Effect of Biomass Fuel Use on Neonatal Outcomes: A Cohort Study of Pregnant Females

<b>Background:</b> Exposure to indoor air pollution (IAP), including particulate matter of size 2.5 µm/m³ (PM_2.5) and carbon monoxide (CO) resulting from the combustion of biomass fuels in homes, is an important risk factor associated with growth and developmental delays in neonates. We investigated the association between exposure to HAP and adverse birth outcomes in a birth cohort study of 594 pregnant females in Sri Lanka. <b>Methods</b>: Pregnant females between the ages of 18 and 40 years were enrolled in their first trimester and followed until delivery. Baseline assessments of fuel used for cooking were used to categorize the females into high-exposure (wood and kerosene) or low-exposure (liquid petroleum gas and electricity) groups. Indoor air quality measurements of PM_2.5 (n = 303) and CO (n = 258) were conducted in a subgroup of households. The outcomes at birth included the neonates' appearance, pulse, grimace, activity, respiration (APGAR) score, Brazelton Neonatal Behavioural Assessment Scale (BNBAS) score, and birth weight. Linear and logistic regressions were used to evaluate the association between household air pollution (HAP) and birth outcomes. <b>Results</b>: Of the 526 neonates assessed at delivery, 55.7% were born to mothers with high HAP exposure and 44.3% with low HAP exposure, respectively. The results of the linear regression found an inverse association between higher exposure to HAP and birthweight in the adjusted and unadjusted models; the birth weight of children in the high-exposure group was lower by 107 g compared to that of the low-exposure group after adjusting for other variables (β = -106.8; 95% confidence intervals: -197.6, -16.0). Exposure status was not associated with birth length, gestational age, or the APGAR score; however, the BNBAS motor score was significantly lower in the neonates of the high-exposure group (6.41 vs. 6.55, <i>p</i> = 0.04), though it was not significant when adjusted for other variables. No correlation was found between the measured indoor PM_2.5 levels and birth weight, birth length, gestational age, APGAR score, or BNBAS score. <b>Conclusions</b>: Exposure to IAP due to emissions from combustion products from biomass fuels adversely affects birth weight. These effects may be more pronounced in vulnerable populations in settings where primary healthcare for pregnant women is limited.