Rollins Research Review: Health Interventions for Pregnant People, Hypertension in Couples, and Household Air Pollution

By Shelby Crosier

This month, Rollins researchers authored papers on a wealth of public health topics. Find summaries of a few highlighted papers below.

Title: “I was having an internal conflict with myself.” COVID-19 vaccination decision-making processes among pregnant women

Journal: Women’s Health

Rollins Author: Subasri Narasimhan, PhD

Important Takeaways:

• Despite the CDC’s recommendation that pregnant people be vaccinated for COVID-19 and evidence that the vaccines are safe and effective, vaccination rates remain low among pregnant women in the U.S.
• Researchers interviewed women who were pregnant during the pandemic to learn about their experiences with prenatal care and delivery, and to understand how they decided whether to be vaccinated.
• The decision-making process around COVID-19 vaccination was complex for pregnant women and was affected by the guidance and support they received, worries about effects of the vaccine on the fetus, their values, and other preventive measures they took.
• This study highlights the need for targeted approaches to help pregnant people make informed decisions about vaccination.

Title:  Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study

Journal: British Journal of Obstetrics and Gynaecology

Rollins Author: Sarah LaPointe, PhD

Important Takeaways:

• Extreme heat has negative impacts on birth outcomes, especially in low- and middle- income countries (LMIC) with limited access to interventions like air conditioning.
• This study investigated the association between extreme heat exposure during pregnancy and low birth weight for pregnant women in Ghana, and explored whether the association was affected by participation in a cash transfer program (a program that provides money to impoverished families at regular intervals).
• Temperatures above 30° C (86° F) were associated with increased odds of low birth weight, but these impacts were less severe for women participating in the cash transfer program.
• The results suggest that poverty alleviation programs such as cash transfer can be a useful tool in combatting the health effects of climate change in LMIC.

Title:  Spousal Concordance of Hypertension Among Middle‐Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India

Journal: Journal of the American Heart Association

Rollins Authors: Jithin Sam Varghese, PhD; Daesung Choi, PhD; Mohammed K. Ali, MD; Shivani Patel, PhD

Important Takeaways:

• Hypertension (high blood pressure) is a health risk that is easily identifiable, preventable, and treatable, but poor diagnosis and management of the condition continue to be an issue worldwide.
• Researchers used data about couples from large studies in the U.S., England, China, and India to investigate similarities in hypertension status between husbands and wives, which is called spousal concordance.
• Even when controlling for things like wealth and education level, spousal concordance of hypertension was high—in about 20-40% of couples in each country, if one spouse had hypertension, so did the other.
• These findings suggest that it may be beneficial to design interventions centered on couples and family units to prevent and treat hypertension.

Title:  Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia

Journal: The New England Journal of Medicine

Rollins Authors: Howard Chang, PhD; Amy Lovvorn; Lance Waller, PhD; Shirin Jabbarzadeh, MD; Jiantong Wang; Kyle Steenland, PhD; Thomas Clasen, PhD

Important Takeaways:

• In LMIC, burning biomass fuel (like wood and charcoal) when cooking is common and contributes to household air pollution, which puts infants at risk for severe pneumonia.
• The Household Air Pollution Intervention Network (HAPIN) trial tested whether cooking with liquid petroleum gas (LPG) instead of biomass would influence levels of indoor air pollution and associated negative health outcomes.
• Although use of LPG stoves reduced exposure to indoor air pollution for pregnant women and their children, it did not significantly lower infants’ risk of developing severe pneumonia.
• Additional efforts to limit indoor air pollution levels, along with widespread community interventions, may be needed to reduce the risk of severe pneumonia in infants.

Title:  Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants

Journal: The New England Journal of Medicine

Rollins Authors: Sheela Sinharoy, PhD; Howard Chang, PhD; Lance Waller, PhD; Kyle Steenland, PhD; Usha Ramakrishnan, PhD; Jiantong Wang; Shirin Jabbarzadeh, MD; Thomas Clasen, PhD

Important Takeaways:

• Stunted growth in infants is associated with household air pollution, which in LMIC, is often related to burning biomass to cook and heat homes.
• The HAPIN trial investigated whether using LPG instead of biomass fuel for cooking during pregnancy and postpartum would have an effect on levels of infant stunting.
• There is evidence that cooking with LPG reduced exposure to household air pollution for both pregnant women and infants, but there was no significant difference in the risk of stunted growth at birth or one year after birth in houses that used LPG rather than biomass fuel.
• This could mean that to prevent stunting, changes to indoor air pollution exposure would need to happen earlier in pregnancy or preconception, or that the level of pollution is not reduced enough by switching to LPG.