Indoor smoke and prenatal and childhood growth: The role of (gestational) age

Abstract

Growth at birth and during infancy predicts several outcomes in the immediate future as well as in the long term. Weight and height are commonly used surrogates of growth, however, infants and young children are constantly growing unlike adults. Hence, weight and height alone are insufficient measures of growth if the time component is not associated with them. Recent studies have investigated the relationship between indoor air pollution and growth using height and weight. In this commentary, I have argued using a directed acyclic graph, that a causal association between indoor pollution exposure and growth at birth cannot be established unless birth weight is adjusted for gestational age. Furthermore, to make any causal inference between growth during the first few years of life and indoor exposure, in addition to age standardization, studies must also account for fetal growth to discount any continuation of prenatal effects, which may be in the causal pathway. A careful consideration is warranted from future studies investigating these relationships.

Keywords: Biofuel; Coal smoke; Wood smoke; Birth weight; Fetal growth; Height

Core tip: Prenatal and early childhood estimators of growth, such as birth weight, height etc. by themselves are inadequate measures for inter-individual comparison, unless accompanied by gestational or chronologic age. The existing evidence points toward an association between indoor air pollution and growth, however few considered age. In order to establish a causal relationship it is imperative to consider age adjusted growth.