Neurodevelopmental performance among school age children in rural Guatemala is associated with prenatal and postnatal exposure to carbon monoxide, a marker for exposure to woodsmoke

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Highlights★ First study on early life chronic woodsmoke exposure and child neurodevelopment. ★ Poorer child performance at age 6 associated with 3rd trimester woodsmoke exposure. ★ Impaired visual–spatial integration, visual motor memory, fine motor, and attention. ★ Many million developing-world households burning biomass could be affected.We investigated whether early life chronic exposure to woodsmoke, using personal passive 48-h carbon monoxide (CO) as an indicator, is associated with children's neurodevelopmental and behavioral performance. CO measures were collected every 3 months from 2002 to 2005 among mother–child dyads during the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) stove intervention trial in San Marcos, Guatemala. From March to June, 2010, study children of age 6–7 years, performed a follow-up non-verbal, culturally adapted neurodevelopmental assessment. We found inverse associations between CO exposure of pregnant mothers during their 3rd trimesters (m = 3.8 ppm ± 3.0 ppm; range: 0.6–12.5 ppm) and child neuropsychological performance. Scores on 4 out of 11 neuropsychological tests were significantly associated with mothers’ 3rd trimester CO exposures, including visuo-spatial integration (p < 0.05), short-term memory recall (p < 0.05), long-term memory recall (p < 0.05), and fine motor performance (p < 0.01) measured using the Bender Gestalt-II's Copy, Immediate Recall, and an adapted version of a Delayed Recall Figures drawing, and the Reitan-Indiana's Finger Tapping Tests, respectively. These 4 significant finding persisted with adjustment for child sex, age, visual acuity, and household assets (socio-economic status). Summary performance scores were also significantly associated with maternal 3rd trimester CO when adjusted for these covariates. Other variables accounting for variance but were excluded in our final multiple regression models included the following: HOME environment stimulation score, child examiner, WHO height-for-age percentile, and age that the infant stopped breastfeeding. This seems to be the first study on woodsmoke exposure and neurodevelopment, and the first longitudinal birth cohort study on chronic early life CO exposures, determined by high quality measures of mothers’ and infants’ personal CO exposures, and using well-established, reliable child neuropsychological tests. Further research is needed to replicate our results and inform future interventions and air quality standards for woodsmoke and CO.

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