{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T04:30:19Z","timestamp":1794544219242,"version":"4.9.1"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T00:00:00Z","timestamp":1582329600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T00:00:00Z","timestamp":1582329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Reprod Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Accruing epidemiological evidence suggests that prenatal exposure to emissions from cooking fuel is associated with increased risks of adverse maternal and perinatal outcomes including hypertensive disorders of pregnancy, low birth weight, stillbirth and infant mortality. We aimed to investigate the relationship between cooking fuel use and various pregnancy related outcomes in a cohort of urban women from the Accra region of Ghana.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Self-reported cooking fuel use was divided into \u201cpolluting\u201d (wood, charcoal, crop residue and kerosene) and \u201cclean\u201d fuels (liquid petroleum gas and electricity) to examine 12 obstetric outcomes in a prospective cohort of pregnant women (<jats:italic>N<\/jats:italic>\u00a0=\u20091010) recruited at &lt;\u200917\u2009weeks of gestation from Accra, Ghana. Logistic and multivariate linear regression analyses adjusted for BMI, maternal age, maternal education and socio-economic status asset index was conducted.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>34% (<jats:italic>n<\/jats:italic>\u00a0=\u2009279) of 819 women with outcome data available for analysis used polluting fuel as their main cooking fuel. Using polluting cooking fuels was associated with perinatal mortality (aOR: 7.6, 95%CI: 1.67\u201336.0) and an adverse Apgar score (&lt;\u20097) at 5\u2009min (aOR:3.83, 95%CI: (1.44\u201310.11). The other outcomes (miscarriage, post-partum hemorrhage, pre-term birth, low birthweight, caesarian section, hypertensive disorders of pregnancy, small for gestational age, and Apgar score at 1 min) had non-statistically significant findings.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We report an increased likelihood of perinatal mortality, and adverse 5-min Apgar scores in association with polluting fuel use. Further research including details on extent of household fuel use exposure is recommended to better quantify the consequences of household fuel use.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Study registration<\/jats:title>\n<jats:p>Ghana Service Ethical Review Committee (GHS-ERC #: 07\u20139-11).<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12978-020-0878-3","type":"journal-article","created":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T14:02:39Z","timestamp":1582380159000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Household fuel use and adverse pregnancy outcomes in a Ghanaian cohort study"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-0179","authenticated-orcid":false,"given":"Eartha","family":"Weber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwame","family":"Adu-Bonsaffoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roel","family":"Vermeulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Klipstein-Grobusch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederick E.","family":"Grobbee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce L.","family":"Browne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George S.","family":"Downward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,22]]},"reference":[{"key":"878_CR1","unstructured":"WHO | World Health Statistics, editor. Monitoring health for the SDGs: WHO; 2018. http:\/\/www.who.int\/gho\/publications\/world_health_statistics\/2018\/en\/"},{"key":"878_CR2","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.toxlet.2016.12.005","volume":"266","author":"E Corsini","year":"2017","unstructured":"Corsini E, et al. Insights on wood combustion generated proinflammatory ultrafine particles (UFP). Toxicol Lett. 2017;266:74\u201384.","journal-title":"Toxicol Lett"},{"key":"878_CR3","unstructured":"WHO | Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. WHO http:\/\/www.who.int\/quantifying_ehimpacts\/publications\/preventing-disease\/en\/."},{"key":"878_CR4","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.trstmh.2008.05.028","volume":"102","author":"DG Fullerton","year":"2008","unstructured":"Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102:843\u201351.","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"878_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11111-017-0269-z","volume":"39","author":"KF Austin","year":"2017","unstructured":"Austin KF, Mejia MT. Household air pollution as a silent killer: women\u2019s status and solid fuel use in developing nations. Popul Environ. 