Forty-Year Biomonitoring of Environmental Contaminants in Russian Arctic: Progress, Gaps and Perspectives

This article presents a comprehensive survey of the studies on the biomonitoring of persistent organic pollutants (POPs) and metals in biota and human tissues on the territory of the Russian Arctic. It is concluded that a relatively small number of studies were carried out during the last 40 years; for several Russian Arctic regions there is no data up to date, and for some regions the data are scarce, with most of the studies carried out in 1990s, followed by the large-scale GEF/AMAP/RAIPON project of 2001-2004 covering four regions. After that, single projects have been implemented in a few regions. Only the Nenets okrug and the Chukotka okrug (and hardly the Murmansk oblast) can be attributed as the regions where the biomonitoring of contaminants was carried out during last decades on several occasions, and for which the content of POPs and metals in biota and the human organism was assessed in 12-15-year dynamic trends (at least "at three points"). For the rest of the Russian Arctic territories, only fragmentary "cross-sections" of biomonitoring data is available, mainly obtained in the 1990s or early 2000s, which do not allow judging either the dynamics of the processes or the current state of affairs. The overwhelming majority of the studies in the Russian Arctic (more than 90%) were carried out within the framework of international projects, i.e., with cofinancing, assistance and contribution (including laboratory analyses) from the foreign colleagues and partners. The shortcomings of the Russian system of biomonitoring, including the weakness of the laboratory and research base, are considered. Perspectives of the Russian Arctic biomonitoring are discussed in detail, with the proposal of the elaboration of the national Russian Arctic Contaminants Program (RACP).

Periconceptional folic acid intake in Northwest Russia: a birth registry study

Introduction

Periconceptional use of folic acid supplementation is an evidence-based measure of birth defects prevention. The study was aimed to assess effect of periconceptual use of folic acid on birth defect prevalence in Arkhangelsk county and to investigate socio-demographic factors, which are associated with adherence to this preventive measure.

Methods

A registry-based study was conducted with data from the Arkhangelsk County Birth Registry for 2012-2015. The study population included 57084 pregnancies to calculate the proportion of women taking folic acid and 53340 pregnancy outcomes without missing data to analyze related socio-demographic characteristics.

Results

The proportion of women followed a folic acid supplementation before pregnancy was 1.3% (95% CI: 1.2-1.4), during pregnancy - 55.8% (95%CI: 54.6-56.4). Such women had less risk to deliver a newborn with any birth defects (OR = 0,84, 95%CI: 0,75 - 0,95). Considering birth defects prevalence of 38,6 per 1000 newborns in Arkhangelsk county, number needed to prevent one case of birth defect was 142,9. Based on multivariate analysis, nulliparous married women with higher education, aged 30 or more, had a higher chance to use folic acid before and during pregnancy. The history of spontaneous abortion in the mother's medical history and the first pregnancy were negatively associated with the probability of folic acid intake both before and during pregnancy.

Conclusions

The compliance to periconceptional intake of folic acid among women in the region was low. A level of compliance was associated with such socio-demographic factors as age, education, marital status, gravidity and parity. The findings have direct applications in improving prenatal care in Arkhangelsk county and establishing targets for prenatal counseling.

Key messages

A level of compliance to primary prevention of birth defects is associated with such socio-demographic factors as age, education, marital status, gravidity and parity. Prenatal counseling in terms of birth defects prevention should be based on socio-demographic characteristics of pregnant women.

Future directions for monitoring and human health research for the Arctic Monitoring and Assessment Programme

For the last two and a half decades, a network of human health experts under the Arctic Monitoring and Assessment Program (AMAP) has produced several human health assessment reports. These reports have provided a base of scientific knowledge regarding environmental contaminants and their impact on human health in the Arctic. These reports provide scientific information and policy-relevant recommendations to Arctic governments. They also support international agreements such as the Stockholm Convention on Persistent Organic Pollutants (POPs) and the Minamata Convention on Mercury. Key topics discussed in this paper regarding future human health research in the circumpolar Arctic are continued contaminant biomonitoring, health effects research and risk communication. The objective of this paper is to describe knowledge gaps and future priorities for these fields.

