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Chong Y.-S.,National University of Singapore | Chong Y.-S.,Agency for Science, Technology and Research Singapore | Cai S.,National University of Singapore | Lin H.,National University of Singapore | And 75 more authors.
BMC Pregnancy and Childbirth | Year: 2014

Background: Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.Methods: 1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26-28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence. Results: Universal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).Conclusion: Risk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes. © 2014 Chong et al.; licensee BioMed Central Ltd.

Veena S.R.,Epidemiology Research Unit | Krishnaveni G.V.,Epidemiology Research Unit | Fall C.H.,Medical Research Council Lifecourse Epidemiology Unit
Diabetes Care | Year: 2012

OBJECTIVE - We aimed to examine detailed neonatal measurements as predictors of later diabetes in both parents. RESEARCH DESIGN AND METHODS - Babies (n = 617) born to nondiabetic parents in Holdsworth Memorial Hospital, Mysore, India, were measured at birth for weight; crown-to-heel length (CHL), crown-to-rump length (CRL), and leg length; skinfolds (triceps and subscapular); and circumferences (head, abdomen, and mid-upper-arm circumference [MUAC]). Nine and a half years later, glucose tolerance and fasting insulinwere measured in their parents (469 mothers and 398 fathers). RESULTS - Sixty-two (15.6%) fathers and 22 (4.7%) mothers had developed diabetes. There were linear inverse associations of the children's birth weight, CHL, CRL, MUAC, and skinfolds with paternal diabetes and insulin resistance (P < 0.05 for all). Offspring birth weight and adiposity (MUAC, abdominal circumference, and skinfolds) showed U-shaped associations with maternal diabetes (P for quadratic association <0.05 for all). These associations persisted after adjusting for the parents' current adiposity and maternal glucose concentrations and adiposity during pregnancy. Newborn adiposity was positively related to maternal insulin resistance; this association was nonsignificant after adjusting for maternal current adiposity. CONCLUSIONS - Newborn size is a window into the future health of the parents. Small newborn size (especially soft-tissue body components) predicts an increased risk of later diabetes in both parents, suggesting a genetic or epigenetic link between parents' diabetes risk and reduced fetal growth in their children. The association of higher birth weight and newborn adiposity with later maternal diabetes suggests effects on fetal adiposity of the intrauterine environment in prediabetic mothers. © 2012 by the American Diabetes Association.

van Sluijs E.M.F.,Medical Research Council Epidemiology Unit | van Sluijs E.M.F.,Center for Diet and Activity Research | McMinn A.M.,Medical Research Council Epidemiology Unit | McMinn A.M.,Center for Diet and Activity Research | And 8 more authors.
PLoS ONE | Year: 2013

Background:Correlates of physical activity (PA) are hypothesized to be context and behaviour specific, but there is limited evidence of this in young children. The aim of the current study is to investigate associations between personal, social and environmental factors and objectively measured light and moderate-to-vigorous PA (LPA and MVPA, respectively) in four-year-old children.Methods:Cross-sectional data were used from the Southampton Women's Survey, a UK population-based longitudinal study. Four-year old children (n = 487, 47.0% male) had valid PA data assessed using accelerometry (Actiheart) and exposure data collected with a validated maternal questionnaire (including data on child personality, family demographics, maternal behaviour, rules and restrictions, and perceived local environment). Linear regression modelling was used to analyse associations with LPA and MVPA separately, interactions with sex were explored.Results:LPA minutes were greater in children whose mothers reported more PA (vs. inactive: regression coefficient±standard error: 6.70±2.94 minutes), and without other children in the neighbourhood to play with (-6.33±2.44). MVPA minutes were greater in children with older siblings (vs. none: 5.81±2.80) and those whose mothers used active transport for short trips (vs. inactive: 6.24±2.95). Children accumulated more MVPA in spring (vs. winter: 9.50±4.03) and, in boys only, less MVPA with availability of other children in the neighbourhood (-3.98±1.70).Discussion:Young children's LPA and MVPA have differing associations with a number of social and environmental variables. Interventions targeting PA promotion in young children outside of formal care settings should consider including intensity specific factors. © 2013 van Sluijs et al.

Pang W.W.,National University of Singapore | Aris I.M.,Agency for Science, Technology and Research Singapore | Fok D.,National University of Singapore | Soh S.-E.,Agency for Science, Technology and Research Singapore | And 14 more authors.
Birth | Year: 2016

Background: Many countries in Asia report low breastfeeding rates and the risk factors for early weaning are not well studied. We assessed the prevalence, duration, and mode of breastfeeding (direct or expressed) among mothers of three Asian ethnic groups. Methods: Participants were 1,030 Singaporean women recruited during early pregnancy. Data collected included early breastfeeding experiences, breastfeeding duration, and mode of breastfeeding. Full breastfeeding was defined as the intake of breast milk, with or without water. Cox regression models were used to identify factors associated with discontinuation of any and full breastfeeding. Logistic regression analyses assessed the association of ethnicity with mode of breastfeeding. Results: At 6 months postpartum, the prevalence of any breastfeeding was 46 percent for Chinese mothers, 22 percent for Malay mothers, and 41 percent for Indian mothers; prevalence of full breastfeeding was 11, 2, and 5 percent, respectively. More Chinese mothers fed their infants expressed breast milk, instead of directly breastfeeding them, compared with the other two ethnic groups. Duration of any and full breastfeeding were positively associated with breastfeeding a few hours after birth, higher maternal age and education, and negatively associated with irregular breastfeeding frequency and being shown how to breastfeed. Adjusting for maternal education, breastfeeding duration was similar in the three ethnic groups, but ethnicity remained a significant predictor of mode of breastfeeding. Conclusions: The low rates and duration of breastfeeding in this population may be improved with breastfeeding education and support, especially in mothers with lower education. Further work is needed to understand the cultural differences in mode of feeding and its implications for maternal and infant health. © 2016 Wiley Periodicals, Inc.

Nightingale C.M.,St Georges, University of London | Krishnaveni G.V.,Epidemiology Research Unit | Rudnicka A.R.,St Georges, University of London | Owen C.G.,St Georges, University of London | And 5 more authors.
PLoS ONE | Year: 2012

Objective: UK Indian adults have higher risks of coronary heart disease and type 2 diabetes than Indian and UK European adults. With growing evidence that these diseases originate in early life, we compared cardiometabolic risk markers in Indian, UK Indian and white European children. Methods: Comparisons were based on the Mysore Parthenon Birth Cohort Study (MPBCS), India and the Child Heart Health Study in England (CHASE), which studied 9-10 year-old children (538 Indian, 483 UK Indian, 1375 white European) using similar methods. Analyses adjusted for study differences in age and sex. Results: Compared with Mysore Indians, UK Indians had markedly higher BMI (% difference 21%, 95%CI 18 to 24%), skinfold thickness (% difference 34%, 95%CI 26 to 42%), LDL-cholesterol (mean difference 0.48, 95%CI 0.38 to 0.57 mmol/L), systolic BP (mean difference 10.3, 95% CI 8.9 to 11.8 mmHg) and fasting insulin (% difference 145%, 95%CI 124 to 168%). These differences (similar in both sexes and little affected by adiposity adjustment) were larger than those between UK Indians and white Europeans. Compared with white Europeans, UK Indians had higher skinfold thickness (% difference 6.0%, 95%CI 1.5 to 10.7%), fasting insulin (% difference 31%, 95%CI 22 to 40%), triglyceride (% difference 13%, 95%CI 8 to 18%) and LDL-cholesterol (mean difference 0.12 mmol/L, 95%CI 0.04 to 0.19 mmol/L). Conclusions: UK Indian children have an adverse cardiometabolic risk profile, especially compared to Indian children. These differences, not simply reflecting greater adiposity, emphasize the need for prevention strategies starting in childhood or earlier. © 2012 Nightingale et al.

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