2017;39:1\u201325.","journal-title":"Popul Environ"},{"key":"878_CR6","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1161\/HYPERTENSIONAHA.114.03545","volume":"64","author":"P Marie","year":"2014","unstructured":"Marie P, et al. Ambient air pollution and pregnancy-induced hypertensive disorders. Hypertension. 2014;64:494\u2013500.","journal-title":"Hypertension"},{"key":"878_CR7","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1093\/epirev\/mxq005","volume":"32","author":"DP Pope","year":"2010","unstructured":"Pope DP, et al. Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries. Epidemiol Rev. 2010;32:70\u201381.","journal-title":"Epidemiol Rev"},{"key":"878_CR8","doi-asserted-by":"publisher","first-page":"e113920","DOI":"10.1371\/journal.pone.0113920","volume":"9","author":"AK Amegah","year":"2014","unstructured":"Amegah AK, Quansah R, Jaakkola JJK. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence. PLoS One. 2014;9:e113920.","journal-title":"PLoS One"},{"key":"878_CR9","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1136\/oemed-2015-103086","volume":"73","author":"N Siddika","year":"2016","unstructured":"Siddika N, Balogun HA, Amegah AK, Jaakkola JJK. Prenatal ambient air pollution exposure and the risk of stillbirth: systematic review and meta-analysis of the empirical evidence. Occup Env Med. 2016;73:573\u201381.","journal-title":"Occup Env Med"},{"key":"878_CR10","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.ijheh.2012.12.006","volume":"216","author":"MB Epstein","year":"2013","unstructured":"Epstein MB, et al. Household fuels, low birth weight, and neonatal death in India: the separate impacts of biomass, kerosene, and coal. Int J Hyg Environ Health. 2013;216:523\u201332.","journal-title":"Int J Hyg Environ Health"},{"key":"878_CR11","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1289\/ehp.9081","volume":"114","author":"S Kannan","year":"2006","unstructured":"Kannan S, Misra DP, Dvonch JT, Krishnakumar A. Exposures to airborne particulate matter and adverse perinatal outcomes: a biologically plausible mechanistic framework for exploring potential effect modification by nutrition. Environ Health Perspect. 2006;114:1636\u201342.","journal-title":"Environ Health Perspect"},{"key":"878_CR12","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1111\/j.1742-7843.2009.00431.x","volume":"105","author":"L Mathiesen","year":"2009","unstructured":"Mathiesen L, Rytting E, Mose T, Knudsen LE. Transport of benzo [alpha] pyrene in the dually perfused human placenta perfusion model: effect of albumin in the perfusion medium. Basic Clin Pharmacol Toxicol. 2009;105:181\u20137.","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"878_CR13","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1289\/ehp.99107s3451","volume":"107","author":"FP Perera","year":"1999","unstructured":"Perera FP, Jedrychowski W, Rauh V, Whyatt RM. Molecular epidemiologic research on the effects of environmental pollutants on the fetus. Environ Health Perspect. 1999;107:451\u201360.","journal-title":"Environ Health Perspect"},{"key":"878_CR14","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1289\/ehp.8939","volume":"114","author":"D Tang","year":"2006","unstructured":"Tang D, et al. PAH-DNA adducts in cord blood and fetal and child development in a Chinese cohort. Environ Health Perspect. 2006;114:1297\u2013300.","journal-title":"Environ Health Perspect"},{"key":"878_CR15","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.placenta.2008.12.012","volume":"30","author":"K Annola","year":"2009","unstructured":"Annola K, et al. Transplacental transfer of Nitrosodimethylamine in perfused human placenta. Placenta. 2009;30:277\u201383.","journal-title":"Placenta"},{"key":"878_CR16","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1111\/ina.12144","volume":"25","author":"S Agrawal","year":"2015","unstructured":"Agrawal S, Yamamoto S. Effect of indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia\/eclampsia in Indian women. Indoor Air. 2015;25:341\u201352.","journal-title":"Indoor Air"},{"key":"878_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1476-069X-13-1","volume":"13","author":"BJ Wylie","year":"2014","unstructured":"Wylie BJ, et al. Impact of biomass fuels on pregnancy outcomes in central East India. Environ Health. 