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Fok D.,National University of Singapore | Aris I.M.,Agency for Science, Technology and Research Singapore | Ho J.,National University of Singapore | Lim S.B.,KK Womens & Childrens Hospital KKH | And 11 more authors.
Birth | Year: 2016

Background: Confinement (restrictions placed on diet and practices during the month right after delivery) represents a key feature of Asian populations. Few studies, however, have focused specifically on ethnic differences in confinement practices. This study assesses the confinement practices of three ethnic groups in a multi-ethnic Asian population. Methods: Participants were part of a prospective birth cohort study that recruited 1,247 pregnant women (57.2% Chinese, 25.5% Malay, and 17.3% Indian) during their first trimester. The 1,220 participants were followed up 3 weeks postpartum at home when questionnaires were administered to ascertain the frequency of adherence to the following confinement practices: showering; confinement-specific meals; going out with or without the baby; choice of caregiver assistance; and the use of massage therapy. Results: Most participants reported that they followed confinement practices during the first 3 weeks postpartum (Chinese: 96.4%, Malay: 92.4%, Indian: 85.6%). Chinese and Indian mothers tended to eat more special confinement diets than Malay mothers (p < 0.001), and Chinese mothers showered less and were more likely to depend on confinement nannies during this period than mothers from the two other ethnic groups (p < 0.001 for all). Malay mothers tended to make greater use of massage therapy (p < 0.001), whilst Indian mothers tended to have their mothers or mothers-in-law as assistant caregivers (p < 0.001). Conclusion: Most Singapore mothers follow confinement practices, but the three Asian ethnic groups differed in specific confinement practices. Future studies should examine whether ethnic differences persist in later childrearing practices. © 2016 Wiley Periodicals, Inc.


PubMed | Agency for Science, Technology and Research Singapore, National University of Singapore, KK Womens and Childrens Hospital KKH, KKH and Medical Research Council Lifecourse Epidemiology Unit
Type: Journal Article | Journal: Birth (Berkeley, Calif.) | Year: 2016

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.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.At 6months 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.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.


PubMed | Agency for Science, Technology and Research Singapore, KK Womens and Childrens Hospital, National University of Singapore and Medical Research Council Lifecourse Epidemiology Unit
Type: Journal Article | Journal: Archives of women's mental health | Year: 2016

This study aimed to investigate associations of physical activity (PA) and sedentary behavior (SB) with depression and anxiety symptoms during pregnancy among Chinese, Malay, and Indian women.Women answered PA and SB (sitting time and television time) interview questions and self-completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) questionnaires, at week 26-28 gestation. Sufficient levels of PA (600MET-minutes/week) and higher sitting time (7h/day) were determined. Associations of PA and SB with probable antenatal depression (EPDS-score 15), higher state anxiety (score 42), and higher trait anxiety (score 43) were determined by logistic regression analysis.Among the 1144 pregnant women included in the study, 7.3, 22.5, and 23.6% had probable antenatal depression, higher state anxiety, and higher trait anxiety symptoms, respectively. In the adjusted models, women with sufficient level of PA were less likely to have probable antenatal depression (OR 0.54, 95% CI 0.31-0.94, p=0.030) and higher trait anxiety symptoms (OR 0.68, 95% CI 0.48-0.94, p=0.022). PA was not associated with state anxiety symptoms. SB was not associated with any of the investigated outcomes.Sufficient PA was associated with a reduced likelihood of probable antenatal depression and trait anxiety symptoms. Further investigation of these findings is warranted to determine cause-effect relationships and identify potential preventive strategies.


