Seremban Cohort Study (SECOST): a prospective study of determinants and pregnancy outcomes of maternal glycaemia in Malaysia

Introduction: Both gestational diabetes mellitus (GDM) and hyperglycaemia less severe than GDM are associated with risk of adverse pregnancy outcomes. We describe the study design of a prospective cohort of pregnant women recruited in early pregnancy with follow-ups of mothers and infants up to 2 years after birth. The primary aim of the study was to identify the determinants and outcomes of maternal glycaemia. Methods and analysis: Seremban Cohort Study (SECOST) is an ongoing prospective cohort study in which eligible pregnant women in first trimester (<10 weeks of gestation) are recruited from Maternal and Child Health clinics in Seremban District, Negeri Sembilan with seven follow-ups during pregnancy through 2 years postnatally. Infants are followed up every 6 months after birth until 2 years old. A standard 75 g oral glucose tolerance test is performed between 24 and 32 of weeks of gestation and as close to 28 weeks of gestation. Pregnancy and birth information are obtained from medical records. Sociodemographic, anthropometric, biochemical, dietary, physical activity, smoking, depression, child feeding and other data of mothers and infants are obtained at follow-ups. Ethics and dissemination: This study is approved by the Medical Research Ethics Committee (MREC), Universiti Putra Malaysia (UPM/FPSK/100-9/2-MJKEtika) and MREC, Ministry of Health Malaysia (KKM/NIHSEC/08/0804/P12- 613). Permission to conduct this study is also obtained from the Head of Seremban District Health Office. All participants are required to provide written informed consent prior to data collection. The research findings will be disseminated at journals and conference presentations

High early pregnancy serum 25-hydroxy vitamin D level, within a sub-optimal range, is associated with gestational diabetes mellitus: a prospective cohort study

Background/objectives: Low early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association. Subjects/methods: This study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression. Results: Nearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status. Conclusions: The high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted

Risk Factors Associated with Underweight Children Under the Age of Five in Putrajaya, Malaysia: A Case-Control Study

The study aimed to determine the associated factors for underweight among children under five years old in Putrajaya, Malaysia. This was a case-control study with a one-to-one ratio matched by sex as well as by three age categories (6‒11 months, 12‒35 months, dan 36‒59 months) between underweight and normal-weight children. There were 364 underweight children and 364 children with normal weight recruited from four government clinics and 118 preschools in Putrajaya. Both groups were assessed via face-to-face interviews; anthropometric measurements; haemoglobin level through finger prick blood sample; and a self-administered 3-day food diary. Underweight is defined as a weight-for-age z score less than -2SD based on World Health Organization (WHO) 2006 Growth Chart. The logistic regression’s final model revealed that various factors were significantly associated with underweight among children under five in Putrajaya. These factors included father being employed as a non-government servant [aOR:1.45 (95% CI:1.04‒2.02) compared to government servant], children from B40 group with a monthly household income less than <RM 7,380 (USD 1727.33) [aOR:2.17 (95% CI:1.01‒4.66) compared to T20], monthly expenditure for childcare less than RM 1,000 (USD 234.06), [aOR:1.77 (95% CI:1.01‒3.10) compared to ≥RM 2,000], underweight mother during prepregnancy [aOR:1.89 (95% CI:1.10‒3.26)] compared to normal weight, anemic children [aOR:1.57 (95% CI:1.15‒2.16)] compared to normal children, children using pacifiers [aOR:1.75 (95% CI:1.21‒2.73)] compared to not using pacifiers and children staying with unregistered babysitters [aOR:2.33 (85% CI:1.52‒3.59)] compared to those attending kindergarten. The above findings suggest several factors are significantly associated with underweight among children under five years old. Therefore, it highlights on the importance of improving household socioeconomic status, maternal nutritional status, and infant and young child feeding practices to prevent underweight issues in this population

Factors associated with vitamin D and gestational diabetes mellitus among pregnant women in selected maternal and child health clinics in Seremban, Negeri Sembilan, Malaysia

The prevalence of Vitamin D deficiency (VDD) is high among pregnant women in Malaysia despite abundance of sunlight all year round. VDD had been associated with many adverse effects in pregnancy and one of them is gestational diabetes mellitus (GDM). Thus, this study aimed to investigate the association between Vitamin D status in first trimester with GDM among pregnant women in selected maternal and child health clinics in Seremban, Negeri Sembilan. This study was a part of the ‘Seremban Cohort Study (SECOST): A prospective study of determinants and pregnancy outcomes of maternal glycemia in Malaysia’. In this study, 170 pregnant women were recruited using purposive sampling method from Senawang and Ampangan Maternal and Child Health Clinics in Seremban, Negeri Sembilan between 2014 - 2015 and followed-up until 2016. A set of pre-tested Malay language interviewer-administered questionnaire was used to obtain information on demographic, socio-economic, dietary intake and physical activity. Obstetrical data were obtained from the antenatal cards of the women. Height and weight of the women were measured in the clinics at the study enrollment (<10 weeks), during Visit 1 (10-14 weeks of gestation) and Visit 2 (24-30 weeks of gestation). Blood samples were obtained during Visit 1 to quantify serum 25-Hydroxy Vitamin D [25(OH)D] and during Visit 2 for a standard 75g Oral Glucose Tolerance Test (OGTT). VDD is defined as serum 25(OH)D <50nmol/L. GDM is diagnosed if fasting plasma glucose ≥ 5.6 nmol/L or 2-hours post prandial plasma glucose ≥ 7.8 nmol/L. All data were analysed using SPSS version 22 and significant level was set at p<0.05. Logistic regression was performed to determine the association between serum Vitamin D status in first trimester and GDM. The prevalence of VDD in first trimester and GDM in the present study was 93% and 14.1% respectively. Pregnant women who had pre-pregnancy BMI of overweight/ obese were 6 times more likely to have mild VDD compared to pregnant women with normal BMI while pregnant women with a family history of Type 2 Diabetes Mellitus (T2DM) were 3 times more likely to have GDM compared to pregnant women who do not have any family history of T2DM. In this study, pregnant women with GDM had a significantly higher mean Vitamin D level compared to non-GDM pregnant women in bivariate analysis. However, serum Vitamin D status was not significantly associated with GDM in the multivariate analysis. In the study, pregnant women with GDM had a higher mean pre-pregnancy BMI and age compared to non-GDM pregnant women. These two factors could have contributed to the onset of GDM regardless of Vitamin D level. A more comprehensive study with a bigger sample size is suggested to obtain concrete evidence on the association between VDD in pregnancy and GDM as only 24 women were diagnosed with GDM in this study

Vitamin D status is associated with high BMI, working status and gravidity among pregnant Malaysian women

Introduction: Vitamin D deficiency (VDD) is associated with adverse health outcomes in pregnancy and newborns. This study aims to determine the Vitamin D status among pregnant Malaysian women and its associations with specific maternal & pregnancy characteristics. Methods: This study utilised cross-sectional data from a prospective cohort study of pregnant women in Seremban district in which 259 pregnant women had available vitamin D data. Blood samples were taken 75nmol/L). Early pregnancy body mass index (AOR=2.95, 95% CI=1.03-8.47), working status (AOR=3.17, 95% CI=1.06-9.50) and gravidity (AOR=0.68, 95% CI=0.48-0.98) were significantly associated with VDD. Conclusion: The present study showed a high prevalence of VDD among pregnant women in Malaysia, especially among those who were overweight or obese, working in indoor environment and primigravida