Family and Children of Ukraine
Family and Children of Ukraine (FCOU) is the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). ELSPAC was initiated in 1985 by the World Health Organization. The aim of ELSPAC is to detect the biologic, psychological, and social factors, as well as factors of external environment, which are connected with survival and health of the fetus, infant and child.
FCOU is administered by a bi-national (Ukraine and U.S.) Steering Committee that is based at the Institute of Pediatrics, Obstetrics, and Gynecology (IPOG) in Kyiv, Ukraine. The co-PIs of FCOU are Dr. Zoreslava Shkyryak-Nyzhnyk from IPOG and Dr. Daniel Hryhorczuk from UIC. UIC supports a data management center at IPOG (the Louise Hamilton Data Management Center) that provides the data management for the study and archives all study materials (other than biological samples). The Data Management Center is directed by Mr. Alexander Zvinchuk.
The design of the FCOU study consisted of recruitment of 1148 pregnant women from the Left Bank district of Kyiv from December 1992 to June 1994, 2156 from the city of Dniprodzerzynsk from December 1992 to June 1994, and 1206 from the Ordzhonikidze district of Mariupol from August 1993 to August 1996. Their offspring are followed to 18 years of age. Data are collected using self-completion questionnaires and medical record review. ELSPAC questionnaires that were administered included About Yourself (prenatal), Having a Baby (prenatal), Prenatal Partner, Delivery, 6 Week Old Child (birth to 6 weeks of age), 6 Month Old Child (6 weeks to 6 months of age), 3 Year Old Child (18 months to 3 years of age) and 7 Year Old Child (3–7 years of age). In 2002 parents were also asked to complete a supplemental 7 Year Old Child ISAAC Asthma Assessment questionnaire. Health records were reviewed and abstracted at delivery and at 6 months (for the period, delivery to 6 months), at 18 months (for the period, 6 months to 18 months), at 3 years (for the period, 18 months to 3 years) and at 7 years (for the period, 3–7 years). In addition to the ELSPAC questionnaires and medical record abstraction, focus studies were conducted by FCOU investigators on 1) Birth Outcomes and Environmental Pollution; 2) Environmental Pollutants and Health Status of Children; and 3) Wheezing Illness in 7 year old children.
Birth Outcomes and Environmental Pollution was a focus study conducted by Dr. Ruth Little and Dr. Beth Gladen from the National Institute of Environmental Health Sciences. Data collection and data management for this study was contracted to UIC with Dr. Daniel Hryhorczuk as the principal investigator. In addition to the ELSPAC antenatal, delivery, and perinatal data collection, we collected samples of placenta, umbilical cord, and breast milk from participants in Kyiv and Dniprodzerzhinsk. NIEHS analyzed 200 of these samples for PAHs, metals, organochlorines, and dioxin. These samples are currently archived at NIEHS.
Environmental Pollutants and Health Status of Children was a series of focus studies initiated by Dr. Daniel Hryhorczuk at UIC and funded by the United States Environmental Protection Agency and USAID. These studies included 1) Exposure to toxic metals and neurobehavioral development; 2) Exposure to PAHs and immune function; and 3) Body burdens of persistent organic pollutants. These studies compared random samples of children who were within 3 months of age 3 years who were members of the Mariupol subcohort to children of similar age in the Kyiv subcohort. The toxic metals and PAH studies included different samples of 50 children from Mariupol and 50 children from Kyiv. The organochlorine body burden (serum levels of organochlorine pesticides and PCBs) included 50 children from Mariupol only.
Wheezing Illness in 7 year old children consisted of administration of the “International Asthma and Allergy in Children” questionnaire to children who participated in the 7 years of age “Family and Children of Ukraine Assessment.”
The most recent data collection took place for the Dniprodzerzhinsk subcohort in 2011. The study population for the 18 years of age assessment included all mothers and their children who participated in the 3 years of age assessment. As with previous ELSPAC assessments (e.g. ages 3 and 7), the survey covered general health status and health behaviors. The 18 years of age assessment focused special attention on the following areas:
- Prevalence of asthma and allergic rhinitis
- Obesity and risk factors for obesity
- Oral health
- Age at menarche
- Risky behaviors (smoking, alcohol, drugs)
The survey instruments for the 18 years of age assessment were constructed by researchers from the Institute of Pediatrics, Obstetrics, and Gynecology and the University of Illinois School of Public Health on the basis of similar survey instruments prepared for two other ELSPAC study sites: Avon, UK (the ALSPAC study) and Brno, Czech Republic (current ELSPAC coordinating center). The survey instruments included:
- The mother’s (caregiver’s) questionnaire (self-administered questionnaire)
- The teenager’s questionnaire (self-administered questionnaire)
- The medical record abstraction form
All study instruments are translated and reverse-translated.