Determinants of antenatal and postnatal care visits among Indigenous people in Bangladesh: a study of the Mru community

INTRODUCTION

Antenatal and postnatal care services are significant interventions to improve maternal health and prevent maternal and infant deaths. However, these services are poorly developed in Bangladesh, particularly among Indigenous women. This study examined factors associated with antenatal and postnatal care visits among the Mru, the most underprivileged Indigenous people in Bangladesh.

METHODS

This cross-sectional study used both quantitative and qualitative methods. In total, 374 currently married Mru women with at least one child aged 5 years or younger were selected from 3 upazilas (sub-districts) of Bandarban District, Bangladesh for survey. In addition, in-depth interviews were performed with 26 Mru leaders, Mru women, traditional midwives, village 'doctors', school teachers, health and non-government organization workers. Associations between antenatal and postnatal care visits and the women's backgrounds characteristics were assessed by bivariate and multivariate analyses.

RESULTS

The traditional Mru prenatal and postnatal practices potentially inhibited women from seeking care. Both antenatal (11.2%) and postnatal (6.4%) care visits among the Mru women were lower than the national level. Most visits were to traditional midwives in their rural villages, rather than to health complexes or hospitals. The main reasons for lack of antenatal and postnatal care were travelling distance to care and transportation problems. Multivariate analysis revealed factors associated with antenatal care were the respondent's place of residence, age, level of education, distance to the service centers and exposure to any mass media. Similar results were obtained with regard to postnatal care visits.

CONCLUSIONS

This study suggests that cultural issues, distance, infrastructure and socioeconomic status are important determinants of maternal healthcare-seeking behavior. Healthcare delivery systems and appropriate education programs should be developed at the village level to improve the health of mothers and children in the Mru community.

Levels and patterns of Persistent Organic Pollutants (POPS) in selected food items from Northwest Russia (1998-2002) and implications for dietary exposure

Residues of persistent organic pollutants (POPs) were analysed in 70 selected food items from Northwest Russia in 1998-2002. Levels of PCBs ranged from 0.2 to 16ng/g wet weight (ww) in dairy products and fats, 0.2 to 23ng/g ww in meat products, 0.5 to 16ng/g ww in eggs and 0.3 to 30ng/g ww in fish. High levels of DDT (16ng/g ww) were found in locally produced butter from Kola Peninsula, in pork fat from Arkhangels region (10 to 130ng/g ww) and in some fish samples from White Sea and Kargopol region (17 and 30ng/g ww). Findings of low DDE/DDT ratios in many of the studied food items indicated recent contamination to DDTs. Mean levels of sum TEQs(WHO1998) of dioxin-like mono-ortho PCBs: PCBs 105, 118, 156 and 157 (∑mo-PCBs-TEQs(WHO1998)) were highest in dairy products, chicken eggs and fish, with levels of 0.292, 0.245 and 0.254pg/g ww, respectively. The estimated daily intake (EDI) for ∑mo-PCBs-TEQs(WHO1998) was 0.74pg/kgbw/day and in the same range as in Sweden and Denmark. Fish, dairy products, eggs and meat were the main contributors to the EDI of ∑mo-PCBs-TEQs(WHO1998). The EDIs of DDTs, HCHs and HCB were several times higher than in Sweden and Denmark. Consumption of meat and poultry were important sources for intake of DDTs and HCHs, respectively. Contamination of animal feed and agricultural practice were assumed the most important causes for the results in the present study. However, increased control on maximum residue levels in food and feed may have resulted in large changes on levels and patterns of POPs in food in the studied areas.

Circumpolar maternal blood contaminant survey, 1994-1997 organochlorine compounds

