Summer 2012 PracticumVeliky Novgorod, Russia

Julie MoozaDepartment of Epidemiology, University of Massachusetts

Outline1. Veliky Novgorod: A Tour of Images• History • Sites• Portrait of Today• Maternity Clinic

2. Practicum Project: An Epidemiological Study• Introduction• Methods• Discussion

History

• Veliky Novgorod translates literally to “Great New City.”

• Originally populated by Scandinavians (Norse).

• Founded in the year 859.

1. Wooden Architecture Museum

2. Local Cathedrals

3. Novgorod Kremlin

Sites

Museum Vitoslavlitsy (wooden architecture museum)

Interior house

Exterior house Cathedral

Local cathedrals

Novgorod Kremlin St. Sephia’s Cathedral

Portrait of Today

Dormitory Around Town

Around Town

Maternity Clinic

Maternity clinic facilities

PRACTICUM PROJECTAn epidemiological study to assess the relationship

between alcohol consumption and smoking during pregnancy and low birth weight (LBW) in infants born

in Veliky Novgorod, Russia.

• Prevalence of LBW

• Morbidity and Mortality of LBW

• Established Risk Factors of LBW

• Physiology of Alcohol, Smoking, and LBW

INTRODUCTION

Prevalence

Russia

Year Prevalence (%)

1990 5.3

2001 6.3

2006 5.9

2007 6.0

Data from Index Mundi. (2011) Profiles of country statistics. Retrieved from www.indexmundi.com on October 26, 2011.

United States

Year Prevalence (%)

1990 7.0

1994 7.3

1998 7.4

2002 7.8

Morbidity

• LBW infants are at increased risk for developing:• Neurodevelopmental handicaps• Congenital anomalies• Lower respiratory tract conditions• Learning disabilities

• LBW infants are 3 times as likely as to have neurodevelopmental handicaps as normal birth weight infants.

Mortality

• During pregnancy, risk of neonatal death is 200 times greater for very low birth weight (VLBW) infants than for normal birth weight infants.

• During first 4 weeks of life, LBW infants are almost 40 times more likely to die than normal birth weight infants.

• During first year of life, LBW infants are 5 times more likely to die than normal birth weight infants.

Risk Factors

Demographic: Age, socioeconomic status, education level, race.

Medical (Predating Pregnancy): Parity, maternal BMI, select diseases, obstetric history, and genetic factors.

Medical (Current Pregnancy): Number of fetuses (singleton, twins, etc.), weight stability, and select diseases.

Health Care: Presence or absence of prenatal care.

Behavioral: Smoking, nutrition, alcohol and substance abuse.

Environmental: Toxic exposures, and high altitudes.

Developing Concepts: Physical and psychological stress, and select diseases.

Intrauterine Growth

Retardation (IUGR)

Physiology

Alcohol Ingestion

Smoke Inhalation

Low Birth Weight

Preterm Birth

Nicotine, Hydrogen Cyanide, Carbon Monoxide

Oxygen Supply is Depleted

EthanolAcetaldehyde

Nutrient Absorption is

Disrupted

• Study Design, Population, Sample Size

• Exposure Assessment

• Outcome Assessment

METHODS

• Study Design: Cross-sectional.

• Study Population: Mothers who gave birth in the maternity clinic between June 1, 2010 and June 1, 2011 in Veliky Novgorod, Russia.

• Sample Size: 84 completed questionnaires were collected from 100 distributed questionnaires.

• Questionnaire: An adaptation of the Centers for Disease Control’s Pregnancy Risk Assessment System (PRAMS).

• Adaptations to the Questionnaire:• Subtracted: Nutrition and health insurance questions.• Condensed: Physical and psychosocial questions.• Added: Two questions regarding medical conditions and

medications.

Exposure Assessment

• Self Report: Mothers reported birth weight on questionnaire.

• Clinical Chart Review: Considered the “gold standard” of collection methods.

Outcome Assessment

AND

• Limitations

• Strengths

DISCUSSION

Sample Size: 84 completed questionnaires.• Results will provide low statistical power.

Selection Bias: There was an 84% participation rate.• Mean differences in birth weight will be underestimated.

Misclassification of Exposure: Women were likely to report no drinking or smoking when in fact they had. • Mean differences in birth weight will be underestimated.

Limitations

Confounding Variables: First study to include this combination of covariates in the regression model.

Study Population: First study to examine this exposure-outcome relationship in Veliky Novgorod and (to my knowledge) the second study to examine this exposure-outcome relationship in Russia.

Strengths

конец