Preterm birth rates in Avon County, England, and urban Ukraine.

OBJECTIVE: We compared rates of total and spontaneous preterm birth in Avon County, England and urban Ukraine to explore whether adverse conditions in the former eastern bloc influenced the preterm rate. STUDY DESIGN: Women who had last menstrual period (LMP) in a specified time window were recruited from geographically defined areas. Data were gathered between 1992 and 1995, using maternal questionnaires and medical record abstraction, with comparable methods in both sites insofar as possible. There were 13731 births in Avon and 3087 in Ukraine. Rates of total and spontaneous preterm births were compared, taking account of maternal characteristics and other relevant variables. RESULTS: The total preterm birth rates were similar (5.9%, Ukraine; 5.5%, Avon) but the spontaneous preterm rate was about 60% higher in Ukraine (5.0% versus 3.1%). Maternal characteristics and measurement differences did not explain the discrepancy. CONCLUSION: The difference in the spontaneous preterm rates may reflect differences in obstetrical management resulting from shortages of medical supplies and equipment in Ukraine.

Placental weight and its ratio to birthweight in a Ukrainian city.

BACKGROUND: Placental weight and its ratio to birthweight have recently been reported to predict later chronic disease. These fetal growth indicators have been measured in the west for over a century with consistent results when methods of preparation were comparable. We investigated whether recent difficult conditions in the former eastern bloc have altered placental weight or its relationship to other fetal size measures from what has historically been reported. METHODS: Placentas were obtained from 1621 singleton births of at least 28 weeks gestation in a Ukrainian city during 1993-1994, using a systematic protocol. Maternal characteristics were obtained from questionnaires. Pregnancy complications and birth size measures (infant weight, length, crown-rump length, and head circumference) were abstracted from medical records. We examined relationships of placental weight and ratio to these variables. RESULTS: Placental weight ranged from 100 to 1000 g, with a mean of 470 g. Mean placental ratio was 13.9%. Placental weights increased and ratios decreased with gestational age. Larger ratios were related to larger maternal BMI. Absolute measures of infant size and placental weight were mutually positively correlated. Placental ratio, infant length, and ponderal index (PI) were nearly uncorrelated. CONCLUSIONS: Absolute and relative weights of Ukrainian placentas were similar to historical reports, as were their relationships to other infant size indicators. Placental weight ratio (PWR), ponderal index, and infant length measured different birth size dimensions. Placental availability, consistency of placental measurements, and placental ratio's reflection of an independent facet of fetal growth make the placenta a useful research tool.

Persistent organochlorine compounds and birth weight.

PURPOSE: To determine whether weight at birth is related to prenatal exposure to persistent organochlorine compounds. METHODS: Birth weight was obtained for 197 singleton infants drawn from the general population born in two cities in Ukraine in 1993 to 1994. Concentrations of seven organochlorine pesticides (p,p'-DDT, p,p'-DDE, beta-hexachlorocyclohexane, hexachlorobenzene, trans-nonachlor, oxychlordane, heptachlor epoxide) and 11 polychlorinated biphenyl congeners measured in maternal milk taken at four or five days after birth were used as an index of prenatal exposure. RESULTS: The greatest differences were seen for beta-hexachlorocyclohexane, with a pattern not suggestive of dose-response; infants in the lowest tertile were small, those in the central tertile were large, and those in the upper tertile were average. Adjustment for gestational age and other potential confounders had little effect on these patterns. Infants in the two upper tertiles for p,p'-DDE were larger than those in the lower tertile, with the effect being more striking after adjustment for gestational age. Adjustment for potential confounders made the pattern disappear. Other chemicals showed no convincing evidence of effects. CONCLUSIONS: Prenatal exposure to the chemicals studied, at concentrations currently seen in this population, does not impact weight at birth.