During the past 20 years a number of studies have found neurological and immunological effects in the developing fetus and infants exposed to background or only slightly elevated levels of persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs). To address concerns arising from possible increased human exposure in the Arctic and possible effects of POPs, all circumpolar countries agreed in 1994 to monitoring of specific human tissues for contaminants in the Arctic under the Arctic Monitoring and Assessment Program (AMAP). Mothers in eight circumpolar countries contributed blood samples that were analysed at a single laboratory for 14 PCB congeners (IUPAC No. 28, 52, 99, 105, 118, 128, 138, 153, 156, 170, 180, 183, 187) and 13 organochlorine pesticides (aldrin, beta-hexachlorocyclohexane (beta-HCH), dichlordiphenyltrichloroethane (p,p'-DDT), diphenyldichloroethylene (p,p'-DDE), dieldrin, heptachlorepoxide, hexachlorobenzene (HCB), mirex, and the chlordane derivatives alpha-chlordane, gamma-chlordane, cis-nonachlor, oxychlordane and trans-nonachlor). Inuit mothers from Greenland and Canada have significantly higher levels of oxychlordane, transnonachlor and mirex than mothers from Norway, Sweden, Iceland and Russia. Inuit mothers from Greenland also have significantly higher levels of these contaminants than Inuit mothers from Canada and Alaska. These differences among Inuit groups may represent regional dietary preferences or different contaminant deposition patterns across the Arctic. Levels of PCBs are also elevated among some arctic populations due to their consumption of marine mammals and are in the range where subtle effects on learning and the immune system have been reported. The Russian mothers who consume mainly food imported from southern Russia have elevated levels of DDT, DDE, beta-HCH and a higher proportion of lower chlorinated PCB congeners. This study has allowed an assessment of the variation of contaminants such as PCBs and various organochlorine pesticides (DDT, chlordane, etc.) in human populations around the circumpolar north.

The importance of diet on exposure to and effects of persistent organic pollutants on human health in the Arctic

AIM

To describe the importance of diet on exposure to and possible health effects of persistent organic pollutants (POPs) in the Arctic.

METHODS

The study is based on a literature review.

RESULTS

Minor decreases in POPs and minor increases in Hg levels in Arctic populations in Greenland, Eastern Russia, Western Alaska and Eastern Canada are likely to occur by the year 2010 and major decreases in both POPs and Hg levels in these same populations by 2030. Levels of POPs and metals in populations in the Faeroe Islands and the Scandinavian countries are already reasonably low and are only likely to decline marginally by 2030. Estimating the effects on the basis of current knowledge is difficult, but the combination of improved methodology and selection of risk groups will be a progressive step in the process. Any strategies based on traditional food substitution should ensure that the value of the dietary components is sustained.

CONCLUSIONS

To improve our understanding of the health effects associated with exposure to contaminants in the Arctic, we recommend that circumpolar epidemiological studies should be implemented on a larger scale. MeHg- and POPs-related effects are still the key issues. However, the role of newly discovered contaminants, such as PBDEs (polybrominated diphenyl ethers) and PCNs (polychlorinated naphthalenes), should be investigated. For exposure assessment, mixtures and nutritional interactions should be considered in epidemiological studies. Epidemiological studies on nutritional benefits of traditional foods should be incorporated in risk-assessment profiles. We need a more nuanced view on human dietary exposure to xenobiotics. Risk should not be evaluated alone, but seen in relation to benefits from specific diets. It is essential that countries ratify and implement multinational environmental agreements.

Geographic variation of chlorinated pesticides, toxaphenes and PCBs in human milk from sub-arctic and arctic locations in Russia

The concentrations of HCB, alpha-, beta- and gamma-HCH, 3 chlordanes (CHLs), p,p'-DDE, p,p'-DDD, p,p'-DDT, and 30 PCBs (polychlorinated biphenyls) were determined in 140 human milk samples from Kargopol (n=19), Severodvinsk (n=50), Arkhangelsk (n=51) and Naryan-Mar (n=20). Pooled samples were used for determination of three toxaphenes (chlorobornanes, CHBs). The concentrations of HCB, beta-HCH and p,p'-DDE in Russian human milk were 2, 10 and 3 times higher than corresponding levels in Norway, respectively, while concentrations of sum-PCBs and sum-TEQs (toxic equivalent quantities) of the mono-ortho substituted PCBs were in the same range as corresponding levels in Norway. The PCB-156 contributed most to the sum-TEQs. Highest mean concentrations of HCB (129 microg/kg milk fat) and sum-PCBs (458 microg/kg milk fat) were detected in Naryan-Mar, while highest mean concentrations of sum-HCHs (408 microg/kg milk fat), sum-CHLs (48 microg/kg milk fat), sum-DDTs (1392 microg/kg milk fat) and sum-toxaphenes (13 microg/kg milk fat) were detected in Arkhangelsk. An eastward geographic trend of increasing ratios of alpha/beta-HCH, gamma/beta-HCH, p,p'-DDT/p,p'-DDE and PCB-180/28 was observed. In all areas the levels of sum-HCHs decreased with parity (number of children born). Considerable variation in levels of the analysed organochlorines (OCs) was found in all the studied areas. Breast milk from mothers nursing their second or third child (multiparas) in Naryan-Mar showed a significant different PCB profile compared to mothers giving birth to their first child (primiparas) from the same area and to primi- and multiparas in the other areas. Both p,p'-DDE and p,p'-DDT showed a significant, but weak, negative correlation with the infants birth weight.

