Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth. The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18–34 years (9–19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24–28 weeks of gestation (the first pregnancy visit), and 32–36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure–response analyses to identify associations between household air pollutants and fetal size. This trial is registered with (. Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0–1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 μm (PM; 35·0 [SD 37·2] μg/m 103·3 [97·9] μg/m) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 0·39; p=0·04), abdominal circumference (0·38 0·39; p=0·99), femur length (0·44 0·45; p=0·73), and estimated fetal weight or birthweight (–0·13 –0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size. Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking. US National Institutes of Health and Bill & Melinda Gates Foundation. For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.

中文翻译：

---

用液化石油气或生物质烹饪与胎儿生长结果：一项多国随机对照试验


家庭空气污染可能会导致怀孕期间胎儿生长受限。我们的目的是调查减少个人在怀孕期间接触家庭空气污染的液化石油气（LPG）干预措施是否会改变胎儿的生长。家庭空气污染干预网络 (HAPIN) 试验是一项开放标签随机对照试验，在危地马拉、印度、秘鲁和卢旺达的 10 个资源有限的地区进行。 18-34 岁（妊娠 9-19 周）的孕妇以 1:1 的比例随机分配接受液化石油气炉、持续燃料输送和行为信息传递，或继续使用生物质进行常规烹饪 18 个月。我们在基线、妊娠 24-28 周（第一次妊娠访视）和妊娠 32-36 周（第二次妊娠访视）进行超声评估，以测量胎儿大小；在这些访问期间，我们监测了个人 24 小时接触家庭空气污染物的情况；我们在孩子出生时称重。我们进行了意向治疗分析，以估计干预组和对照组之间胎儿大小的差异，并进行暴露反应分析，以确定家庭空气污染物与胎儿大小之间的关联。该试验注册于（。2018年5月7日至2020年2月29日期间，我们随机分配了3200名孕妇（干预组1593人，对照组1607人）。平均孕龄为14·5（SD 3 ·0) 周，平均孕产妇年龄为 25·6 (4·5) 岁。我们对 3147 名 (98·3%) 妇女进行了基线超声评估，对 3052 名 (95·4%) 妇女进行了第一次妊娠就诊，并进行了超声评估。 2962 (92·6%) 第二次怀孕就诊，截至 2020 年 8 月 25 日。 干预依从性很高（使用生物质炉灶的天数中位数比例为 0·0%，IQR 0·0–1·6），干预组中的孕妇平均暴露于直径小于 2· 的颗粒物的情况较低比对照组女性低 5 μm（PM；35·0 [SD 37·2] μg/m 103·3 [97·9] μg/m）。我们没有发现头围（0·30 0·39；p=0·04）、腹围（0·38 0·39；p=0·99）、股骨长度（ 0·44 0·45；p=0·73），以及干预组和对照组之间的估计胎儿体重或出生体重（–0·13 –0·12；p=0·70）。个人接触家庭空气污染物与胎儿大小无关。尽管液化石油气烹饪干预成功地减少了怀孕期间个人接触空气污染的情况，但它并没有影响胎儿的大小。我们的研究结果不支持在生物质燃料主要用于烹饪的环境中使用不通风的液化石油气炉作为促进胎儿生长的策略。美国国立卫生研究院和比尔及梅琳达·盖茨基金会。有关摘要的基尼亚卢旺达语、西班牙语和泰米尔语翻译，请参阅补充材料部分。