Effects of a Liquefied Petroleum Gas Stove and Continuous Fuel Distribution Intervention on Anthropometric Outcomes at Birth

Background and Aims: Air pollution may contribute to childhood stunting and impaired cognitive development. Potential anthropometric markers of poor growth and cognition include head circumference and length at birth. The Household Air Pollution Intervention Network (HAPIN) trial in India, Guatemala, Peru, and Rwanda was a randomized controlled field trial among 3200 pregnant women that assessed the effect of liquefied petroleum gas (LPG) stove and continuous free fuel intervention compared to cooking with biomass on health outcomes. We conducted an intention-to-treat analysis of the LPG intervention delivered during pregnancy starting at 9-19 weeks of gestation on head circumference and length at birth among offspring. Methods: Length and head circumference were measured in centimeters within 24 hours of birth. Birth length and head circumference z-scores were calculated using INTERGROWTH-21st standards which accounts for gestational age at birth. Separate linear regression models (adjusted for 10 strata, representing settings in Guatemala (1 site), Rwanda (1 site), India (2 sites) and Peru (six sites)) were created for head circumference, head circumference z-score, birth length and birth length z-score. Results: A total of 3060 live births were included in the analysis. The intervention had small or no effect on birth length (β=0.14, 95% CI -0.01 to 0.29), birth length Z-scores (β=0.09, 95% CI 0.01 to 0.16), head circumference (β= -0.01, 95% CI -0.11 to 0.09) and head-circumference Z-scores (β= -0.01, 95% CI -0.08 to 0.07). More than 90% of the women had a full-term pregnancy (94.6% in control and 94.1% in intervention group), and the mean (SD) time with the intervention was 21.23 weeks (3.67 weeks). Conclusion: Our intervention strategy aimed at reducing household air pollution during pregnancy had small or no effects on length and head circumference at birth among offspring. Keywords: Household air pollution, liquefied petroleum gas, biomass fuel, head circumference, birth length, newborn