this association based on a nationwide retrospective cohort study of 149,005 preschoolers in China. We divided the objects into the prenatal SHS-exposed group or the no prenatal smoke exposed group (NS-exposed group). Preschoolers were assessed for motor proficiency by the Chinese version of Little Developmental Coordination Disorder Questionnaire (LDCDQ). Multivariable logistic regression was used to evaluate the associations. The prevalence of prenatal SHS exposure was 23.89%. Generally, the prevalence of suspected DCD was significantly higher in prenatal SHS-exposed group (16.38% VS. 14.19%, P < 0.001). With the increase of age, the mean total scores of LDCDQ of both boys and girls increased gradually; and the prevalence of suspected DCD in girls was higher than that in boys in the same age group. After adjusting for covariates, prenatal SHS exposure had the negative association with the total score of LDCDQ and increased the risk of suspected DCD. Our results suggest a need for interventions designed to reduce maternal SHS exposure during pregnancy, early screen for DCD and increase targeted movement and coordination skill training for vulnerable children.
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Affiliation(s)
- Meiqin Wu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gareth J. Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Guixia Chen
- Department of Children Healthcare, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Lan Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunping Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaotian Dai
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom,*Correspondence: Wenchong Du
| | - Jing Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China,Jing Hua
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Yue H, Yang X, Wu X, Geng X, Ji X, Li G, Sang N. Maternal NO 2 exposure disturbs the long noncoding RNA expression profile in the lungs of offspring in time-series patterns. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 246:114140. [PMID: 36209526 DOI: 10.1016/j.ecoenv.2022.114140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Gestation is a sensitive window to nitrogen dioxide (NO2) exposure, which may disturb fetal lung development and lung function later in life. Animal and epidemiological studies indicated that long noncoding RNAs (lncRNAs) participate in abnormal lung development induced by environmental pollutant exposure. In the present study, pregnant C57BL/6J mice were exposed to 2.5 ppm NO2 (mimicking indoor occupational exposure) or clean air, and lncRNAs expression profiles in the lungs of offspring mice were determined by lncRNA-seq on embryonic day 13.5 (E13.5), E18.5, postnatal day 1 (P1), and P14. The lung histopathology examination of offspring was performed, followed by weighted gene coexpression network analysis (WGCNA), prediction of lncRNAs-target genes, and the biological processes enrichment analysis of lncRNAs. Our results indicated that maternal NO2 exposure induced hypoalveolarization on P14 and differentially expressed lncRNAs showed a time-series pattern. Following WGCNA and enrichment analysis, 2 modules participated in development-related pathways. Importantly, the expressions of related genes were altered, some of which were confirmed to be related to abnormal vascular development and even lung diseases. The research points out that the maternal NO2 exposure leads to abnormal lung development in offspring that might be related to altered lncRNAs expression profiles with time-series-pattern.
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Affiliation(s)
- Huifeng Yue
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Xiaowen Yang
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Xiaoyun Wu
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Xilin Geng
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Xiaotong Ji
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China.
| | - Guangke Li
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Nan Sang
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
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Morakinyo OM, Mokgobu MI. Indoor Household Exposures and Associated Morbidity and Mortality Outcomes in Children and Adults in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159471. [PMID: 35954827 PMCID: PMC9367742 DOI: 10.3390/ijerph19159471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
Human exposure to indoor pollution is one of the most well-established ways that housing affects health. We conducted a review to document evidence on the morbidity and mortality outcomes associated with indoor household exposures in children and adults in South Africa. The authors conducted a scientific review of the publicly available literature up to April 2022 using different search engines (PubMed, ProQuest, Science Direct, Scopus and Google Scholar) to identify the literature that assessed the link between indoor household exposures and morbidity and mortality outcomes in children and adults. A total of 16 studies with 16,920 participants were included. Bioaerosols, allergens, dampness, tobacco smoking, household cooking and heating fuels, particulate matter, gaseous pollutants and indoor spray residue play a significant role in different morbidity outcomes. These health outcomes include dental caries, asthma, tuberculosis, severe airway inflammation, airway blockage, wheeze, rhinitis, bronchial hyperresponsiveness, phlegm on the chest, current rhinoconjunctivitis, hay fever, poor early life immune function, hypertensive disorders of pregnancy, gestational hypertension, and increased incidence of nasopharyngeal bacteria, which may predispose people to lower respiratory tract infections. The findings of this research highlight the need for more initiatives, programs, strategies, and policies to better reduce the negative consequences of indoor household exposures.
