1. Compared to biomass stoves, there was no difference in the birth weight of children born to participants who used liquefied petroleum gas (LPG) stoves during pregnancy.
2. Compared to biomass stoves, there was also no difference in the incidence of premature births, premature deliveries or stillbirths among participants who used LPG stoves during pregnancy.
Level of evidence assessment: 1 (Excellent)
Summary of the study: Low birth weight and premature infant deaths remain significant public health issues, particularly in low- and middle-income countries. The practice of using open fires and traditional biomass fuels, such as wood or charcoal, is associated with increased exposure to carbon particles and remains a popular practice in many countries around the world. Currently, the effects of using biomass cookstoves versus improved cookstoves, such as LPG cookstoves, on infant birth weight and other birth parameters are unclear. This study was a multicentre randomized controlled trial comparing the use of traditional biomass stoves with LPG stoves in pregnant women to determine whether the choice of stoves resulted in a significant difference in infant birth weight. The results demonstrated that the use of an improved LPG cookstove did not lead to a significant difference in the birth weight of the infant compared to the use of traditional biomass cookstoves. Although this study did not find a significant difference, future investigations using fine particle levels as the primary exposure and longitudinal follow-up of developing infants in the homes of caregivers who use an LPG stove versus biomass could be an interesting area of future study. .
Click to read the study in the NEJM
In depth [randomized controlled trial]: This study was a multicenter, parallel-group, randomized controlled trial evaluating the effect of using LPG stoves or home biomass stoves on various newborn health parameters, such as birth weight, in low- and middle-income countries. Women aged 18 to 34 years with ultrasound-confirmed pregnancies of 9 to <20 weeks gestation were included. Pregnant women who smoked tobacco, planned to move outside the geographic trial area within the next year, or already used a clean fuel stove at home were excluded. After applying the inclusion and exclusion criteria, 3,200 women were randomized in a 1:1 ratio to the LPG stove intervention group (n=1,593) or to a biomass stove control group (n=1607). The primary endpoint was the infant's birth weight within 24 hours of birth. Secondary outcomes included gestational age at birth using age derived from ultrasound, birth <37 weeks gestation, delivery <37 weeks gestation, and stillbirth. The results of the primary analysis revealed that there was no significant difference in birth weight between the intervention and control groups (mean difference in birth weight, 19.5 g; 95% confidence, -10.1 to 49.2). Similarly, there were no significant differences between the groups for the secondary outcomes of interest. Overall, this study provided evidence that the choice of home between LPG and biomass does not lead to significant differences in the birth weight of newborns.
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