Early life cookstove interventions and children's blood pressure: Evidence from the Ghana randomized air pollution and health study.

Evidence on household air pollution (HAP) and childhood blood pressure (BP) is scarce. We leveraged a prospective pregnancy cohort derived from the Ghana Randomized Air Pollution and Health Study (GRAPHS) to determine associations between cookstove interventions to reduce HAP exposure in the prenatal and first year of life, and BP measured annually from age 4 through 9 years (n = 691). GRAPHS was a randomized-controlled trial of two cookstove interventions-Liquefied Petroleum Gas stove (LPG), improved biomass stove-or Control (three-stone open fire) initiated in early pregnancy and maintained through age one year. We used Poisson and linear mixed-effects models, and Poisson Generalized Estimating Equations to examine associations between stove assignment and high versus normal BP, as determined by BP percentiles for sex, age and height, or secondarily with BP as a continuous outcome. As compared to control, the LPG intervention was associated with lower risk of high Diastolic BP (DBP) [strongest association: age 4-5 (adjusted RR = 0.66; 95 % CI = 0.58, 0.75; unadjusted p < 0.001; Holm-adjusted p < 0.001)], lower risk of having at least one count of high DBP (adjusted RR = 0.86; 95 % CI = 0.78, 0.95, p = 0.002), and lower mean DBP [strongest association: age 4-5 (adjusted β = -1.69; 95 % CI = -2.96, -0.42; unadjusted p = 0.01); Holm-adjusted p = 0.02] compared to control. No associations between improved biomass and BP were identified. These results suggest that an LPG intervention to reduce HAP during prenatal and first year of life is associated with better early to mid-childhood cardiovascular health, highlighting the importance of HAP reduction beginning prenatally.