Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India

Abstract

Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.

Role of Living Conditions and Socioenvironmental Factors on Chronotype in Adolescents

“…Recent evidence suggests that residential proximity to industry, exposure to second-hand smoke (SHS), inappropriate indoor environment, and use of biomass cooking fuel were associated with sleep disturbance [14][15][16][17][18][19][20][21][22][23]. Biomass cooking fuel is a well-known risk factor for several chronic respiratory and cardiac diseases [24,25]. In developing countries like India, a large proportion of the population who are at the lower bar in the socioeconomic status does not have a separate kitchen and has to cook inside the living room area using biomass fuel.…”

Effect of low-cost kitchen with improved cookstove on birthweight of neonates in Shahjadpur, Bangladesh: a cluster-randomised controlled trial

“… 42 Another study conducted in India confirmed that biomass fuel has adverse respiratory impact e.g., dyspnoea and airway inflammation on pregnant women. 43 A recent study conducted in Ghana also found a positive association between inhalation of CO discharged from burning biomass fuel and prolonged coughing, wheezing, phlegm, and other respiratory infection 44 Similarly, one more study in Ghana observed effects of CO on birthweight, birth length, and gestational age. 31 The findings from the study suggested for the neonates born to mothers without reported placental malaria, each 1 ppm increase in CO was associated with reduced gestational age (−0.5 days [95% CI: −1.3, 0.2 days]), birthweight (−38.7 g [95% CI: −66.2, −11.1 g]), birth length (−0.3 cm [95% CI: −0.5, −0.02 cm]).…”

The Indian Epidemiological Evidences on Household Air Pollution and Respiratory Health Outcomes

“…Several recent reviews have found strong evidence linking HAP to various respiratory infections, chronic lung illnesses, cardiovascular disorders and respiratory cancers (Gordon et al, 2014;Mortimer et al, 2012;Smith, 2000). A study which evaluated the prevalence of respiratory illness, using pulmonary questionnaires and fractional exhaled nitric oxide (FeNO) measurements (a non-invasive biomarker of inflammation that can help to better understand the physiologic effects of biomass smoke on pregnant women), among pregnant women found that FeNO levels were higher in the biomass versus LPG group (25.4 ppb vs. 8.6 ppb; p value = .001), and increased FeNO levels and higher dyspnoea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy (Parikh et al, 2020).…”