In addition our research personnel (physicians) abstracted data from the participant’s medical records using the medical abstraction form. Data entry for the 18 years of age assessment has not yet been completed. Funding for data management for this part of the study is comes from our Fogarty grant: “Building on Excellence: a GEOHealth Hub in Ukraine-U.S.
FCOU participants had high spontaneous pre-term birth rates (Little, 2004). Rates of hospitalization during pregnancy were higher than in the U.S. (Little, 2001) and perinatal mortality was 3 times higher than the U.S. rate (Little, 1999). Low net pregnancy weight gain was significantly associated with pre-term birth (Monaghan 2000, 2001). Placental weight correlated positively with infant size (Little, 2003). Prenatal exposure to persistent organochlorine compounds or PAHS did not impact birth weight (Gladen, 2000, 2003).
Maternal breast milk had high levels of DDE (Gladen BC, 1999) but not dioxins (Gladen, 1999). Three-year-old children in Mariupol had evidence of high exposure to PAHs as measured by urinary 1-hydroxypyrene (Mucha,2006). Elevated lead levels in children were associated with paternal occupation and mother smoking indoors (Friedman, 2005). Elevated blood cadmium levels were associated with father’s occupation, low body mass index, and zinc supplementation (Friedman, 2006).
We also evaluated risk factors for obesity among these three-year-old children (Friedman, 2008). We used principal components analysis as a data reduction tool for dietary, built environment and activity variables and evaluated predictors of elevated BMI using a multivariable logistic regression model. Risk factors for an elevated BMI included mother’s weight, higher social class, residence in a better neighborhood, and meat consumption. Infrequent outings to places that require spending money was associated with lower BMI.
At the 7 years of age assessment, we investigated risk factors for wheezing illness. The incidence of wheezing illness was significantly lower in Dniprodzerzhinsk than at our other FCOU sites (Dardynskaia, 2007). Factors significantly associated with increased risk of wheezing illness at age 7 in adjusted analyses included mother’s asthma, mother’s allergy problems, rarely playing with other children at age 3, water intrusion and inadequate heating of the home during pregnancy. Factors protective of wheezing at age 7 included being first-born, living in the city of Dniprodzerzynsk as compared with Kyiv and weekly contact with furry animals before age 3 (Hryhorczuk, 2009). Research training of Ukrainian FCOU investigators has been supported through our NIH Fogarty Center grant called International Research and Training in Environmental and Occupational Health.
PREVIOUS PUBLICATIONS FROM THE FCOU STUDY
Dardynskaia I, Luk’anova E, Antipkin Y, Shiriak-Nizhnik Z, Hryhorczuk D, Chislovska N, Matwyshyn-Fuoco M. 2007. The prevalence of asthma-related symptoms among children in three Ukrainian cities with environmental problems. Lik Sprava Apr-May(3):13-8. Ukrainian.
Friedman LS, Lukyanova EM, Serdiuk A, Shkiryak-Nizhnyk ZA, Chislovska NV, Zvinchuk AV, et al. 2008. Social-environmental factors associated with elevated body mass index in a Ukrainian cohort of children. Int J Pediatr Obes: 1-10.
Friedman LS, Lukyanova EM, Kundiev YI, Shkiryak-Nizhnyk ZA, Chislovska NV, Mucha A, Zvinchuk AV, Oliynyk I, Hryhorczuk D. 2006. Anthropometric, environmental, and dietary predictors of elevated blood cadmium levels in Ukrainian children: Ukraine ELSPAC group. Environ Res. 102(1):83-9.
Friedman LS, Lukyanova OM, Kundiev YI, Shkiryak-Nizhnyk ZA, Chislovska NV, Mucha A, Zvinchuk AV, Oliynyk I, Hryhorczuk D. 2005. Predictors of elevated blood lead levels among 3-year-old children: a nested case-control study. Environ Res. 99(2):235-42.
Friedman LS, Lukyanova EM, Serdiuk A, Shkiryak-Nizhnyk ZA, Chislovska NV, Zvinchuk AV, Oliynyk I, Hryhorczuk D. 2009. Social-environmental factors associated with elevated body mass index in a Ukrainian cohort of children. Int J Pediatr Obes 4(2):81-90.
Gladen BC, Monaghan SC, Lukyanova EM, Hulchiy OP, Shkyryak-Nyzhnyk ZA, Sericano JL, Little RE. 1999. Organochlorines in breast milk from two cities in Ukraine. Environ Health Perspect. 107(6):459-62.
Gladen BC, Schecter AJ, Papke O, Shkyryak-Nyzhnyk ZA, Hryhorczuk DO, Little RE. 1999. Polychloriniated dibenzo-p-dioxins, polychlorinated dibenzofurans, and coplanar PCBs in breast milk from two cities in Ukraine. J Toxicol Environ Health. 58(3):119-27.
Gladen BC, Zadorozhnaya TD, Chislovska N, Hryhorczuk DO, Kennicutt MC 2nd, Little RE. 2000. Polycyclic aromatic hydrocarbons in placenta. Hum Exp Toxicol. 19(11):597-603.
