1. In comparison to biomass cookstoves, there was no difference in infant birth weight born to participants who used liquefied petroleum gas (LPG) cookstoves during pregnancy.

2. In comparison to biomass cookstoves, there was also no difference in the incidence of premature birth, premature labor, or stillbirth born to participants who used LPG cookstoves during pregnancy. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Low birth weight and premature infant death remain significant public health challenges, particularly in low-income 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 particulates and remains a popular practice in many countries around the world. Currently, the effects of using biomass stovetops in comparison to improved cookstoves, such as LPG stovetops, on infant birth weight and other birth parameters are unclear. This study was a multicenter, randomized controlled trial comparing the use of traditional biomass cookstoves against LPG cookstoves in pregnant women to see whether the choice of cookstoves results in a significant difference in infant birth weight. Results demonstrated that the use of an improved LPG cookstove did not cause a significant difference in infant birth weight in comparison to the use of traditional biomass cookstoves. While this study did not find a significant difference, future investigations using levels of fine particulate matter as the primary exposure and longitudinal follow-up of developing infants in the home of caregivers who use an LPG vs biomass stove may be an interesting area of future study.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: This study was a multicenter, parallel-group, randomized controlled trial evaluating the effect of LPG cookstove use or biomass cookstove use at home on various health parameters of the newborn, such as birth weight, in low-income and middle-income countries. Women between the ages of 18 to 34 years old with ultrasound-confirmed pregnancies of 9 to <20 weeks’ gestation were included. Pregnant women who smoked tobacco, were planning to move outside of the trial geographical area within the next year, or already used a clean-fuel cookstove at home were excluded. After applying inclusion and exclusion criteria, 3,200 women were randomized in a 1:1 ratio to the intervention group with LPG cookstove (n=1,593) or a control group with biomass cookstove (n=1,607). The primary outcome of interest was infant birth weight within 24 hours of birth. Secondary outcomes included gestational age at birth using ultrasound-derived age, birth <37 weeks gestation, delivery <37 weeks gestation, and stillbirth. Results of the primary analysis found that there was not a significant difference in birth weight between the intervention and control groups (mean difference birth weight, 19.5g; 95% Confidence Interval, -10.1 to 49.2). Similarly, there were no significant between-group differences for any secondary outcomes of interest. Overall, this study provided evidence that the choice of cookstove between LPG and biomass does not cause significant differences in the birth weight of newborns.

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