ArticleBMJ open respiratory research2026
Antenatal environmental exposure to indoor air pollution and environmental tobacco smoke: association with birth outcomes in an African birth cohort.
Article in BMJ open respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Indoor air pollution (IAP) and environmental tobacco smoke exposure (ETS) are important antenatal environmental exposures that may adversely impact birth outcomes.
objectivesTo investigate the impact of IAP and ETS during pregnancy on birth outcomes including respiratory distress in an African birth cohort, the Drakenstein Child Health Study.
settingProspective cohort study conducted in a periurban setting in sub-Saharan Africa within a large birth cohort.
participantsConsenting pregnant women (n=1137) enrolled between 20 and 28 weeks' gestation, with 1143 live births included in the analysis. Participants were recruited antenatally, with inclusion based on residency in the study area and availability of exposure and outcome data. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary exposures included antenatal IAP (particulate matter (PM10), carbon monoxide (CO), nitrogen dioxide, sulphur dioxide, volatile organic compounds) and ETS (maternal urine cotinine). Outcomes included birth anthropometry, prematurity, low birth weight and neonatal respiratory distress.
resultsAmong 1143 live births, 17% were premature, 15% had low birth weight and 7% had respiratory distress. Maternal active smoking was associated with reduced weight-for-age z-scores (WfAz; β -0.54; p<0.001). Babies exposed to PM
conclusionsAntenatal exposure to IAP and ETS is associated with adverse birth outcomes, including impaired growth and increased risk of respiratory distress. These findings support the need for targeted public health interventions to reduce exposure during pregnancy and highlight the importance of improving air quality to mitigate long-term respiratory health risks.
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