2014;13:1.","journal-title":"Environ Health"},{"issue":"7","key":"878_CR18","doi-asserted-by":"publisher","first-page":"2270","DOI":"10.1021\/es903276s","volume":"44","author":"Kathie L. Dionisio","year":"2010","unstructured":"Air Pollution in Accra Neighborhoods: Spatial, Socioeconomic, and Temporal Patterns | Environmental Science & Technology. https:\/\/doi.org\/10.1021\/es903276s.","journal-title":"Environmental Science & Technology"},{"key":"878_CR19","doi-asserted-by":"publisher","first-page":"10310","DOI":"10.3390\/ijerph111010310","volume":"11","author":"EL Rhodes","year":"2014","unstructured":"Rhodes EL, et al. Behavioral attitudes and preferences in cooking practices with traditional open-fire stoves in Peru, Nepal, and Kenya: implications for improved Cookstove interventions. Int J Environ Res Public Health. 2014;11:10310\u201326.","journal-title":"Int J Environ Res Public Health"},{"key":"878_CR20","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/s12889-015-1414-1","volume":"15","author":"KL Dickinson","year":"2015","unstructured":"Dickinson KL, et al. Research on emissions, air quality, climate, and cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol. BMC Public Health. 2015;15:126.","journal-title":"BMC Public Health"},{"key":"878_CR21","doi-asserted-by":"publisher","first-page":"65009","DOI":"10.1088\/1748-9326\/aa7036","volume":"12","author":"C Wiedinmyer","year":"2017","unstructured":"Wiedinmyer C, et al. Rural\u2013urban differences in cooking practices and exposures in northern Ghana. Environ Res Lett. 2017;12:65009.","journal-title":"Environ Res Lett"},{"key":"878_CR22","unstructured":"Clean Cooking Alliance. Clean Cooking Alliance http:\/\/cleancookingalliance.org\/country-profiles\/focus-countries\/1-ghana.html."},{"key":"878_CR23","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/1476-069X-11-78","volume":"11","author":"AK Amegah","year":"2012","unstructured":"Amegah AK, Jaakkola JJ, Quansah R, Norgbe GK, Dzodzomenyo M. Cooking fuel choices and garbage burning practices as determinants of birth weight: a cross-sectional study in Accra. Ghana Environ Health. 2012;11:78.","journal-title":"Ghana Environ Health"},{"key":"878_CR24","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1111\/tmi.12606","volume":"20","author":"JL Browne","year":"2015","unstructured":"Browne JL, et al. Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting. Tropical Med Int Health. 2015;20:1778\u201386.","journal-title":"Tropical Med Int Health"},{"key":"878_CR25","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1002\/oby.21210","volume":"24","author":"EL Van Der Linden","year":"2016","unstructured":"Van Der Linden EL, et al. Maternal body mass index and adverse pregnancy outcomes: a ghanaian cohort study. Obes Silver Spring Md. 2016;24:215\u201322.","journal-title":"Obes Silver Spring Md"},{"key":"878_CR26","unstructured":"De Groot A, et al. Equity in maternal health outcomes in a middle-income urban setting: a cohort study. Reprod. Health. 2019;16:84."},{"key":"878_CR27","unstructured":"Croissant Y. mlogit: Multinomial Logit Models. R package version 3.6; 2018"},{"key":"878_CR28","unstructured":"R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013. http:\/\/www.R-project.org\/."},{"key":"878_CR29","unstructured":"Achim Zeleis & Hothorn T. lmtest: Diagnostic Checking in Regression Relationships. R package verson 3.6; 2002."},{"key":"878_CR30","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1080\/09603120500288913","volume":"15","author":"PD Vinod Mishra","year":"2005","unstructured":"Vinod Mishra PD, Retherford RD, Smith KR. Cooking smoke and tobacco smoke as risk factors for stillbirth. Int J Environ Health Res. 2005;15:397\u2013410.","journal-title":"Int J Environ Health Res"},{"key":"878_CR31","first-page":"435","volume":"69","author":"DV Mavalankar","year":"1991","unstructured":"Mavalankar DV, Trivedi CR, Gray RH. Levels and risk factors for perinatal mortality in Ahmedabad. India Bull World Health Organ. 1991;69:435\u201342.","journal-title":"India Bull World Health Organ"},{"key":"878_CR32","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s40748-015-0019-0","volume":"1","author":"AB Patel","year":"2015","unstructured":"Patel AB, et al. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol. 2015;1:18.","journal-title":"Matern Health Neonatol Perinatol"},{"key":"878_CR33","unstructured":"Deupmann, E. a. M. Housing characteristics and infant mortality in Ghana; secondary analysis of 2003 and 2008 Demographic and Health Survey data (Unpublished Master\u2019s Thesis). http:\/\/dspace.library.uu.nl\/handle\/1874\/296126 (2014)."},{"key":"878_CR34","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/0895-4356(88)90100-X","volume":"41","author":"B Schmidt","year":"1988","unstructured":"Schmidt B, Kirpalani H, Rosenbaum P, Cadman D. Strengths and limitations of the Apgar score: a critical appraisal. J Clin Epidemiol. 