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Affiliation(s)
- Oyewale Mayowa Morakinyo
- Department of Environmental Health, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa;
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200284, Nigeria
- Correspondence:
| | - Matlou Ingrid Mokgobu
- Department of Environmental Health, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa;
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Quiñones Z, Li D, McIntosh S, Avendaño E, Sánchez JJ, DiMare-Hering C, Flores-Golfin D, Wang S, Pérez-Ramos JG, Dye TDV, Ossip DJ. Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras. Nicotine Tob Res 2022; 24:909-913. [PMID: 35084495 PMCID: PMC9048917 DOI: 10.1093/ntr/ntac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras. METHODS Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings. RESULTS Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes. CONCLUSIONS SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations. IMPLICATIONS The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.
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Affiliation(s)
- Zahira Quiñones
- Escuela de Medicina, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago de los Caballeros, Santiago, Dominican Republic
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Dongmei Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Scott McIntosh
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Esteban Avendaño
- Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - José Javier Sánchez
- Escuela de Medicina, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago de los Caballeros, Santiago, Dominican Republic
| | - Carmen DiMare-Hering
- Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Daniel Flores-Golfin
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Sijiu Wang
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL, USA
| | - José G Pérez-Ramos
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy D V Dye
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah J Ossip
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
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Sun J, Wang J, Yang J, Shi X, Li S, Cheng J, Chen S, Sun K, Wu Y. Association between maternal exposure to indoor air pollution and offspring congenital heart disease: a case–control study in East China. BMC Public Health 2022; 22:767. [PMID: 35428227 PMCID: PMC9013107 DOI: 10.1186/s12889-022-13174-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous research suggested an association between maternal exposure to ambient air pollutants and the risk of congenital heart disease (CHD). However, the effect of individual prenatal exposure to indoor air pollutants on CHD occurrence was not reported. Methods We performed a hospital-based case–control study to investigate the association between personal air pollution exposure during pregnancy and the risk of CHD in offspring. A total of 44 cases and 75 controls were included from two hospitals in East China. We investigated maternal and residential environmental characteristics using a questionnaire and obtained personal indoor air samples to assess particulate matter (PM) and volatile organic compounds (VOCs) from 22–30 gestational weeks. Formaldehyde, benzene, toluene, xylene, total volatile organic compounds (TVOCs), PM2.5, and PM10 were assessed. Logistic regression was performed to assess associations and interactions between individual indoor air pollutants and CHD after adjusting for confounders. The potential residential environmental factors affecting the risks of indoor air pollutants on CHD were also assessed. Results Median TVOC (0.400 vs. 0.005 mg/m3, P < 0.001) exposure levels in cases were significantly higher than controls. A logistic regression model adjusted for confounders revealed that exposure to high levels of indoor TVOCs (AOR 7.09, 95% CI 2.10–23.88) during pregnancy was associated with risks for CHD and the occurrence of some major CHD subtype in offspring. These risk effects were enhanced in pregnant women living in a newly renovated house but were mitigated by household use of smoke ventilators when cooking. We observed a positive interaction of maternal exposure to TVOCs and PM2.5 and the risk for CHD. Conclusions Maternal exposure to indoor VOCs and PMs may increase the risk of giving birth to foetuses with CHD. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13174-0.
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Sharma T, Khapre M. Exposure of second hand smoke in women and children: A narrative review. J Family Med Prim Care 2021; 10:1804-1807. [PMID: 34195106 PMCID: PMC8208198 DOI: 10.4103/jfmpc.jfmpc_1397_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/17/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.
