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  1. Author Response:

    Public Review:

    Li and colleagues used data from 2000 to 2014 in 54 low and middle-income countries (LMICs) to study the association between exposure to landscape fire smoke PM2.5 and birthweight, including very low birthweight. While there is a relatively robust epidemiological literature that supports an association between non-biomass fire smoke PM2.5 and low birthweight, there are relatively few studies that are specific to biomass smoke PM2.5 and birthweight. The authors of this paper conducted their study to specifically address this data gap. They took advantage of satellite data which provide estimates of PM2.5 levels that are now available for most locations in the world at a high geographic resolution (0.5 x 0.5 km). They enhanced the satellite exposure data using a chemical transport model to distinguish fire-sourced PM2.5 from non-fire PM2.5. The exposure modeling approach is sophisticated as is the statistical analysis of the association between the fire-sourced PM2.5 exposure estimates and birthweight outcomes.

    The study has multiple strengths, including the first study of the association between fire-sourced PM2.5 and birthweight to use a sibling-matched case-control design, a large sample size (227,948 births born to 109,137 mothers), the focus on LMICs, the exposure modeling, a careful statistical analytic approach with alternate non-linear regression and sensitivity analyses, and the outcome of very low birthweight that is one of the World Health Organization targets to reduce the global burden of disease. Limitations notwithstanding, this is an impactful study. The results of the authors' analyses provide strong support for the concept that exposure to biomass smoke -- whether from a landscape fire set by farmers, a wildfire, or cooking with solid fuels -- can lead to low birthweight. This concept is especially important for LMICs that have large portions of their populations engaging in slash and burn agriculture and/or cooking with solid fuels. Given that reducing the incidence of low birthweight is a necessary to meet the 2025 United Nations Sustainable Development Goals, it is incumbent that policies to reduce landscape fires and household air pollution from cooking with solid fuels be considered by governments of LMICs. Such policies would also have a climate change mitigation benefit through reduction of greenhouse gases and aerosols.

    Future research efforts to actually measure landscape fire smoke PM2.5 in different locations to provide ground-truthing for the chemical transport model exposure estimates used by the authors would be useful as would a study that could obtain gestation duration data.

    We thank the reviewer for pointing the strengths of this study. We agree with the reviewer on the shortages of this study, particularly the exposure misclassifications caused by multiple reasons. We revise the manuscript accordingly, and enhance the discussions on limitations of this study.

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  2. Evaluation Summary:

    This paper reports the results of an analysis of the association between maternal exposure to landscape fire smoke during pregnancy and low birthweight of the offspring. Given the increasing number, intensity, and duration of landscape fires across the globe as well as the impact of low birthweight on public health, the manuscript will be of interest to both scientists and policymakers. The size of the study population drawn from 54 low and middle-income countries makes the paper an important contribution to the literature on the adverse health effects of biomass fire smoke.

    (This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. Reviewer #1 agreed to share their name with the authors.)

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  3. Public Review:

    Li and colleagues used data from 2000 to 2014 in 54 low and middle-income countries (LMICs) to study the association between exposure to landscape fire smoke PM2.5 and birthweight, including very low birthweight. While there is a relatively robust epidemiological literature that supports an association between non-biomass fire smoke PM2.5 and low birthweight, there are relatively few studies that are specific to biomass smoke PM2.5 and birthweight. The authors of this paper conducted their study to specifically address this data gap. They took advantage of satellite data which provide estimates of PM2.5 levels that are now available for most locations in the world at a high geographic resolution (0.5 x 0.5 km). They enhanced the satellite exposure data using a chemical transport model to distinguish fire-sourced PM2.5 from non-fire PM2.5. The exposure modeling approach is sophisticated as is the statistical analysis of the association between the fire-sourced PM2.5 exposure estimates and birthweight outcomes.

    The study has multiple strengths, including the first study of the association between fire-sourced PM2.5 and birthweight to use a sibling-matched case-control design, a large sample size (227,948 births born to 109,137 mothers), the focus on LMICs, the exposure modeling, a careful statistical analytic approach with alternate non-linear regression and sensitivity analyses, and the outcome of very low birthweight that is one of the World Health Organization targets to reduce the global burden of disease. Limitations notwithstanding, this is an impactful study. The results of the authors' analyses provide strong support for the concept that exposure to biomass smoke -- whether from a landscape fire set by farmers, a wildfire, or cooking with solid fuels -- can lead to low birthweight. This concept is especially important for LMICs that have large portions of their populations engaging in slash and burn agriculture and/or cooking with solid fuels. Given that reducing the incidence of low birthweight is a necessary to meet the 2025 United Nations Sustainable Development Goals, it is incumbent that policies to reduce landscape fires and household air pollution from cooking with solid fuels be considered by governments of LMICs. Such policies would also have a climate change mitigation benefit through reduction of greenhouse gases and aerosols.

    Future research efforts to actually measure landscape fire smoke PM2.5 in different locations to provide ground-truthing for the chemical transport model exposure estimates used by the authors would be useful as would a study that could obtain gestation duration data.

    Read the original source
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