• Donee Alexander, Amanda Northcross, Nathaniel Wilson, Anindita Dutta, Rishi Pandya, Tope Ibigbami, Damilola Adu, John Olamijulo, Oludare Morhason-Bello, Theodore Karrison, Oladosu Ojengbede, and Christopher O Olopade.
• 1 Center for Global Health.
• Am. J. Respir. Crit. Care Med. 2017 Jun 15; 195 (12): 1629-1639.

RationaleHypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP).ObjectivesTo investigate the ability of a clean cookstove intervention to lower BP during pregnancy.MethodsWe conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects.Measurements And Main ResultsThe change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029).ConclusionsTo our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution. Clinical trial registered with www.clinicaltrials.gov (NCT02394574).

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