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Affiliation(s)
- Twinkle Sharma
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
| | - Meenakshi Khapre
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
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Shezi B, Jafta N, Naidoo RN. Exposure assessment of indoor particulate matter during pregnancy: a narrative review of the literature. REVIEWS ON ENVIRONMENTAL HEALTH 2020; 35:427-442. [PMID: 32598324 DOI: 10.1515/reveh-2020-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this review was to summarize the evidence of the exposure assessment approaches of indoor particulate matter (PM) during pregnancy and to recommend future focus areas. CONTENT Exposure to indoor PM during pregnancy is associated with adverse birth outcomes. However, many questions remain about the consistency of the findings and the magnitude of this effect. This may be due to the exposure assessment methods used and the challenges of characterizing exposure during pregnancy. Exposure is unlikely to remain constant over the nine-month period. Pregnant females' mobility and activities vary - for example, employment status may be random among females, but among those employed, activities are likely to be greater in the early pregnancy than closer to the delivery of the child. SUMMARY Forty three studies that used one of the five categories of indoor PM exposure assessment (self-reported, personal air monitoring, household air monitoring, exposure models and integrated approaches) were assessed. Our results indicate that each of these exposure assessment approaches has unique characteristics, strengths, and weaknesses. While questionnaires and interviews are based on self-report and recall, they were a major component in the reviewed exposure assessment studies. These studies predominantly used large sample sizes. Precision and detail were observed in studies that used integrated approaches (i. e. questionnaires, measurements and exposure models). OUTLOOK Given the limitations presented by these studies, exposure misclassification remains possible because of personal, within and between household variability, seasonal changes, and spatiotemporal variability during pregnancy. Therefore, using integrated approaches (i. e. questionnaire, measurements and exposure models) may provide better estimates of PM levels across trimesters. This may provide precision for exposure estimates in the exposure-response relationship.
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Affiliation(s)
- Busisiwe Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, Environment and Health Research Unit, Durban, South Africa
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103744. [PMID: 32466270 PMCID: PMC7277525 DOI: 10.3390/ijerph17103744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023]
Abstract
The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants' health.
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Woolley K, Bartington SE, Pope FD, Price MJ, Thomas GN, Kabera T. Biomass cooking carbon monoxide levels in commercial canteens in Kigali, Rwanda. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:75-85. [PMID: 32400286 DOI: 10.1080/19338244.2020.1761279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carbon monoxide (CO) is harmful to human health, yet there is limited evidence concerning emissions associated with biomass fuel cooking in occupational settings. Real-time 48-hour monitoring of CO concentrations at breathing height, was undertaken in staff and student kitchen and serving areas of two commercial canteens. We characterized two diurnal CO peaks coinciding with cooking activities. Peak CO concentrations of 255.5 ppm and 1-hour average of 76.3 ppm (IQR: 57.8-109.0 ppm) were observed in the student kitchen; the staff kitchen levels were 208.5 ppm, and 76.3 ppm (IQR: 52.5-114.0 ppm), respectively. High magnitude CO concentrations (8-hour average: 40.7 ppm SD: 40.0 ppm) which exceed World Health Organisation (WHO) Indoor Air Quality standards were observed. Further investigation of personal exposure and health impacts among kitchen staff is required, to inform interventions in this setting.
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Affiliation(s)
- Katherine Woolley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Telesphore Kabera
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
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Lu C, Zhang W, Zheng X, Sun J, Chen L, Deng Q. Combined effects of ambient air pollution and home environmental factors on low birth weight. CHEMOSPHERE 2020; 240:124836. [PMID: 31561165 DOI: 10.1016/j.chemosphere.2019.124836] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Low birth weight (LBW) remains a major public health problem worldwide, yet its crucial environmental risk factors are still unclear. OBJECTIVE To examine the association between LBW (term and preterm LBW) and prenatal exposure to ambient air pollution and home environmental factors as well as their combination, in order to identify critical time window for exposure and key outdoor and indoor factors in LBW development. METHODS A cohort study of 3509 preschool children was performed in Changsha, China during the period 2011-2012. A questionnaire was conducted to survey each child's birth outcome and each mother's exposure to home environmental factors including parental smoking, new furniture, redecoration, mold/damp stains, window pane condensation, and household pets during pregnancy. Maternal exposure to inhalable particulate matter (PM10), industrial air pollutant (SO2), and traffic air pollutant (NO2) was estimated during different time windows of gestation, including conception month, three trimesters, birth month, and whole gestation. Associations of term and preterm LBW with ambient air pollutants and home environmental factors were assessed by multiple logistic regression models in terms of odds ratio (OR) with 95% confidence interval (CI). RESULTS Term LBW (TLBW) was significantly associated with exposure to ambient PM10 during pregnancy, with OR (95% CI) = 1.47 (1.00-2.14) for per IQR increase after adjustment for the covariates and home environmental factors. Specifically, we identified the significant association in early phase of pregnancy including conception month (1.90, 1.09-3.30) and the first trimester (1.72, 1.10-2.69). We further found that TLBW was significantly related with parental smoking at home, OR (95% CI) = 2.17 (1.09-4.33). However, no association was observed for preterm LBW (PLBW). The TLBW risk of ambient air pollution and home environmental factors was independent each other and hence the combined exposure to ambient PM10 and indoor parental smoking caused the highest risk. Sensitivity analysis suggested that foetus with younger mothers were significantly more susceptible to risk of indoor parental smoking, while those with smaller house and cockroaches were more sensitive to risk of outdoor PM10 exposure. CONCLUSION Prenatal exposure to combined outdoor and indoor air pollution, particularly in critical window(s) during early pregnancy, significantly increases the risk of term LBW.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China; Hunan Engineering Research Center of Early Life Development and Disease Prevention, XiangYa Hospital, Central South University, Changsha, China.