1988;41:843\u201350.","journal-title":"J Clin Epidemiol"},{"key":"878_CR35","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1289\/ehp.02110109","volume":"110","author":"B Erick","year":"2002","unstructured":"Erick B, Nigel B, Hern\u00e1n D. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ Health Perspect. 2002;110:109\u201314.","journal-title":"Environ Health Perspect"},{"key":"878_CR36","doi-asserted-by":"publisher","first-page":"33","DOI":"10.2165\/00007256-199723010-00004","volume":"23","author":"B Sternfeld","year":"1997","unstructured":"Sternfeld B. Physical activity and pregnancy outcome. Sports Med. 1997;23:33\u201347.","journal-title":"Sports Med"},{"key":"878_CR37","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s10654-010-9458-0","volume":"25","author":"MI Both","year":"2010","unstructured":"Both MI, Overvest MA, Wildhagen MF, Golding J, Wildschut HIJ. The association of daily physical activity and birth outcome: a population-based cohort study. Eur J Epidemiol. 2010;25:421\u20139.","journal-title":"Eur J Epidemiol"},{"key":"878_CR38","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1093\/ije\/19.1.90","volume":"19","author":"G Ahlborg","year":"1990","unstructured":"Ahlborg G, Bodin L, Hogstedt C. Heavy lifting during pregnancy\u2014a Hazard to the fetus? A Prospective Study. Int J Epidemiol. 1990;19:90\u20137.","journal-title":"Int J Epidemiol"},{"key":"878_CR39","doi-asserted-by":"publisher","first-page":"e0201842","DOI":"10.1371\/journal.pone.0201842","volume":"13","author":"CS Sejbaek","year":"2018","unstructured":"Sejbaek CS, et al. Combined exposure to lifting and psychosocial strain at work and adverse pregnancy outcomes\u2014a study in the Danish National Birth Cohort. PLoS One. 2018;13:e0201842.","journal-title":"PLoS One"},{"key":"878_CR40","doi-asserted-by":"publisher","first-page":"e10095","DOI":"10.2196\/10095","volume":"7","author":"E Kwegyir-Afful","year":"2018","unstructured":"Kwegyir-Afful E, Verbeek J, Aziato L, Seffah JD, R\u00e4s\u00e4nen K. A Liftless intervention to prevent preterm birth and low Birthweight among pregnant Ghanaian women: protocol of a stepped-wedge cluster randomized controlled trial. JMIR Res Protoc. 2018;7:e10095.","journal-title":"JMIR Res Protoc"},{"key":"878_CR41","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1289\/ehp.1206429","volume":"121","author":"ML Clark","year":"2013","unstructured":"Clark ML, et al. Health and household air pollution from solid fuel use: the need for improved exposure assessment. Environ Health Perspect. 2013;121:1120\u20138.","journal-title":"Environ Health Perspect"},{"key":"878_CR42","unstructured":"WHO | Ghana: country profiles. WHO http:\/\/www.who.int\/gho\/countries\/gha\/country_profiles\/en\/."},{"key":"878_CR43","unstructured":"Opportunities for transition to clean household energy: application of the household energy assessment rapid tool (HEART): Ghana. https:\/\/apps.who.int\/iris\/handle\/10665\/274281."},{"key":"878_CR44","unstructured":"Boston, 677 Huntington Avenue & Ma 02115 +1495\u20131000. A rights-based approach to indoor air pollution. Health and Human Rights Journal https:\/\/www.hhrjournal.org\/2013\/12\/a-rights-based-approach-to-indoor-air-pollution\/ (2013)."},{"issue":"4","key":"878_CR45","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1056\/NEJMsa0805646","volume":"360","author":"C. Arden Pope","year":"2009","unstructured":"Fine-Particulate Air Pollution and Life Expectancy in the United States | NEJM. https:\/\/doi.org\/10.1056\/NEJMsa0805646.","journal-title":"New England Journal of Medicine"}],"container-title":["Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-020-0878-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12978-020-0878-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-020-0878-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T02:37:09Z","timestamp":1613875029000},"score":1,"resource":{"primary":{"URL":"https:\/\/reproductive-health-journal.biomedcentral.com\/articles\/10.1186\/s12978-020-0878-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,22]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["878"],"URL":"https:\/\/doi.org\/10.1186\/s12978-020-0878-3","relation":{},"ISSN":["1742-4755"],"issn-type":[{"value":"1742-4755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,22]]},"assertion":[{"value":"16 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 February 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Research on this cohort was approved by the Ghana Service Ethical Review Committee (GHS-ERC #: 07\u20139-11). All participants enrolled provided written or thumb print consent.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable since no individual level data is shown.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29"}}