News Article | October 27, 2016
Site: www.eurekalert.org

Vitamin D supplements are less effective at raising vitamin D levels in pregnant women if they deliver their babies in the winter, have low levels of vitamin D early in pregnancy or gain more weight during pregnancy, a new Southampton study has shown. The findings, published the Endocrine Society's Journal of Clinical Endocrinology & Metabolism, showed pregnant women respond differently to vitamin D supplementation depending on their individual attributes. The University of Southampton researchers suggest that supplement levels should be tailored according to individual risk factors. Vitamin D is a hormone that helps the body absorb calcium. It plays a crucial role in bone and muscle health. The skin naturally produces vitamin D after exposure to sunlight but people also obtain smaller amounts of the vitamin through foods, such as milk fortified with vitamin D. Evidence suggests vitamin D deficiency during pregnancy can harm maternal health, fetal development and the child's long-term skeletal health. Professor Nicholas Harvey, of the Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, who led the study with Dr Rebecca Moon, Clinical Research Fellow, comments: "It is important for pregnant women to have sufficient levels of vitamin D for the health of their baby. Our study findings suggest that in order to optimise vitamin D concentrations through pregnancy, the supplemental dose given may need to be tailored to a woman's individual circumstances, such as the anticipated season of delivery." The Maternal Vitamin D Osteoporosis Study (MAVIDOS), is a multi-centre, double-blind, randomised, placebo-controlled trial of vitamin D supplementation in pregnancy. More than 800 pregnant women were recruited and randomised to take either 1000 units (25 micrograms) of vitamin D every day or a matched placebo capsule from 14 week's gestation until delivery of the baby. Analysis showed that participants who received the vitamin D supplement achieved different levels of vitamin D in the blood, even though they received the same dose. Researchers found women who delivered in the summer, who gained less weight during pregnancy and who had higher vitamin D levels early in pregnancy tended to have higher levels of vitamin D in the blood than their counterparts. Women who consistently took the supplement also had higher levels of vitamin D than participants who did not. "Our findings of varied responses to vitamin D supplementation according to individual attributes can be used to tailor approaches to antenatal care," said Professor Cyrus Cooper, Director, and Professor of Rheumatology at the MRC Lifecourse Epidemiology Unit, University of Southampton. "This work forms part of a larger programme of research at the MRC Lifecourse Epidemiology Unit, University of Southampton, addressing the early life determinants of bone development, and will inform novel strategies aimed at improving bone health across future generations." The study was funded by the charity Arthritis Research UK, with further funding support from the MRC, National Institute for Health Research (NIHR) and the Bupa Foundation.


Kajantie E.,Finnish National Institute for Health and Welfare | Kajantie E.,University of Helsinki | Osmond C.,Medical Research Council Lifecourse Epidemiology Unit | Osmond C.,University of Southampton | And 8 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - The association between low birth weight and type 2 diabetes is well established. We studied whether preterm birth carries a similar risk. RESEARCH DESIGN AND METHODS - The Helsinki Birth Cohort includes 13,345 men and women born between 1934 and 1944. Of them, 12,813 had adequate data on length of gestation, which we linked with data on special reimbursement for diabetes medication. RESULTS - Of the subjects, 5.1% had received special reimbursement after age 40. In subjects born before 35 weeks of gestation, the odds ratio for diabetes was 1.68 (95% CI 1.06-2.65) compared with that in those born at term. After adjustment for birth weight relative to length of gestation, the odds ratio was 1.59 (1.00-2.52). CONCLUSIONS - Preterm birth before 35 weeks of gestation is associated with an increased risk of type 2 diabetes in adult life. The risk is independent of that associated with slow fetal growth. © 2010 by the American Diabetes Association.


Duncan E.L.,University of Queensland | Danoy P.,University of Queensland | Kemp J.P.,University of Bristol | Leo P.J.,University of Queensland | And 53 more authors.
PLoS Genetics | Year: 2011

Osteoporotic fracture is a major cause of morbidity and mortality worldwide. Low bone mineral density (BMD) is a major predisposing factor to fracture and is known to be highly heritable. Site-, gender-, and age-specific genetic effects on BMD are thought to be significant, but have largely not been considered in the design of genome-wide association studies (GWAS) of BMD to date. We report here a GWAS using a novel study design focusing on women of a specific age (postmenopausal women, age 55-85 years), with either extreme high or low hip BMD (age- and gender-adjusted BMD z-scores of +1.5 to +4.0, n = 1055, or -4.0 to -1.5, n = 900), with replication in cohorts of women drawn from the general population (n = 20,898). The study replicates 21 of 26 known BMD-associated genes. Additionally, we report suggestive association of a further six new genetic associations in or around the genes CLCN7, GALNT3, IBSP, LTBP3, RSPO3, and SOX4, with replication in two independent datasets. A novel mouse model with a loss-of-function mutation in GALNT3 is also reported, which has high bone mass, supporting the involvement of this gene in BMD determination. In addition to identifying further genes associated with BMD, this study confirms the efficiency of extreme-truncate selection designs for quantitative trait association studies. © 2011 Duncan et al.