| | - Weishe Zhang
- Hunan Engineering Research Center of Early Life Development and Disease Prevention, XiangYa Hospital, Central South University, Changsha, China; Department of Obstetrics, XiangYa Hospital, Central South University, Changsha, China
| | - Xiangrong Zheng
- Department of Pediatrics, XiangYa Hospital, Central South University, Changsha, China
| | - Jingchi Sun
- Department of Obstetrics, XiangYa Hospital, Central South University, Changsha, China
| | - Lv Chen
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, China; Hunan Engineering Research Center of Early Life Development and Disease Prevention, XiangYa Hospital, Central South University, Changsha, China; School of Architecture and Art, Central South University, Changsha, China.
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Gioda A, Tonietto GB, Leon APD. Exposure to the use of firewood for cooking in Brazil and its relation with the health problems of the population. CIENCIA & SAUDE COLETIVA 2019; 24:3079-3088. [PMID: 31389554 DOI: 10.1590/1413-81232018248.23492017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Indoor air pollution is exacerbated by the burning of firewood in rustic stoves and poorly ventilated environments. Exposure to the pollutants emitted by this type of fuel results in increased morbidity and mortality. In Brazil, studies and estimates regarding these conditions are scarce. In order to understand this problem, the objective of this work was to investigate the use of firewood using the data series of government agencies to estimate the number of exposed people. The results indicated that firewood is the second most used fuel for cooking, being used by a significant portion of the population, more than 30 million Brazilians. A decisive factor in the increased use of this fuel is the socioeconomic level of the population associated with the price of liquefied petroleum gas (LPG). The studies carried out in the country recorded high concentrations of particles during firewood burning, exceeding the limits suggested by the World Health Organization (WHO). Associations were also observed between the exposure to the pollutants generated by the burning and the aggravation of health problems, among them respiratory diseases and cancer. Replacing fuelwood and other solid fuels with cleaner fuels should be the government's goal to minimize health costs.
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Affiliation(s)
- Adriana Gioda
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro. R. Marquês de São Vicente 225, Gávea. 22451-900 Rio de Janeiro RJ Brasil.
| | - Gisele Birman Tonietto
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro. R. Marquês de São Vicente 225, Gávea. 22451-900 Rio de Janeiro RJ Brasil.
