Environmental exposures and adverse pregnancy outcomes in Ethiopia: A systematic review and meta-analysis

Abstract

Background Maternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects. Objective This review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia. Method A systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software. Result The pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33–3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25–4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58–3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82–5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09–6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36–6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61–7.57) compared with non-exposed pregnant women. Conclusion Household air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects. Trial registration PROSPERO 2022: CRD42022337140.

Effect of a chimney-fitted improved stove on pregnancy outcomes in Northwest Ethiopia: a randomized controlled trial

“…Beyond the cardiorespiratory impact, emerging evidences indicate a link between HAP and detrimental pregnancy outcomes [ 7 , 32 , 33 ] encompassing conditions such as low birth weight (LBW), pre-term birth (PTB), congenital anomalies [ 34 , 35 ] and post-neonatal infant mortality [ 36 ]. Because, fetuses during pregnancy are uniquely susceptible to air pollution due to the critical stage of development they are in, where rapidly dividing cells and shifting metabolic needs make them sensitive to environmental toxins [ 37 , 38 ].…”

Is exposure to pesticides associated with biological aging? A systematic review and meta-analysis

“…Although acute non-intentional poisoning incidents have become infrequent, long-term and low-dose exposure to pesticides has various adverse effects to human health including neurologic diseases (Bemanalizadeh et al, 2022;Yan et al, 2016), cancers (Togawa et al, 2021), birth defects (Enyew et al, 2023) and diabetes (Jia et al, 2023). Moreover, evidence from longitudinal population-based studies indicates that exposure to pesticides is associated with a higher risk of all-cause mortality (Bao et al, 2020;Di et al, 2023).…”