Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence

PLoS One. 2014 Dec 2;9(12):e113920. doi: 10.1371/journal.pone.0113920. eCollection 2014.


Background: About 41% of households globally, mainly in developing countries rely on solid fuels for cooking with consequences for fetal growth and development. Previous reviews were limited in scope, assessing only two outcomes (birth weight, stillbirth). With important evidence accumulating, there is a need to improve the previous estimates and assess additional outcomes. We conducted a systematic review and meta-analysis to evaluate the quality and strength of available evidence on household air pollution (HAP) and the whole range of adverse pregnancy outcomes.

Methods: PubMed, Ovid Medline, Scopus and CINAHL were searched from their inception to the end of April 2013. All epidemiological study designs were eligible for inclusion in the review. The random-effects model was applied in computing the summary-effect estimates (EE) and their corresponding 95% confidence interval (CI).

Results: Of 1505 studies screened, 19 studies satisfied the inclusion criteria. Household combustion of solid fuels resulted in an 86.43 g (95% CI: 55.49, 117.37) reduction in birth weight, and a 35% (EE = 1.35, 95% CI: 1.23, 1.48) and 29% (EE = 1.29, 95% CI: 1.18, 1.41) increased risk of LBW and stillbirth respectively.

Conclusion: Combustion of solid fuels at home increases the risk of a wide range of adverse pregnancy outcomes. Access to clean household energy solutions is the surest way to combat HAP and mitigate their adverse effects.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Air Pollution, Indoor / adverse effects*
  • Birth Weight
  • Empirical Research
  • Female
  • Fossil Fuels / adverse effects*
  • Humans
  • Infant, Low Birth Weight
  • Pregnancy
  • Pregnancy Outcome*
  • Publication Bias
  • Risk Factors
  • Stillbirth / epidemiology


  • Fossil Fuels

Grants and funding

This work was funded by Academy of Finland Medical Research Council grant No. 266314. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.