Intercommunity and temporal variation of eleven essential and five toxic elements in human placentas from deliveries in thirteen arctic and sub-arctic areas of Russia and Norway

Research is described that constitutes an extension of an earlier paper (J. Environ. Monit., 2001, 3, 177-184), in which concentrations were measured in 263 human placentas of 11 essential elements (P, Ca, Mg, Cu, S, Na, Fe, Zn, K, Se, Mn) and 5 toxic elements (Ba, Sr, Pb, Ni, Cd). The additional data considered derive from earlier visits to 4 of the original 6 communities and 3 others, all but one of which are located in northern Norway and neighbouring areas of Russia. This more than doubled the number of placental samples available (263 to 571). Unfortunately, the personal, life-style and morphometric information obtained for the first study group was not available for the additional mothers. Country differences were evident for all elements except Ba, Fe and Zn; Cd, Cu, Mn, Na, Se, Ni, Pb, Sr and S were higher and K, P, Ca and Mg were lower in Russia (p < 0.03). Not unexpectedly, the highest median lead concentration was observed for the largest city in the western arctic region of Russia, namely Murmansk. Similarly, the higher median nickel level observed for Russia reflects the established observation that urinary nickel concentrations are higher in the Russian than in the Norwegian communities. Even though sampling was performed at different times of the year and before and after a 3-year interval in four centres, inter-collection differences were of relatively small magnitude and appear not to be linked to seasonal or temporal changes. Principal component analysis (PCA) confirmed the prominence of Factor 1, which grouped those metals that are known to form insoluble phosphate complexes and whose concentrations showed a dependence on gestational age and maternal smoking in the earlier study. It is concluded that PCA is a powerful statistical tool for exploring and identifying fundamental pathways and processes involved in governing the inorganic elemental composition of placental tissue. It also has the potential of identifying study limitations and quality assurance shortfalls. Further our findings show promise that placental concentrations of toxic elements may serve as an index of exposure and of nutritional intake for selected essential micro-elements.

Atopic diseases among schoolchildren in Nikel, Russia, an Arctic area with heavy air pollution

The objective of this study was to describe the prevalence rate of atopic diseases among schoolchildren living in the heavily polluted Arctic town of Nikel, Russia. A self-administered questionnaire was distributed to the parents of 1,800 children aged 8-17 years, 1,684 of whom (93.6%) completed and returned the questionnaire. Atopic diseases were reported in 508 (30.2%) of the children and prevalence was similar for both sexes. Atopic dermatitis occurred most frequently (15.5%), followed by allergic rhinoconjunctivitis (13.9%) and asthma (3.9%). The most pronounced influence on atopic diseases in children was having parents with asthma. Indoor dampness was a significant risk factor eliciting atopic diseases, whereas furred pets, passive smoking and carpets did not influence the prevalence of allergy. We conclude that although atopic diseases are a common health problem in Nikel, they are less prevalent than has been reported in recent studies of Northern European countries. Air pollution does not seem to be a major risk factor for the development of atopic diseases.

Asthma and allergy in Russian and Norwegian schoolchildren: results from two questionnaire-based studies in the Kola Peninsula, Russia, and northern Norway

BACKGROUND

Previous studies have shown that the prevalence of asthma and allergy in children is lower in Eastern than Western Europe.

METHODS

We have compared the prevalence of asthma, respiratory symptoms, allergic rhinoconjunctivitis, and atopic dermatitis in schoolchildren aged 7-13 years in a questionnaire-based study conducted in the city of Nikel on the Kola Peninsula, Russia, in 1994 (n = 1143) and another conducted in northern Norway in 1995 (n = 8676).

RESULTS

The prevalence of diagnosed asthma was 5.1% in Russian children and 8.6% in Norwegian children; RR =0.58 (95% CI: 0.44-0.76). The prevalence of all respiratory symptoms was higher in Russian children. The prevalence of allergic rhinoconjunctivitis was 16.9%, in Russian children and 22.1%, in Norwegian children: RR =0.74 (95% CI: 0.65-0.85). The prevalence of atopic dermatitis was 7.4% in Russian children and 19.7% in Norwegian children; RR=0.38 (95% CI: 0.31-0.46).

