Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial

Wenlu Ye; Ajay Pillarisetti; Oscar de León; Kyle Steenland; Jennifer L Peel; Maggie L Clark; William Checkley; Lindsay J Underhill; Ashlinn Quinn; Kalpana Balakrishnan; Sarada S Garg; John P McCracken; Lisa M Thompson; Anaité Díaz-Artiga; Ghislaine Rosa; Victor G Davila-Roman; Lisa de Las Fuentes; Aris T Papageorghiou; Yunyun Chen; Jiantong Wang; F C Thomas; Household Air Pollution Intervention Network (HAPIN) trial Investigators

doi:10.1101/2023.01.23.23284847

Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial

medRxiv [Preprint]. 2023 Jan 26:2023.01.23.23284847. doi: 10.1101/2023.01.23.23284847.

Authors

Wenlu Ye^{1

2}, Ajay Pillarisetti^{1

2}, Oscar de León¹, Kyle Steenland¹, Jennifer L Peel³, Maggie L Clark³, William Checkley^{4

5}, Lindsay J Underhill⁶, Ashlinn Quinn⁷, Kalpana Balakrishnan⁸, Sarada S Garg⁸, John P McCracken⁹, Lisa M Thompson¹⁰, Anaité Díaz-Artiga¹¹, Ghislaine Rosa¹², Victor G Davila-Roman⁶, Lisa de Las Fuentes⁶, Aris T Papageorghiou¹³, Yunyun Chen¹⁴, Jiantong Wang¹⁴, F C Thomas^{1

2

3

4

5

6

7

8

9

10

11

12

13

14}; Household Air Pollution Intervention Network (HAPIN) trial Investigators

Affiliations

¹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
² Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA.
³ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
⁴ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁶ Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA.
⁷ Berkeley Air Monitoring Group, Berkeley, California, USA.
⁸ Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
⁹ Global Health Institute, Collage of Public Health, University of Georgia, Athens, Georgia, USA.
¹⁰ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
¹¹ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala.
¹² Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
¹³ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁴ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Abstract

Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study. We assessed associations between PM_2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm), BC (black carbon), and CO (carbon monoxide) exposures and blood pressure at baseline, prior to intervention, among 3195 pregnant women between 9 and 19 weeks of gestation. We measured 24-hour personal exposure to PM_2.5/BC/CO and gestational blood pressure. Multivariable linear regression models were used to evaluate associations between personal exposures to three air pollutants and blood pressure parameters. Trial-wide, we found moderate increases in systolic blood pressure (SBP) and decreases in diastolic blood pressure (DBP) as exposure to PM_2.5, BC, and CO increased. None of these associations, however, were significant at the 0.05 level. HAP exposure and blood pressure associations were inconsistent in direction and magnitude within each country. We observed effect modification by body mass index (BMI) in India and Peru. Compared to women with normal weights, obese women in India and Peru (but not in Rwanda or Guatemala) had higher SBP per unit increase in log transformed PM_2.5 and BC exposures. We did not find a cross-sectional association between HAP exposure and blood pressure in pregnant women; however, HAP may be associated with higher blood pressure in pregnant women who are obese, but this increase was not consistent across settings.

Keywords: Blood Pressure; Household Air Pollution; Pregnant Women; Solid Fuels.

Publication types

Preprint

Grants and funding

UM1 HL134590/HL/NHLBI NIH HHS/United States