| | - Antonio Ponce de Leon
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Junaid M, Syed JH, Abbasi NA, Hashmi MZ, Malik RN, Pei DS. Status of indoor air pollution (IAP) through particulate matter (PM) emissions and associated health concerns in South Asia. CHEMOSPHERE 2018; 191:651-663. [PMID: 29078189 DOI: 10.1016/j.chemosphere.2017.10.097] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
Exposure to particulate emissions poses a variety of public health concerns worldwide, specifically in developing countries. This review summarized the documented studies on indoor particulate matter (PM) emissions and their major health concerns in South Asia. Reviewed literature illustrated the alarming levels of indoor air pollution (IAP) in India, Pakistan, Nepal, and Bangladesh, while Sri Lanka and Bhutan are confronted with relatively lower levels, albeit not safe. To our knowledge, data on this issue are absent from Afghanistan and Maldives. We found that the reported levels of PM10 and PM2.5 in Nepal, Pakistan, Bangladesh, and India were 2-65, 3-30, 4-22, 2-28 and 1-139, 2-180, 3-77, 1-40 fold higher than WHO standards for indoor PM10 (50 μg/m3) and PM2.5 (25 μg/m3), respectively. Regarding IAP-mediated health concerns, mortality rates and incidences of respiratory and non-respiratory diseases were increasing with alarming rates, specifically in India, Pakistan, Nepal, and Bangladesh. The major cause might be the reliance of approximately 80% population on conventional biomass burning in the region. Current review also highlighted the prospects of IAP reduction strategies, which in future can help to improve the status of indoor air quality and public health in South Asia.
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Affiliation(s)
- Muhammad Junaid
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China; University of Chinese Academy of Sciences, Beijing, 100049, China; Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Jabir Hussain Syed
- Department of Meteorology, COMSATS University, Islamabad Campuses, Pakistan; Department of Civil and Environmental Engineering, Hong Kong Polytechnic University, Hong Kong
| | - Naeem Akhtar Abbasi
- Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | | | - Riffat Naseem Malik
- Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, 45320, Pakistan.
| | - De-Sheng Pei
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China.
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Abstract
Importance Travel among US citizens is becoming increasingly common, and travel during pregnancy is also speculated to be increasingly common. During pregnancy, the obstetric provider may be the first or only clinician approached with questions regarding travel. Objective In this review, we discuss the reasons women travel during pregnancy, medical considerations for long-haul air travel, destination-specific medical complications, and precautions for pregnant women to take both before travel and while abroad. To improve the quality of pretravel counseling for patients before or during pregnancy, we have created 2 tools: a guide for assessing the pregnant patient's risk during travel and a pretravel checklist for the obstetric provider. Evidence Acquisition A PubMed search for English-language publications about travel during pregnancy was performed using the search terms "travel" and "pregnancy" and was limited to those published since the year 2000. Studies on subtopics were not limited by year of publication. Results Eight review articles were identified. Three additional studies that analyzed data from travel clinics were found, and 2 studies reported on the frequency of international travel during pregnancy. Additional publications addressed air travel during pregnancy (10 reviews, 16 studies), high-altitude travel during pregnancy (5 reviews, 5 studies), and destination-specific illnesses in pregnant travelers. Conclusions and Relevance Travel during pregnancy including international travel is common. Pregnant travelers have unique travel-related and destination-specific risks. We review those risks and provide tools for obstetric providers to use in counseling pregnant travelers.
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Rey-Ares L, Irazola V, Althabe F, Sobrino E, Mazzoni A, Serón P, Lanas F, Calandreli M, Rubinstein A. Lower tract respiratory infection in children younger than 5 years of age and adverse pregnancy outcomes related to household air pollution in Bariloche (Argentina) and Temuco (Chile). INDOOR AIR 2016; 26:964-975. [PMID: 26615053 PMCID: PMC4884553 DOI: 10.1111/ina.12274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
The main objective of this study was to evaluate the association between household air pollution with lower tract respiratory infection (LRTI) in children younger than 5 years old and adverse pregnancy outcomes. This retrospective cohort study took place in two cities in Patagonia. Using systemic random sampling, we selected households in which at least one child <5 years had lived and/or a child had been born alive or stillborn. Trained interviewers administered the questionnaire. We included 926 households with 695 pregnancies and 1074 children. Household cooking was conducted indoors in ventilated rooms and the use of wood as the principal fuel for cooking was lower in Temuco (13% vs. 17%). In exposed to biomass fuel use, the adjusted OR for LRTI was 1.87 (95% CI 0.98-3.55; P = 0.056) in Temuco and 1.12 (95% CI 0.61-2.05; P = 0.716) in Bariloche. For perinatal morbidity, the OR was 3.11 (95% CI 0.86-11.32; P = 0.084) and 1.41 (95% CI 0.50-3.97; P = 0.518), respectively. However, none of the effects were statistically significant (P > 0.05). The use of biomass fuel to cook in traditional cookstoves in ventilated dwellings may increase the risk of perinatal morbidity and LRTI.
