COLEGA MARJORELEE TABALDO
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obgcmt@nus.edu.sg
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Publication Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study(MDPI AG, 2021-01-28) AKURASSA HEWAGE SUMALI SUBHASHINI HEWAGE; KOH XIN YU, HAZEL; SOH SHU E; PANG WEI WEI; Fok, Doris; Cai Shirong; MUELLER-RIEMENSCHNEIDER FALK; FABIAN YAP KOK PENG; TAN KOK HIAN; CHUA MEI CHIEN; Lim, Sok Bee; Godfrey, Keith M; COLEGA MARJORELEE TABALDO; CHONG YAP SENG; CHAN SHIAO-YNG; Yoong, Joanne; MARY CHONG FOONG FONG; Loh Ngiuk Lan, Doris; SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; OBSTETRICS & GYNAECOLOGY(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test(OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding(<1,≥1to<6,and≥6months). (3)Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and≥1monthto<6months(IRR0.91;95%confidenceinterval[CI]0.57,1.43;p=0.68)and≥6months (IRR0.50;95%CI0.27,0.91;p=0.02)breastfeeding compared to<1monthofanybreastfeeding. After adjusting for key confounders, the IRR for the≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.Publication Prepregnancy adherence to plant-based diet indices and exploratory dietary patterns in relation to fecundability.(Oxford University Press (OUP), 2022-02-09) Lim, Shan Xuan; Loy, See Ling; Colega, Marjorelee T; Lai, Jun Shi; Godfrey, Keith M; Lee, Yung Seng; Tan, Kok Hian; Yap, Fabian; Shek, Lynette Pei-Chi; Chong, Yap Seng; Eriksson, Johan G; Chan, Jerry Kok Yen; Chan, Shiao-Yng; Chong, Mary Foong-Fong; Dr Shu Qin Ooi; DEAN'S OFFICE (MEDICINE); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; PAEDIATRICS; OBSTETRICS & GYNAECOLOGYBACKGROUND: Modest associations have been reported between specific food groups or nutrients and fecundability [measured by time to pregnancy (TTP)]. Examining overall diets provides a more holistic approach towards understanding their associations with fecundability. It is not known whether plant-based diets indices or exploratory dietary patterns are associated with fecundability. OBJECTIVES: We examine the associations between adherence to 1) plant-based diet indices; and 2) exploratory dietary patterns and fecundability among women planning pregnancy. METHODS: Data were analyzed from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. Prepregnancy diet was assessed using a semi-quantitative FFQ from which the overall, healthful, and unhealthful plant-based diet indices (oPDI, hPDI, and uPDI, respectively) were calculated. Exploratory dietary patterns were derived using factor analysis based on 44 predefined food groups. Participants were categorized into quintiles based on their dietary pattern scores. TTP (expressed in menstrual cycles) was ascertained within a year from the prepregnancy dietary assessment. Discrete-time proportional hazard models, adjusted for confounders, were used to estimate fecundability ratios (FRs) and 95% CIs, with FR > 1 indicating a shorter TTP. RESULTS: Among 805 women, 383 pregnancies were confirmed by ultrasound scans. Compared with women in the lowest quintile, those in the highest quintile of the uPDI had reduced fecundability (FR of Q5 compared with Q1, 0.65; 95% CI, 0.46-0.91; P trend, 0.009). Conversely, greater adherence to the hPDI was associated with increased fecundability (1.46; 95% CI, 1.02-2.07; P trend, 0.036). The oPDI was not associated with fecundability. Among the 3 exploratory dietary patterns, only greater adherence to the Fast Food and Sweetened Beverages (FFSB) pattern was associated with reduced fecundability (0.61; 95% CI, 0.40-0.91; P trend, 0.018). CONCLUSIONS: Greater adherence to the uPDI or the FFSB dietary pattern was associated with reduced fecundability among Asian women. Greater adherence to the hPDI may be beneficial for fecundability, though this requires confirmation by future studies.Publication Dietary Supplement Intake and Fecundability in a Singapore Preconception Cohort Study(MDPI, 2022-12-01) Ku C.W.; Ku C.O.; Tay L.P.C.; Xing H.K.; Cheung Y.B.; Godfrey K.M.; Colega M.T.; Teo C.; Tan K.M.L.; Chong Y.