CONCLUSIONS

We conclude that the prevalence of diagnosed asthma, allergic rhinoconjunctivitis, and atopic dermatitis was higher in Norwegian than Russian schoolchildren. The higher prevalence of respiratory symptoms in Russian children probably reflects a higher prevalence of undiagnosed, nonallergic asthma.

Atopic diseases among adults in the two geographically related arctic areas Nikel, Russia and Sør-Varanger, Norway: possible effects of indoor and outdoor air pollution

BACKGROUND

Previous studies have shown lower prevalence of atopic diseases among adults and school-children in Eastern Europe.

OBJECTIVES

To compare the prevalence of atopic diseases among adults in two geographically related arctic areas, Nikel, Russia and Sør-Varanger, Norway. Nikel is a heavily polluted town on the Kola Peninsula.

METHODS

The prevalence of eczema, asthma and allergic rhinoconjunctivitis (AR) was assessed using two identical questionnaire studies. The study in Sør-Varanger was conducted in the autumn of 1991 and comprised 1102 adults. In the spring of 1994, 3368 adults in Nikel completed the 4-page questionnaire. Results The lifetime prevalence of atopic diseases was significantly higher in Sør-Varanger than in Nikel (25.2% vs. 11.2%; P < 0.001), most pronounced for eczema (15.9% vs. 5.9%; P < 0.001) and AR (10.3% vs. 5.6%; P < 0.001). There was no significant difference in the prevalence of asthma between the two areas (5.6% vs. 4.9%; RR 1.1). Indoor dampness, carpeted floors and outdoor pollution were found to be significantly higher in Nikel than in Sør-Varanger (P < 0.0001). Smoking habits were different in the two areas.

CONCLUSION

Atopic diseases in Sør-Varanger were more than twice that found in Nikel. Western lifestyle and new building techniques resulting in poorly ventilated homes may be the main reasons for these differences. Other factors, such as differences in seeking medical help for physical complaints and in the social and political environment, are also suggested.

Perinatal deaths in a Norwegian county 1986-96 classified by the Nordic-Baltic perinatal classification: geographical contrasts as a basis for quality assessment

BACKGROUND

Quality assessment of perinatal care can be carried out by classifying perinatal deaths. In the following we have analyzed the geographical contrasts in perinatal deaths according to the Nordic-Baltic perinatal death classification in a sparsely populated Norwegian county.

MATERIAL AND METHODS

All stillbirths (> or =28 weeks of gestation) and neonatal deaths (gestational age > or =22 weeks; death < or =28 days) in 1986-96 from Nordland county (240,000 inhabitants) were classified. For comparison the county was geographically divided into six general local hospital areas and one central hospital area.

RESULTS

The classification showed a well acceptable inter and intra observer variation. One hundred and seventy-one stillbirths and 155 neonatal deaths were analyzed. The death rate (pr 1,000 births) for single, non-malformed, antenatal stillbirths was higher in the central hospital area than in the local hospital areas (3.22 vs. 2.02). The death rate for extreme preterm infants (22-27 weeks of gestation) was on the other hand higher in the local hospital areas (2.45 vs. 1.05). One of the general local hospital areas was singled out with an especially high neonatal death rate among extreme preterm infants. This was to some extent explained by the death of extreme preterm twins and triplets.

CONCLUSION

The Nordic-Baltic perinatal death classification system is a consistent and reproducible tool also for studying perinatal death in restricted geographical areas. The observed contrasts in perinatal deaths were used as basis for programs aimed at improving perinatal care. The observation of an unexplained increased number of antenatal stillbirths in the central hospital area resulted in a program for prospective recording and better characterization of the placenta and umbilical cord. Proposals for a better antenatal program preventing extreme preterm birth of twins for the whole county has been launched. In utero transfer to a hospital with a neonatal intensive care unit seems crucial in improving the prognosis for these infants.

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND

Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome.

METHODS

Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry.

RESULTS

The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles.

CONCLUSION

Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.

