In a peri-urban community with electricity but polluted air, doctors say many infants arrive in the world already struggling to breathe.
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Pregnant women who spend nine months breathing smoky, polluted indoor air may be setting their babies up for a tough start in life, University of Cape Town (UCT) paediatricians warn in a new study.
Their research links household air pollution and tobacco smoke to poor growth and breathing problems in newborns – even in communities that technically have access to electricity.
What the study found
The team analysed 1 143 live births from the Drakenstein Child Health Study, one of Africa’s largest birth cohorts, to track how indoor air and tobacco exposure shapes newborn health.
They report that 17% of babies were born prematurely, 15% had low birth weight and 7% struggled with respiratory distress at birth.
Babies whose mothers were exposed to high levels of particulate matter (PM10) during pregnancy were almost twice as likely to experience breathing difficulties immediately after delivery.
Elevated carbon monoxide also pushed the odds of respiratory distress to more than double, although this trend did not reach the same statistical strength.
Smoke and stunted growth
The study does not only focus on breathing problems; it also flags growth concerns.
Active maternal smoking was linked to reduced weight-for-age scores in newborns, suggesting babies are starting life smaller and more vulnerable.
Despite 93% of households having electricity, nearly half recorded particulate matter and benzene levels above accepted ambient standards which points to clear evidence that fossil fuels and other dirty-burning sources remain part of everyday life.
Tobacco smoke exposure was widespread. Almost one-third (32%) of mothers were active smokers during pregnancy, while another 45% tested as passive smokers based on urine cotinine, a biomarker of tobacco exposure.
In other words, most babies in this cohort were exposed to smoke before they took their first breath.
‘The air a mother breathes’
“Pregnancy is a critical window of development, and our findings show that the air a mother breathes can have important consequences for her baby’s health from the moment they are born,” said lead researcher Prof Aneesa Vanker from UCT’s Department of Paediatrics and Child Health.
She notes that air pollutants can cross the placenta, exposing the foetus directly and potentially disrupting development long before labour begins.
Vanker and her colleagues, Dr Kirsty Brittain, Dr Whitney Barnett and Prof Heather Zar, went beyond questionnaires and self-reported exposure.
They installed monitors inside participants’ homes to measure particulate matter, carbon monoxide, nitrogen dioxide, sulphur dioxide and volatile organic compounds, giving a hard, numerical picture of what pregnant women were actually breathing.
Policy and public health implications
For Vanker, the findings are a call to action as much as a scientific warning.
“Our research shows that reducing indoor air pollution and tobacco smoke exposure during pregnancy could improve birth outcomes and potentially protect children’s respiratory health over the long term,” she said.
She argues that the data should feed directly into public health planning in South Africa’s peri-urban communities, where formal services and informal practices often collide.
“Preventing these exposures before and during pregnancy offers an opportunity to improve health outcomes at the very beginning of life with life-long consequences,” Vanker added.
She says the results support policies that expand access to clean energy and intensify education campaigns on the dangers of smoking and household air pollution during pregnancy, as well as investment in antenatal programmes that help mothers reduce exposure.
