In-utero exposure to multiple air pollutants and childhood undernutrition in India
Arup Jana1, Akancha Singh1, Sara D Adar2
1Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
Insights
Exposure to indoor and ambient air pollution during pregnancy significantly increases the risk of child undernutrition, including stunting, underweight, and anemia. Combined exposure to both pollution types exacerbates these negative health outcomes in children.
Area of Science:
- Environmental Health
- Pediatric Nutrition
- Public Health
Background:
- Previous research focused on socioeconomic and maternal factors impacting child undernutrition.
- Limited studies have investigated the combined effects of indoor fuel use and ambient air pollution on child health.
- Existing literature predominantly concentrated on particulate matter 2.5 (PM$_{2.5}$) exposure.
Purpose of the Study:
- To examine the individual and community-level associations between indoor (cooking fuel) and ambient air pollution (PM$_{2.5}$, NO$_{2}$, SO$_{2}$) during gestation and child undernutrition.
- To assess the joint impacts of various air pollutants on fetal development and subsequent child health outcomes.
Main Methods:
- Analysis of stunting, underweight, and anemia in children aged 0-59 months using the National Family Health Survey (n=259,627).
- Estimation of in-utero exposure to ambient PM$_{2.5}$, NO$_{2}$, and SO$_{2}$ via satellite data; indoor pollution assessed by self-reported fuel type.
- Application of spatial lag models and multivariable logistic regression, adjusting for covariates, to evaluate pollution effects at individual and community levels.
Main Results:
- Higher indoor and ambient air pollution concentrations were observed in Northern and parts of Central India.
- Increased maternal exposure to ambient PM$_{2.5}$ was associated with higher prevalence of stunting (0.11 pp), underweight (9 pp), and anemia (19 pp) per 1 μg/m$^3$ increase.
- Exposure to both indoor and ambient air pollution during gestation significantly increased the odds of child undernutrition, with combined exposure showing amplified risks.
Conclusions:
- This study provides initial evidence on the individual impacts of indoor and outdoor air pollution exposure during fetal development on children's nutritional status.
- Ambient PM$_{2.5}$ and NO$_{2}$ showed significant associations with increased odds of stunting, underweight, and anemia in children.
- Combined exposure to indoor and ambient air pollution during pregnancy poses a greater risk for childhood undernutrition.
Background:
Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5.
Objective:
This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition.
Methods:
This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels.
Results:
Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished.
Impact Statement:
Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.
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