Abstract
Evidence linking household air pollution exposure and blood hemoglobin concentration is lacking. We examine the effect of a liquefied petroleum gas cookstove and fuel intervention on hemoglobin concentration, along with associations between household air pollution exposures and hemoglobin concentration, among pregnant women. We enroll 800 pregnant women each in Guatemala, Peru, India, and Rwanda in an open-label randomized controlled trial (NCT02944682). In 3178 women (intervention=1585; control=1593), we measure hemoglobin concentration and 24-hour personal exposure to particulate matter with an aerodynamic diameter ≤2.5μm (PM2.5), black carbon (BC), and carbon monoxide (CO) at three timepoints (9-20, 24-28, and 32-36 weeks gestation). We evaluate the effects of the intervention on hemoglobin concentration and conduct exposure-response analyses to examine associations between 24-hour personal exposure to measured pollutants and hemoglobin concentration. We identify a significant increase in hemoglobin in the intervention group (0.074 g/dL, 95% CI: 0.002, 0.145) compared to the control group. In exposure-response analyses, each 1ppm increase in CO exposure is associated with a 0.015 g/dL (95% CI: 0.008, 0.023) increase in hemoglobin. In our analyses, neither PM2.5 nor BC are associated with hemoglobin concentration. Further research may be needed to examine the biological mechanisms underlying our findings.
Acknowledgements
The investigators would like to thank the members of the advisory committee – Drs. Patrick Breysse, Donna Spiegelman, and Joel Kaufman – for their valuable insight and guidance throughout the implementation of the trial. We also wish to acknowledge all research staff and study participants for their dedication to and participation in this important trial. A multidisciplinary, independent Data and Safety Monitoring Board (DSMB) appointed by the National Heart, Lung, and Blood Institute (NHLBI) monitored the quality of the data and protected the safety of patients enrolled in the HAPIN trial. The DSMB consisted of: Catherine Karr (Chair), Nancy R. Cook, Stephen Hecht, Joseph Millum, Nalini Sathiakumar (deceased), Paul K. Whelton, and Gail Weinmann and Thomas Croxton (Executive Secretaries). Program Coordination: Gail Rodgers, Bill & Melinda Gates Foundation; Claudia L. Thompson, National Institute of Environmental Health Sciences; Mark J. Parascandola, National Cancer Institute; Marion Koso-Thomas, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Joshua P. Rosenthal, Fogarty International Center; Concepcion R. Nierras, NIH Office of Strategic Coordination – The Common Fund; Katherine Kavounis, Dong-Yun Kim, Barry S. Schmetter (deceased), and Antonello Punturieri, NHLBI. This research represents the NIH’s contribution to the Global Alliance for Chronic Diseases (GACD) coordinated call for research on prevention and management of chronic lung diseases for 2016.
Funding
The HAPIN trial was funded by the U.S. National Institutes of Health (cooperative agreement 1UM1HL134590 to W.C., J.P., and T.C.) in collaboration with the Bill & Melinda Gates Foundation [OPP1131279 to W.C., J.P., and T.C.]. The sponsors did not have any role in study design; in the collection, analysis, or interpretation of data; or in the writing of the report. Research reported in this publication was supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under Award Number 1UM1HL134590. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. It is subject to the NIH Public Access Policy. Through acceptance of this federal funding, NIH has been given the right to make this manuscript publicly available in PubMed Central upon the Official Date of Publication, as defined by NIH. This work was supported, in whole or in part, by the Gates Foundation [OPP1131279]. The conclusions and opinions expressed in this work are those of the author(s) alone and shall not be attributed to the Foundation. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Please note that works submitted as a preprint have not undergone a peer review process.
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Sinharoy, S.S., Ye, W., Pillarisetti, A. et al. Effects of cooking with liquefied petroleum gas versus biomass on hemoglobin concentrations in pregnant women: a pre-specified exploratory analysis of the HAPIN trial. Nat Commun (2026). https://doi.org/10.1038/s41467-026-74114-9
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DOI: https://doi.org/10.1038/s41467-026-74114-9