-S.; Shek L.P.-C.; Tan K.H.; Chan S.-Y.; Lim S.X.; Chong M.F.-F.; Yap F.; Chan J.K.Y.; Loy S.L.; DEAN'S OFFICE (MEDICINE); DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; OBSTETRICS & GYNAECOLOGYSubfertility is a global problem affecting millions worldwide, with declining total fertility rates. Preconception dietary supplementation may improve fecundability, but the magnitude of impact remains unclear. This prospective cohort study aimed to examine the association of preconception micronutrient supplements with fecundability, measured by time to pregnancy (TTP). The study was conducted at KK Women’s and Children’s Hospital, Singapore, between February 2015 and October 2017, on 908 women aged 18-45 years old, who were trying to conceive and were enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO). Baseline sociodemographic characteristics and supplement intake were collected through face-to-face interviews. The fecundability ratio (FR) was estimated using discrete-time proportional hazard modelling. Adjusting for potentially confounding variables, folic acid (FA) (FR 1.26, 95% confidence interval 1.03–1.56) and iodine (1.28, 1.00–1.65) supplement users had higher fecundability compared to non-users. Conversely, evening primrose oil supplement users had lower fecundability (0.56, 0.31–0.99) than non-users. In this study, preconception FA and iodine supplementation were associated with shortened TTP, while evening primrose oil use was associated with longer TTP. Nonetheless, the association between supplement use and the magnitude of fecundability changes will need to be further confirmed with well-designed randomised controlled trials. © 2022 by the authors.Publication Maternal Night-Fasting Interval during Pregnancy Is Directly Associated with Neonatal Head Circumference and Adiposity in Girls but Not Boys(American Society for Nutrition, 2017-07-01) Loy, See Ling; Wee, Poh Hui; Colega, Majorelee T; Cheung, Yin Bun; Izzuddin M. Aris; Chan, Kok Yen Jerry; Godfrey, Keith M.; Gluckman, Peter D; Tan, Kok Hian; Shek, Pei Chi Lynette; Chong, Yap Seng; Natarajan, Padmapriya; Muller-Riemenschneider, Falk; Lek, Ngee; Rajadurai, Victor Samuel; Mya, Thway Tint; Lee, Yung Seng; Chong, Foong Fong Mary; Yap, Kok Peng Fabian; BIOMEDICAL ENGINEERING; PSYCHOLOGICAL MEDICINEPublication Modifiable Risk Factor Score and Fecundability in a Preconception Cohort in Singapore. JAMA Netw Open. 2023 Feb 1;6(2):e2255001. doi: 10.1001/jamanetworkopen.2022.55001. PMID: 36749588.(JAMA Network, 2023-02-07) Loy SL; Ku CW; Tiong MMY; Ng CST; Cheung YB; Godfrey KM; Lim SX; Colega MT; Lai JS; Chong YS; Shek LP; Tan KH; Chan SY; Chong MF; Yap F; Chan JKY; DEAN'S OFFICE (MEDICINE); DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; PAEDIATRICS; OBSTETRICS & GYNAECOLOGYPublication Changes in Diet Quality from Pregnancy to 6 Years Postpregnancy and Associations with Cardiometabolic Risk Markers(MDPI, 2023-04-23) Lai JS; Colega MT; Godfrey KM; Tan KH; Yap F; Chong YS; Lee YS; Eriksson JG; Chan SY; Chong MFF; DEAN'S OFFICE (MEDICINE); DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; OBSTETRICS & GYNAECOLOGYPublication Effect of Maternal Dietary Patterns during Pregnancy on Self-Reported Allergic Diseases in the First 3 Years of Life: Results from the GUSTO Study(KARGER, 2017-01-01) Loo, Evelyn Xiu Ling; Ong, Lynn; Goh, Anne; Chia, Ai-Ru; Teoh, Oon Hoe; Colega, Marjorelee T; Chan, Yiong Huak; Saw, Seang Mei; Kwek, Kenneth; Gluckman, Peter D; Godfrey, Keith M; Van Bever, Hugo; Lee, Bee Wah; Chong, Yap Seng; Chong, Mary Foong-Fong; Shek, Lynette Pei-chi; Dr Airu Chia; DEAN'S OFFICE (MEDICINE); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; PAEDIATRICS; OBSTETRICS & GYNAECOLOGYBackground: Maternal diet during pregnancy has been suggested to be an