1. Summer 2012 Practicum Veliky Novgorod, Russia Julie Mooza Department of Epidemiology, University of Massachusetts

2. Outline 1. Veliky Novgorod: A Tour of Images History Sites Portrait of Today Maternity Clinic 2. Practicum Project: An Epidemiological Study Introduction Methods Discussion

3. History Veliky Novgorod translates literally to “Great New City.” Originally populated by Scandinavians (Norse). Founded in the year 859.

4. 1.Wooden Architecture Museum 2.Local Cathedrals 3.Novgorod Kremlin Sites

5. Museum Vitoslavlitsy (wooden architecture museum)

6. Interior house

7. Exterior house Cathedral

8. Local cathedrals

9. Novgorod Kremlin St. Sephia’s Cathedral

10. Portrait of Today

11. Dormitory Around Town

13. Maternity Clinic

14. Maternity clinic facilities

15. PRACTICUM PROJECT An 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.

16. Prevalence of LBW Morbidity and Mortality of LBW Established Risk Factors of LBW Physiology of Alcohol, Smoking, and LBW INTRODUCTION

17. Prevalence Russia YearPrevalence (%) 19905.3 20016.3 20065.9 20076.0 Data from Index Mundi. (2011) Profiles of country statistics. Retrieved from www.indexmundi.com on October 26, 2011.www.indexmundi.com United States YearPrevalence (%) 19907.0 19947.3 19987.4 20027.8

18. 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.

19. 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.

20. 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.

21. Intrauterine Growth Retardation (IUGR) Physiology Alcohol Ingestion Smoke Inhalation Low Birth Weight Preterm Birth Nicotine, Hydrogen Cyanide, Carbon Monoxide Oxygen Supply is Depleted Ethanol Acetaldehyde Nutrient Absorption is Disrupted

22. Study Design, Population, Sample Size Exposure Assessment Outcome Assessment METHODS

23. 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.

24. 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

25. Self Report: Mothers reported birth weight on questionnaire. Clinical Chart Review: Considered the “gold standard” of collection methods. Outcome Assessment AND

26. Limitations Strengths DISCUSSION

27. 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

28. 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

29. конец