Antenatal exposure to household air pollution and its association with increased risk of retinopathy

Abstract

Background: Household air pollution (HAP) has been implicated in endothelial dysfunction and systemic inflammation which are the underlying mechanisms for retinopathy of prematurity (ROP). Objective: The study aims to estimate the incidence of ROP and its risk factors, specifically exploring antenatal exposure to HAP due to the use of traditional stoves/chullah as a risk factor for ROP. Methods: This cross-sectional observational study was conducted at a neonatal intensive care unit (NICU) of tertiary care hospital in Nagpur, India. Screening for ROP was done in 196 hospitalized preterm neonates discharged from NICU for a period of
23 months in between December 2012 and October 2014. Mothers were considered as exposed to HAP if there was predominant use of chullah or open fire using wood, charcoal, crop waste, etc., for household cooking activities during her pregnancy and if cooking was done in the same room as the living room. Results: The incidence of any ROP in preterm neonates of mothers who were exposed to high polluting fuels (HPFs) antenatally was 51% as compared to 30% among those exposed to low polluting fuels. Those pregnant women who cooked outdoors or in a separate room had significantly lesser chances of developing ROP. Multivariate
analysis showed that environmental factors such as smoking in the household and usage of HPFs while cooking in the living room of the house (odds ratio 10.15; 95% confidence interval [1.3, 79.43]) increased the risk of developing ROP, after adjusting for other risk factors. In our study population, exposure to smoking and HAP were associated with higher risks of developing ROP, independent of covariates. Conclusion: Effective interventions to a committed and determined intersectoral coordination toward the promotion of public health are the need of the hour.