Gladen BC, Shkiryak-Nyzhnyk ZA, Chyslovska N, Zadorozhnaya TD, Little RE. 2003. Persistent organochlorine compounds and birth weight. Ann Epidemiol 13(3): 151-7.
Hryhorczuk D, Dardynskaia I, Lukyanova E, Matwyshyn-Fuoco M, Friedman L, Shkiryak-Nizhnyk Z, Zvinchuk A, Chislovska N, Antipkin Y. 2009. Risk factors for wheezing in Ukrainian children: Ukraine ELSPAC Group. Paediatr Perinat Epidemiol. 23(4):346-51.
Hryhorczuk DO, Monaghan S, Lukyanova E, Truchly L, Shkyryak-Nyzhnyk Z, Oliynyk I, and Zvinchuk A. 2006. Collaborative research and research training through the “Family and Children of Ukraine” research program. Int J Occup Environ Health. 12(4):423-4.
Little RE, Monaghan SC, Gladen BC, Shkyryak-Nyzhnyk ZA, Wilcox AJ. Outcomes of 17,137 pregnancies in urban areas of Ukraine. 1999. Am J Public Health. 89(12):1832-6.
Little RE, Little AS, Chislovska N, Hulchiy OP, Monaghan SC, Gladen BC. 2001. Hospital admissions during pregnancy in two urban areas of Ukraine. Paediatr Perinat Epidemiol 15(4):323-7.
Little RE, Zadorozhnaya TD, Hulchiy OP, Mendel NA, Shkyryak-Nyzhnyk ZA, Chyslovska N, Gladen BC. 2003. Placental weight and its ratio to birth weight in a Ukrainian city. Early Hum Dev 71(2):117-27.
Little RE, Gladen BC, Birmingham K, Shkyryak-Nyzhnyk ZA, Chyslovska N, ALSPAC Study Team. 2004. Preterm birth rates in Avon County, England, and urban Ukraine. Eur J Obstet Gynecol Reprod Biol 113(2):154-9.
Monaghan SC, Little RE, Hulschiy O, Strassner H, Gladen BC. 2001. Risk factors for spontaneous preterm birth in two urban areas of Ukraine. Paediatr Perinat Epidemiol 15(2):123-30.
Monaghan SC, Little RE, Hulchiy O, Strassner H. Gladen BC. 2000. Preterm birth in two urban areas of Ukraine. Obstet Gynecol. 95(5): 752-5.
Mucha AP, Hryhorczuk D, Serdyk A, Nakonechny J, Zvinchuk A, Erdal S, Caudill M, Scheff P, Lukyanova E, Shiryak-Nyzhnyk Z, Chislovska N. 2006. Urinary 1-hydroxyperene as a biomarker of PAH exposure in 3-year-old Ukrainian children. Environ Health Perspect. 114(4):603-9.
Hryhorczuk D, Dardynskaia I, Lukyanova E, Matwyshin-Fuoco M, Friedman L, Shkiryak-Nizhnyk Y, Chislovska N, Zvinchuk A. Risk factors for wheezing illness in Ukrainian children: Ukraine ELSPAC study. 2010. Longitudinal and Life Course Studies 1(Supp3):36.
Shkiryak-Nizhnyk Z, Hryhorczuk D, Chyslovska N, Monaghan S, Hulchiy O. Family and Children of Ukraine: a long-term epidemiologic study of children’s state of health in Ukraine’s cities. 2010. Longitudinal and Life Course Studies 1(Supp3):159.
Iakunchukova OP, Addreeva TI, Shkiryak-Nizhnyk ZA, Antipkin YG, Hryhorczuk DO, Zvinchuk AV, Chislovska NV. Optimal scaling for early life stress measurement. Tobacco Control and Public Health in Eastern Europe. 2013. 3(1):17-26.
Larsen PS, Kamper-Jørgensen M, Adamson A, Barros H, Bonde JP, Brescianini S, Brophy S, Casas M, Charles M-A,Devereux G, Eggesbø Ml,Fantini MP, Frey U, Gehring U, Grazuleviciene R,Henriksen TB, Hertz-Picciotto I,Heude B,Hryhorczuk DO, Inskip H, Jaddoe V, Lawlor DA, Ludvigsson J, Kelleher CC, Kiess W, Koletzko B, Kuehni CE, Kull I, Kyhl HB, Magnus P, Momas I, Murray D, Pekkanen J,Polanska K, Porta D, Poulsen G, Richiardi L, Roeleveld N, Skovgaard AM, Sram RJ, Strandberg-Larsen K, Thijs C, Van Eijsden M, Wright J, Vrijheid M, Nybo Andersen A-M. Pregnancy and birth cohort resources in Europe: an opportunity for aetiological child health research. 2013. Pediatric and Perinatal Epidemiology. 2013. 27:393-414.