important early-life exposure that influences immune tolerance and the development of allergic diseases in offspring. Methods: We examined the relationship between maternal dietary patterns assessed using 24-h recalls and food diaries at 26-28 weeks of pregnancy and the subsequent development of allergic outcomes in the offspring in the Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort. Exploratory factor analysis was used to characterize maternal dietary patterns during pregnancy. During repeated visits in the first 36 months of life, questionnaires were administered to ascertain allergic symptoms, namely, eczema, rhinitis, and wheeze. At ages 18 and 36 months, we administered skin-prick testing to inhalant and food allergens. Results: Of the 3 maternal dietary patterns that emerged, the seafood and noodles pattern was associated with a reduced risk of developing allergen sensitization at both 18 months (odds ratio [95% confidence interval]: 0.7 [0.5-0.9]) and 36 months (0.7 [0.6-0.9]) after adjustment for a family history of allergy, and ethnicity, sex, and maternal education levels. No associations between the patterns vegetables, fruit, and white rice or pasta, cheese, and processed meat were observed with any of the allergic outcomes in the first 18 and 36 months of life. Conclusion: Maternal diet during pregnancy can influence the subsequent development of allergic outcomes in offspring.Publication Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study(Springer Science and Business Media Deutschland GmbH, 2022) Lee Y.Q.; Colega M.; Sugianto R.; Lai J.S.; Godfrey K.M.; Tan K.H.; Shek L.P.-C.; Loy S.L.; Müller-Riemenschneider F.; Padmapriya N.; Chong Y.S.; Eriksson J.G.; Chan J.K.Y.; Chan S.-Y.; Tai B.C.; Chong M.F.-F.; DEAN'S OFFICE (MEDICINE); DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; OBSTETRICS & GYNAECOLOGYPurpose: Few studies have described adherence to dietary patterns over time in women of childbearing age. This study aims to describe, examine the stability and changes in dietary patterns between pregnancy and 6 years post-pregnancy and the sociodemographic and lifestyle factors influencing the adherence over time. Methods: During pregnancy and at 6 years post-pregnancy, 24-h recalls and food frequency questionnaires were collected, respectively, from 709 women. Data on sociodemographic and lifestyle factors were collected via questionnaires. Dietary patterns were identified using principal component analysis and stability assessed using Pearson’s correlation coefficients (r) and Cohen’s weighted kappa (?). Associations with sociodemographic characteristics were assessed by multiple logistic regression. Results: The ‘Fruits, Vegetables and Legumes’ (FVL) and ‘Seafood, Noodle, Soup’ (SNS) patterns were identified at both time points, with low correlation for the dietary pattern z scores (r 0.2 and 0.3, respectively) and modest agreement in tertile assignment, suggesting poor stability. An ‘unhealthy’ pattern was only observed at 6 years post-pregnancy. Women who showed increased adherence to FVL pattern had higher educational attainment and exhibited healthy lifestyle behaviours. Women who had gestational diabetes during pregnancy were less likely to decrease adherence to FVL pattern over time. Women who adhered more closely to the ‘unhealthy’ pattern at 6 years post-pregnancy tended to be younger, of Malay ethnicity, had lower socioeconomic status, were less physically active and had additional pregnancies. Conclusions: Dietary habits of women became less healthy during the transition from pregnancy to 6 years post-pregnancy. However, results should be interpreted with caution due to the different dietary assessment tools used at the two time points. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.Publication Risk score to stratify miscarriage risk levels in preconception women(Nature Research, 2021-06-08) Xin Hui Choo; Chee Wai Ku; Yin Bun Cheung; