Socio-demographic determinants of pregnancy outcomes and infant growth in transitional Russia

There is a growing body of literature exploring social, demographic, and life-style factors in relation to pregnancy outcomes and infant growth patterns. However, only a few studies on the topic were conducted in transitional economies of Eastern Europe despite considerable political, economic, and social changes in these countries during the last 15 years. The changes in Russia have been even more profound, although no studies on the topic were performed there.

The purpose of the study was to estimate the effect of the socio-demographic and lifestyle factors on selected pregnancy outcomes and infant growth in transitional Russia. The specific aims were to describe social circumstances around pregnant women in an urban Russian setting and to study social determinants of foetal growth, preterm delivery, initiation and duration of breastfeeding as well as social variations in infant growth patterns.

The study was performed in Severodvinsk, a town in Northwest Russia. All 1559 pregnant women registered at prenatal care centres in 1999 were enrolled in a cohort and followed through delivery and their infants were then followed up during one year. Data about maternal social and demographic characteristics as well as the medical history were obtained from the medical records. In addition, a questionnaire on living conditions and life-style factors was completed at the first antenatal visit. Data on breastfeeding and infant growth are taken from the records at the paediatrics hospitals.

The study revealed considerable social variations in pregnancy outcomes. Clear gradients of birth weight and spontaneous preterm birth rates by maternal educational level were revealed. Maternal education was the most important social factor influencing birth weight, ponderal index and preterm birth rates even after adjustment for known or strongly suspected explanatory mechanisms. Poor housing conditions, perceived stress, and smoking were negatively associated with birth weight. Placental complications, stress, and a history of foetal death in previous pregnancies were associated with elevated risks for preterm delivery, while smoking, hypertension, and multigravidity were associated with reduced length of pregnancy in metric form.

The rates of breastfeeding in Severodvinsk were high. Only 1.3% of infants were never breastfed. Breastfeeding rates at 3, 6, and 12 months were 75.0%, 47.2%, and 18.4% respectively, which is substantially higher than previously reported from Russia. Maternal education, age, and marital status influenced the duration of breastfeeding thereby raising concern of inequalities in breastfeeding practices in Russia.

Prevalence rates of stunting, underweight, and wasting at 12 months of age were 1.1%, 1.1%, and 0.5% respectively - much lower than previously reported from Russia. Mean weight-for-length Z-scores considerably increased from birth to 12 months, while length-forage Z-scores remained largely unchanged. However, social variations in linear growth indices tended to increase during the first year of life. Positive trends between linear growth and maternal age and education were observed.

In summary, this is the first community-based mother-and-child cohort study, which documents the importance of social determinants of pregnancy outcomes and infant health in transitional Russia. Social variations in pregnancy outcomes, breastfeeding rates, and infant growth patterns indicate existence of inequalities in maternal and child health that might further increase with age.

List of scientific papers

I. Grjibovski A, Bygren LO, Svartbo B (2002). Socio-demographic determinants of poor infant outcome in north-west Russia. Paediatr Perinat Epidemiol. 16(3): 255-62.
https://doi.org/10.1046/j.1365-3016.2002.00429.x

II. Grjibovski AM, Bygren LO, Svartbo B, Magnus P (2003). Social variations in fetal growth in a Russian setting: an analysis of medical records. Ann Epidemiol. 13(9): 599-605.
https://doi.org/10.1016/S1047-2797(03)00052-8

III. Grjibovski A, Bygren LO, Svartbo B, Magnus P (2004). Housing conditions, perceived stress, smoking, and alcohol: determinants of fetal growth in Northwest Russia. Acta Obstet Gynecol Scand. 83(12): 1159-66.
https://doi.org/10.1111/j.0001-6349.2004.00443.x

IV. Grjibovski AM, Bygren LO, Yngve A, Sjostrom M (2005). Large social disparities in spontaneous preterm birth rates in transitional Russia. Public Health. 119(2): 77-86.
https://doi.org/10.1016/j.puhe.2004.06.005

V. Grjibovski AM, Yngve A, Bygren LO, Sjostrom M (2005). Socio-demographic determinants of initiation and duration of breastfeeding in Northwest Russia.
https://doi.org/10.1080/08035250410023296

VI. Grjibovski AM, Bygren LO, Yngve A, Sjostrom M (2004). Social variations in infant growth performance in Severodvinsk, Northwest Russia: community-based cohort study. Croat Med J. 45(6): 757-63.
https://pubmed.ncbi.nlm.nih.gov/15578812