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.


Simmonds S.J.,Medical Research Council Lifecourse Epidemiology Unit | Syddall H.E.,Medical Research Council Lifecourse Epidemiology Unit | Westbury L.D.,Medical Research Council Lifecourse Epidemiology Unit | Dodds R.M.,Medical Research Council Lifecourse Epidemiology Unit | And 6 more authors.
Age and Ageing | Year: 2015

Background: lower grip strength on admission to hospital is known to be associated with longer stay, but the link between customary grip and risk of future admission is less clear.Objective: to compare grip strength with subsequent risk of hospital admission among community-dwelling older people in a UK setting.Design: cohort study with linked administrative data.Setting: Hertfordshire, UK.Subjects: a total of 2,997 community-dwelling men and women aged 59-73 years at baseline.Methods: the Hertfordshire Cohort Study (HCS) participants completed a baseline assessment between 1998 and 2004, during which grip strength was measured. Hospital Episode Statistics and mortality data to March 2010 were linked with the HCS database. Statistical models were used to investigate the association of grip strength with subsequent elective, emergency and long-stay hospitalisation and readmission.Results: there was a statistically significant negative association between grip strength and all classes of admission in women [unadjusted hazard ratio per standard deviation (SD) decrease in grip strength for: any admission/death 1.10 (95% CI: 1.06, 1.14), elective admission/death 1.09 (95% CI: 1.05, 1.13), emergency admission/death 1.21 (95% CI: 1.13, 1.31), long-stay admission/death 1.22 (95% CI: 1.13, 1.32) and unadjusted relative risk per SD decrease in grip strength for 30-day readmission/death 1.30 (95% CI: 1.19, 1.43)]. These associations remained significant after adjustment for potential confounding factors (age, height, weight for height, smoking, alcohol, social class). In men, unadjusted rates for emergency admission/death, long-stay admission/death and readmission/death were significantly associated with grip strength; associations that similarly withstood adjustment.Conclusion: this study provides the first evidence that grip strength among community-dwelling men and women in the UK is associated with risk of hospital admission over the following decade. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


PubMed | National Health Research Institute, University of Southern Denmark, University of Southampton, UK National Institute for Medical Research and Medical Research Council Lifecourse Epidemiology Unit
Type: Journal Article | Journal: The American journal of clinical nutrition | Year: 2016

Studies in older adults and animals have suggested contrasting relations between bone health and different vitamin A compounds. To our knowledge, the associations between maternal vitamin A status and offspring bone development have not previously been elucidated.We examined the associations between maternal serum retinol and -carotene concentrations during late pregnancy and offspring bone mineralization assessed at birth with the use of dual-energy X-ray absorptiometry.In the Southampton Womens Survey mother-offspring birth cohort, maternal health, lifestyle, and diet were assessed prepregnancy and at 11 and 34 wk of gestation. In late pregnancy, maternal serum retinol and -carotene concentrations were measured. Offspring total body bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) were measured within 2 wk after birth.In total, 520 and 446 mother-offspring pairs had measurements of maternal serum retinol and -carotene, respectively. Higher maternal serum retinol in late pregnancy was associated with lower offspring total body BMC ( = -0.10 SD/SD; 95% CI: -0.19, -0.02; P = 0.020) and BA ( = -0.12 SD/SD; 95% CI: -0.20, -0.03; P = 0.009) but not BMD. Conversely, higher maternal serum -carotene concentrations in late pregnancy were associated with greater total body BMC ( = 0.12 SD/SD; 95% CI: 0.02, 0.21; P = 0.016) and BA ( = 0.12 SD/SD; 95% CI: 0.03, 0.22; P = 0.010) but not BMD.Maternal serum retinol and -carotene concentrations had differing associations with offspring bone size and growth at birth: retinol was negatively associated with these measurements, whereas -carotene was positively associated. These findings highlight the need for further investigation of the effects of maternal retinol and carotenoid status on offspring bone development.

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