Case Studies

Testing for toxins in Mariupol.

UKRAINE: Family and Children of Ukraine

Family and Children of Ukraine is the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). ELSPAC was initiated by the World Health Organization, and the research protocols were developed by the ELSPAC Coordinating Committee, which is based in the Department of Child Health, University of Bristol, England. ELSPAC is a prospective, geographically-based series of population studies designed to include pregnancy and to follow the cohort of births until the age of 7 years. Family and Children of Ukraine is administered by a binational executive committee and is based in the Ukrainian Institute of Pediatrics, Obstetrics, and Gynecology (IPOG), in Kyiv. Family and Children of Ukraine was initiated, in part, with support from NIEHS (Dr. Ruth Little and Dr. Beth Gladen) and was continued with support from the National Center for Health Statistics (Dr. Ken Schoendorf). With the support of our ITREOH program, IPOG established its own Institutional Research Ethics Committee to review issues associated with human subjects research relative to this study. ITREOH funding also provided research training for Ukrainian scientists involved in this research and supported the data management and analysis through the UIC Louise Hamilton Center.

Family and Children of Ukraine recruited 8,000 pregnant women in 5 cities in Ukraine (Kyiv, Dniproderzhinsk, Mariupol, Ivano-Frankivsk, and Krasny Louch) beginning in 1992. Information about these women and their children was collected by means of self-completion of questionnaires and abstraction of medical records at certain points in time. The questionnaires used in the Family and Children of Ukraine study are based on the ELSPAC questionnaires and are modified for use in Ukraine. They have been translated, reverse-translated and approved by the Coordinating Committee in Bristol. The questionnaires include:

Measuring weight in Mariupol.

1. two antepartum questionnaires completed by the mother;
2. an antepartum questionnaire completed by the partner;
3. 6-week of infant age postpartum questionnaire;
4. 6-month of age questionnaire;
5. 18-month of age questionnaire;
6. 3-year of age questionnaire;
7. 5-year of age questionnaire; and
8. 7-year of age questionnaire.

In addition, medical records are abstracted at delivery, 6 months, 18 months, 3 years, 5 years, and 7 years, at the time of any hospitalization, and in the event of death or miscarriage. In addition to the main study, local investigators initiate focus studies using these cohorts that address specific research questions.

The children enrolled in this study are now approaching 7 years of age, and we are beginning administration of the 7-year old questionnaire and medical record abstraction this year. We are also in the process of analyzing the large amounts of data that have been gathered to date. A major aim of the data analysis is to identify risk factors for adverse pregnancy outcomes and childhood illness which are amenable to clinical or public health interventions. For example, in one of our focus studies, Environmental Pollution and Health Status of Children, we observed that 3 y.o. children living in the city of Mariupol had urinary 1-OH pyrene levels (biomarkers of exposure to polycyclic aromatic hydrocarbons), that were twice as high as the most polluted cities in Japan. Mariupol has been targeted by USEPA, USAID, and the World Bank for international support for pollution prevention.