Concentrations of essential trace elements in maternal serum and the effect on birth weight and newborn body mass index in sub-arctic and arctic populations of Norway and Russia

BACKGROUND

This project is part of an assessment of the impact of environmental factors on human health in the Kola Peninsula of Russia and the neighboring arctic area of Norway. Pregnant women and their newborns were studied to explore a relationship between maternal status of essential metals and birth weight.

METHODS

Life-style information and serum specimens were collected from at least 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities (N=151 and 167, respectively). Pregnancy outcomes were verified by consulting medical records. Copper, selenium and zinc in serum were determined by atomic absorption spectrometry and ferritin by an automated analyzer method.

RESULTS

Mean birth weight and child's body mass index (BMIC) were significantly lower in the Russian group (p<0.001), with or without adjustment for gestational age. Copper, iron (as ferritin) and selenium serum concentrations were in the normal range, while zinc levels in both countries were mostly below the lower limit (10.8 micromol/L) of reported reference intervals. A positive correlation between zinc and birth weight or BMIC was only observed for concentrations exceeding 10.8 micromol/L. Analysis by quartiles showed that maternal urinary creatinine and birth weight were negatively correlated (p=0.001). The influence of the different elements on BMIC, grouped by quartiles, was significantly positive only for selenium (p=0.03) and ferritin (p=0.02), while there was no significant relationship for copper or zinc. Adjustment of birth weight and BMIC for gestational age did not alter substantially the various associations indicated.

CONCLUSIONS

With the exception of zinc, the mineral status of delivering women in arctic and sub-arctic regions of Norway and western Russia appears to be adequate. The significantly lower BMIC for the Russian group suggests the likely occurrence of nutritional deficiencies during pregnancy in Russia. However, the significant contribution of a country factor in the predictive model implies that the maternal serum trace-element concentrations explored in this study are incomplete indicators of fetal undernourishment.

Critical evaluation of medical, statistical, and occupational data sources in the Kola Peninsula of Russia pertinent to reproductive health studies

BACKGROUND

The feasibility study described herein was prompted by a report in 1992 of possible reproductive and developmental health concerns among female workers in a Russian nickel refinery.

OBJECTIVE

The primary goal was to ascertain whether medical, statistical, and occupational data bases could be accessed for information about the pregnancy histories, occupational histories, and life-style factors of the women affected.

METHODS

The project was facilitated by construction of a registry of all births in three towns with a nickel refinery and verification of its contents against patients' records obtained from hospital delivery and gynecology departments and community polyclinics. Municipal Registration Board, Regional Health Statistics Board, and nickel company records were also reviewed.

RESULTS

Reproductive/developmental outcome information and workplace histories were acceptable. Sample-size calculations indicated that a cohort or cross-sectional study would be amenable and suitable for the detection of an excess risk for spontaneous abortion with adequate statistical significance and power. Such investigations would need to be supplemented by workplace environmental/biological monitoring assessments for evaluation of exposure to occupational hazardous factors and a worker's questionnaire to obtain information about life-style factors. A case-control design is recommended for the study of congenital defects.

CONCLUSIONS

A well-designed, comprehensive epidemiology study is technically feasible because of the availability of a favorable pool of study subjects, reproductive/developmental outcome data, information to control for major confounders, and suitable occupational records.

Self-reported ethnic status of delivering women, newborn body mass index, blood or urine concentrations of toxic metals, and essential elements in sera of Norwegian and Russian Arctic populations

As part of the Arctic Monitoring and Assessment Programme (AMAP), we assessed pregnancy outcome among Sami and Norwegian populations of Finnmark County in Norway and Russians living in the Kola Peninsula of Russia using body mass index of the newborn child (BMIC) as the main indicator; concentrations of essential and toxic elements in biological fluids of delivering women and their children served as additional sources of information. At the hospitals of Hammerfest and Kirkenes in the period November 1993-June 1994 a total of 107 consecutive women gave birth to a child, of whom 15 regarded themselves as Sami. The Russian group (N = 151) delivered their children in the same period. The Sami women were significantly older than the Russian group (28.5 versus 25.1 years, p = 0.04). The mean birth weight was significantly lower in the Sami group compared to non-Sami Norwegians (p = 0.01), but was of comparable magnitude to that recorded in Russia (p = 0.4). For BMIC, the Sami and non-Sami Norwegian results were similar (p = 0.2); both were significantly higher than in Russia (p < 0.001). The essential elements copper, zinc, selenium and iron (as ferritin) in serum showed no differences between the groups, although relatively low levels of serum zinc were documented in all populations studied. Blood cadmium concentrations were strongly related to smoking frequency. Blood lead and urinary nickel levels were significantly higher for the Russian mothers, but did not reach levels of medical concern.

