Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India

Wenlu Ye; Gurusamy Thangavel; Ajay Pillarisetti; Kyle Steenland; Jennifer L Peel; Kalpana Balakrishnan; Shirin Jabbarzadeh; William Checkley; Thomas Clasen; HAPIN Investigators

doi:10.1016/j.envres.2022.112756

Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India

Environ Res. 2022 May 15:208:112756. doi: 10.1016/j.envres.2022.112756. Epub 2022 Jan 20.

Authors

Wenlu Ye¹, Gurusamy Thangavel², Ajay Pillarisetti³, Kyle Steenland⁴, Jennifer L Peel⁵, Kalpana Balakrishnan², Shirin Jabbarzadeh⁶, William Checkley⁷, Thomas Clasen⁴; HAPIN Investigators

Affiliations

¹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: wenlu.ye@emory.edu.
² Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA.
⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
⁶ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁷ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Background: The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing multi-center randomized controlled trial assessing the impact of a liquified petroleum gas (LPG) cookstove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from burning solid fuels on cardiovascular health during pregnancy, we sought to determine whether baseline exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5), black carbon (BC) and carbon monoxide (CO) were associated with blood pressure among 799 pregnant women in Tamil Nadu, India, one of the HAPIN trial centers.

Methods: Multivariable linear regression models were used to examine the association between 24-h personal exposure to PM_2.5/BC/CO and systolic and diastolic blood pressure, controlling for maternal age, body mass index (BMI), mother's education, household wealth, gestational age, and season. At the time of measurement, women were between 9- and 20-weeks of gestation.

Results: We found that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in pregnant women exposed to higher levels of HAP, though only the result for CO and DBP reached conventional statistical significance (p < 0.05). We observed a positive association between CO and DBP among the entire study cohort: a 1-log μg/m³ increase in CO exposure was associated with 0.36 mmHg higher DBP (95% confidence interval [CI]: 0.02 to 0.70). The effect was stronger in pregnant women with higher CO exposures (in the 3rd [≥ 0.9 and < 2.1 ppm] and 4th quartiles [≥ 2.1 and ≤ 46.9 ppm]). We also found that pregnant women with PM_2.5 exposures in the highest quartile (≥ 129.9 and ≤ 2100 μg/m³) had a borderline significant association (p = 0.054) with DBP compared to those who had PM_2.5 exposures in the lowest quartile (≥ 9.4 and < 47.7 μg/m³). No evidence of association was observed for BC exposure and blood pressure.

Conclusion: This study contributes to limited evidence regarding the relationship between HAP exposure and blood pressure among women during pregnancy, a critical window for both mother and child's life-course health. Results from this cross-sectional study suggest that exposures to PM_2.5 and CO from solid fuel use are associated with higher blood pressure in pregnant women during their first or second trimester.

Keywords: Blood pressure; Household air pollution; Pregnant women; Solid fuels.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants / analysis
Air Pollutants / toxicity
Air Pollution, Indoor* / adverse effects
Air Pollution, Indoor* / analysis
Blood Pressure* / physiology
Carbon Monoxide / analysis
Carbon Monoxide / toxicity
Cooking* / methods
Cross-Sectional Studies
Female
Gestational Age
Humans
Hypertension / chemically induced
Hypertension / epidemiology
India / epidemiology
Maternal Exposure* / adverse effects
Maternal Exposure* / statistics & numerical data
Particulate Matter / analysis
Particulate Matter / toxicity
Pregnancy
Pregnancy Complications, Cardiovascular / chemically induced
Pregnancy Complications, Cardiovascular / epidemiology
Rural Health / statistics & numerical data

Substances

Air Pollutants
Particulate Matter
Carbon Monoxide

Grants and funding

UM1 HL134590/HL/NHLBI NIH HHS/United States