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Affiliation(s)
- L Rey-Ares
- Southern Cone American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
| | - V Irazola
- Southern Cone American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
| | - F Althabe
- Maternal and Child's Health Department, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
| | - E Sobrino
- Southern Cone American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
| | - A Mazzoni
- Maternal and Child's Health Department, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
| | - P Serón
- CIGES, Universidad de la Frontera, Temuco, Araucanía, Chile
| | - F Lanas
- CIGES, Universidad de la Frontera, Temuco, Araucanía, Chile
| | - M Calandreli
- Cardiología, Sanatorio San Carlos, San Carlos de Bariloche, Rio Negro, Argentina
| | - A Rubinstein
- Southern Cone American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy - IECS, Buenos Aires, Argentina
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Firoz T, Vidler M, Makanga PT, Boene H, Chiaú R, Sevene E, Magee LA, von Dadelszen P, Munguambe K. Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study. Reprod Health 2016; 13:112. [PMID: 27719679 PMCID: PMC5056498 DOI: 10.1186/s12978-016-0217-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Mozambique has one of the highest rates of maternal mortality in sub-Saharan Africa. The main influences on maternal health encompass social, economic, political, environmental and cultural determinants of health. To effectively address maternal mortality in the post-2015 agenda, interventions need to consider the determinants of health so that their delivery is not limited to the health sector. The objective of this exploratory qualitative study was to identify key community groups’ perspectives on the perceived determinants of maternal health in rural areas of southern Mozambique. Methods Eleven focus group discussions were conducted with women of reproductive age, pregnant women, matrons, male partners, community leaders and health workers. Participants were recruited using sampling techniques of convenience and snow balling. Focus groups had an average of nine participants each. The heads of 12 administrative posts were also interviewed to understand the local context. Data were coded and analysed thematically using NVivo software. Results A broad range of political, economic, socio-cultural and environmental determinants of maternal health were identified by community representatives. It was perceived that the civil war has resulted in local unemployment and poverty that had a number of downstream effects including lack of funds for accessing medical care and transport, and influence on socio-cultural determinants, particularly gender relations that disadvantaged women. Socio-cultural determinants included intimate partner violence toward women, and strained relationships with in-laws and co-spouses. Social relationships were complex as there were both negative and positive impacts on maternal health. Environmental determinants included natural disasters and poor access to roads and transport exacerbated by the wet season and subsequent flooding. Conclusions In rural southern Mozambique, community perceptions of the determinants of maternal health included political, economic, socio-cultural and environmental factors. These determinants were closely linked with one another and highlight the importance of including the local history, context, culture and geography in the design of maternal health programs. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0217-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tabassum Firoz
- Department of Medicine, University of British Columbia, 330 E. Columbia Street, New Westminister, BC, V3L 3LW, Canada.
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology and the Child and Family Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada
| | - Prestige Tatenda Makanga
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada.,Department of Surveying and Geomatics, Midlands State University, P Bag 9055, Gweru, Zimbabwe
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Rogério Chiaú
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
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Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, Chomba E, McClure EM, Wright LL, Koso-Thomas M, Moore JL, Saleem S, Liechty EA, Goldenberg RL, Derman RJ, Hambidge KM, Carlo WA, Hibberd PL. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol 2015; 1:18. [PMID: 27057335 PMCID: PMC4823690 DOI: 10.1186/s40748-015-0019-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/25/2015] [Indexed: 01/03/2023] Open
Abstract
Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India
| | - Sreelatha Meleth
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Omrana Pasha
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Ana L Garces
- IMSALUD, San Carlos University, Guatemala City, Guatemala
| | | | | | - Linda L Wright
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Marion Koso-Thomas
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Sarah Saleem
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA
| | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA
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Amegah AK, Quansah R, Jaakkola JJK. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence. PLoS One 2014; 9:e113920. [PMID: 25463771 PMCID: PMC4252082 DOI: 10.1371/journal.pone.0113920] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022] Open
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. Conclusion 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.