CONCLUSION

No ethnic differences in concentrations of essential elements in biological fluids, nor of cadmium and mercury, were observed. However, national differences for lead and nickel were evident. Because of small sample size, these conclusions need confirmation. The similar BMIC values observed for the non-Sami Norwegian and Sami newborns, compared to the Russian group, suggest that BMIC may serve as a good indicator of the nutritional status and possibly also the general health condition of neonates.

Persistent organic pollutants in maternal blood plasma and breast milk from Russian arctic populations

Under the auspices of Arctic Monitoring and Assessment Programme (AMAP), a Russian-Norwegian co-operation project was established to assess the exposure of delivering women to persistent organic pollutants (POPs) in Arctic areas of Russia. In the period 1993-95 blood and breast milk samples were collected from 94 delivering women in Yamal and Tajmyr Autonomous Regions of Siberia. Concentrations of chlorinated pesticides and polychlorinated biphenyls (PCBs) were determined by high resolution gas chromatography with electron capture detection. The POP levels in maternal plasma among the non-indigenous women were higher than the native population, especially in total PCB, HCHs (hexachlorocyclohexanes) and the DDT-group. The dietary questionnaires showed that the non-indigenous populations consumed considerably less local food items like reindeer meat and fresh water fish. There was no correlation between local food consumption and elevated levels of pollutants. Even if the indigenous groups had lower concentrations of the most important pollutants than the non-indigenous population, they were still higher than the levels measured in the Scandinavian countries of the AMAP-study and up to levels of medical concern. The most important sources of organic pollutants for the Russian Arctic populations of Yamal and Tajmyr seems to be imported food from other areas of Russia and local use of pesticides. It must be a high priority concern to further elucidate these trends and initiate prophylactic measures for the exposed population groups.

Ectopic pregnancy and chlamydial serology

OBJECTIVES

To determine the prevalence of humoral IgG antibodies to Chlamydia trachomatis in women with tubal pregnancies.

METHODS

A study was made of 49 women with tubal pregnancies. The control group consisted of 50 pregnant women without any known fertility problems.

RESULTS

Compared with the pregnant group of women, a statistically significant higher prevalence of chlamydial IgG antibody titer > or = 64 was observed among the patients with gross abnormalities in the fallopian tube contralateral to the ectopic gestation (P = 0.002). The differences in geometric mean titer (GMT) were also statistically significant (P = 0.0004) between those two groups. The recall frequency of past pelvic inflammatory disease (PID) was increased 5-6-fold in patients with ectopic pregnancy, compared with the intrauterine pregnant women. Twenty-five of 30 patients (83%) with ectopic pregnancy and macroscopic tubal sequelae recalled a history of PID. The prevalence of chlamydial IgG antibody titer > or = 64 among women with a past history of PID was 75.6% (34/45), compared with 44.4% (24/54) among the women without any history of past PID history (P = 0.002). Concerning GMT, the numbers were 27 and 154 among women with and without a past history of PID, respectively (Fig. 2).

CONCLUSIONS

These findings suggest that C. trachomatis is a major cause of oviductal damage, which predisposes to ectopic pregnancy.

[Conservative treatment of ectopic pregnancy]

During the last decades the incidence of ectopic pregnancy has been steadily rising. The chosen therapy has usually been unilateral salpingectomy. Recently, different conservative (tube-preserving) treatment-modalities have been introduced in clinical practice. We have tried conservative treatment by local injection of prostaglandin F2a (total dose 2-4 mg) directly into the tubal pregnancy and, if feasible, also into the corpus luteum graviditate. The treatment was successful in 13 out of 16 patients. In one patient laparotomia was performed because of pain, and revealed a haematoma in fossa Douglasi. Reinjection of prostaglandin was necessary in one patient because of rising HCG titres. One patient was hospitalized for four days because of nausea and pain. The treatment was otherwise successful. The method may be useful as a non-surgical alternative in haemodynamically stable patients without tubal rupture. Further studies are needed to evaluate the outcome in terms of future fertility.