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Affiliation(s)
- Adeladza K. Amegah
- 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
| | - Reginald Quansah
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- School of Public Health, University of Ghana, Legon, Ghana
| | - Jouni J. K. Jaakkola
- 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
- * E-mail:
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Wylie BJ, Coull BA, Hamer DH, Singh MP, Jack D, Yeboah-Antwi K, Sabin L, Singh N, MacLeod WB. Impact of biomass fuels on pregnancy outcomes in central East India. Environ Health 2014; 13:1. [PMID: 24405644 PMCID: PMC3922846 DOI: 10.1186/1476-069x-13-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/02/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND Smoke from biomass burning has been linked to reduced birth weight; association with other birth outcomes is poorly understood. Our objective was to evaluate effects of exposure to biomass smoke on birth weight, preterm birth and stillbirth. METHODS Information on household cooking fuel was available for secondary analysis from two cohorts of pregnant women enrolled at delivery in India (n = 1744). Birth weight was measured and the modified Ballard performed to assess gestational age. Linear and logistic regression models were used to explore associations between fuel and birth outcomes. Effect sizes were adjusted in multivariate models for socio-demographic characteristics using propensity score techniques and for medical/obstetric covariates. RESULTS Compared to women who use gas (n = 265), women cooking with wood (n = 1306) delivered infants that were on average 112 grams lighter (95% CI -170.1, -54.6) and more likely to be preterm (OR 3.11, 95% CI 2.12, 4.59). Stillbirths were also more common in the wood group (4% versus 0%, p < 0.001). In adjusted models, the association between wood use and birth weight was no longer significant (14 g reduction; 95% CI -93, 66); however, the increased odds for preterm birth persisted (aOR 2.29; 95% CI 1.24, 4.21). Wood fuel use did not increase the risk of delivering either a low birth weight or small for gestational age infant. CONCLUSIONS The association between wood fuel use and reduced birth weight was insignificant in multivariate models using propensity score techniques to account for socio-demographic differences. In contrast, we demonstrated a persistent adverse impact of wood fuel use on preterm delivery. If prematurity is confirmed as a consequence of antenatal exposure to household air pollution, perinatal morbidity and mortality from household air pollution may be higher than previously appreciated.
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Affiliation(s)
- Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, USA
- Center for Global Health and Development, Boston University, Boston, MA, USA
- Department of International Health, Boston University of School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Brent A Coull
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
- Departments of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Davidson H Hamer
- Center for Global Health and Development, Boston University, Boston, MA, USA
- Department of International Health, Boston University of School of Public Health, Boston, MA, USA
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
- Zambia Centre for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Mrigendra P Singh
- National Institute for Malaria Research Field Station, Jabalpur, Madhya Pradesh, India
| | - Darby Jack
- Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kojo Yeboah-Antwi
- Center for Global Health and Development, Boston University, Boston, MA, USA
| | - Lora Sabin
- Center for Global Health and Development, Boston University, Boston, MA, USA
| | - Neeru Singh
- Regional Medical Research Centre for Tribals (Indian Council for Medical Research), Jabalpur, Madhya Pradesh, India
| | - William B MacLeod
- Center for Global Health and Development, Boston University, Boston, MA, USA
- Department of International Health, Boston University of School of Public Health, Boston, MA, USA
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Patel AB, Dhande LA, Pusdekar YV, Borkar JA, Badhoniya NB, Hibberd PL. Childhood illness in households using biomass fuels in India: secondary data analysis of nationally representative national family health surveys. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2013; 19:35-42. [DOI: 10.1179/2049396712y.0000000013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chamberlain C, O’Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; 10:CD001055. [PMID: 24154953 PMCID: PMC4022453 DOI: 10.1002/14651858.cd001055.pub4] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. MAIN RESULTS Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy.In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small.Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11).Feedback interventions demonstrated a significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20 studies; average RR 1.48, 95% CI 1.17 to 1.87). There was no significant difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however the effect was unclear in three dissemination trials of counselling interventions where the focus on the intervention was at an organisational level (average RR 0.96, 95% CI 0.37 to 2.50). The pooled effects were similar in interventions provided for women with predominantly low socio-economic status (44 studies; average RR 1.41, 95% CI 1.19 to 1.66), compared to other women (26 studies; average RR 1.47, 95% CI 1.21 to 1.79); though the effect was unclear in interventions among women from ethnic minority groups (five studies; average RR 1.08, 95% CI 0.83 to 1.40) and aboriginal women (two studies; average RR 0.40, 95% CI 0.06 to 2.67). Importantly, pooled results demonstrated that women who received psychosocial interventions had an 18% reduction in preterm births (14 studies; average RR 0.82, 95% CI 0.70 to 0.96), and infants born with low birthweight (14 studies; average RR 0.82, 95% CI 0.71 to 0.94). There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy, and reduce low birthweight and preterm births.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison O’Mara-Eves
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Jenny R Caird
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Susan M Perlen
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sandra J Eades
- School of Public Health, Sydney School of Medicine, University of Sydney, Sydney, Australia
| | - James Thomas
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
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Abusalah A, Gavana M, Haidich AB, Smyrnakis E, Papadakis N, Papanikolaou A, Benos A. Low birth weight and prenatal exposure to indoor pollution from tobacco smoke and wood fuel smoke: a matched case-control study in Gaza Strip. Matern Child Health J 2012; 16:1718-27. [PMID: 21842400 DOI: 10.1007/s10995-011-0851-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Maternal exposure to environmental tobacco smoke (ETS) is a major health hazard as it contains lower doses of the toxins that smokers' inhale. Prenatal exposure to wood fuel smoke has been linked to delivering low birth weight (LBW) infants. The study aims to assess the association between prenatal exposure to ETS and wood fuel smoke and LBW. A case-control study in ratio 1:1 was conducted in two hospitals with obstetric services in Gaza Strip. Subjects were selected during May-June and July-August 2007 from attenders of Mbarak Hospital and Shifa Medical Centre, respectively. 184 (41.2%), and 79 (17.7%) out of 446 participants were exposed to environmental tobacco smoke and wood fuel smoke, respectively. Adjusted maternal exposure to ETS (especially the number of cigarettes smoked, water pipe and wood fuel smoke) was associated with LBW infants. Cigarette smoke exhibits an independent dose-response risk of LBW after adjusting for confounders. Prenatal exposure to cigarette smoke indoors is related to a reduction in birth weight of infants of -237 g (95% CI: -415, -58) for pregnant women exposed to 1-20 cigarettes per day and -391 g (95% CI: -642, -140) for exposure to more than 20 cigarettes per day. Exposure to wood fuel smoke exhibits a reduction of infants' adjusted mean birth weight by -186 g (95% CI: -354, -19). Prenatal exposure to passive smoking and wood fuel smoke are independently associated with LBW. Both these factors are modifiable exposures that could possibly lead to a reduction of delivering LBW infants.
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Affiliation(s)
- Akram Abusalah
- Department of Hygiene and Social Medicine, Medical School, Aristotle University of Thessaloniki, PO box: 1689, 54006, Thessaloniki, Greece
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Current world literature. Curr Opin Pulm Med 2011; 17:126-30. [PMID: 21285709 DOI: 10.1097/mcp.0b013e3283440e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Situational analysis of household energy and biomass use and associated health burden of indoor air pollution and mitigation efforts in Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2940-52. [PMID: 20717550 PMCID: PMC2922737 DOI: 10.3390/ijerph7072940] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 06/30/2010] [Accepted: 07/12/2010] [Indexed: 11/22/2022]
Abstract
Biomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly to indoor air pollution (IAP). A situational analysis of household energy and biomass use and associated health effects of IAP was conducted by reviewing published and un-published literature about the situation in Pakistan. In addition to attempt to quantify the burden of ill health due to IAP, this paper also appraises the mitigation measures undertaken to avert the problem in Pakistan. Unfortunately, IAP is still not a recognized environmental hazard in Pakistan and there are no policies and standards to control it at the household level. Only a few original studies related to health effects of IAP have been conducted, mainly on women’s health and birth outcome, and only a few governmental, non-governmental and academic institutions are working to improve the IAP situation by introducing improved stoves and renewable energy technology at a small scale. Control of IAP health hazards in Pakistan requires an initial meeting of the stakeholders to define a policy and an action agenda. Simultaneously, studies gathering evidence of impact of intervention through available technologies such as improved stoves would have favorable impact on the health, especially of women and children in Pakistan.
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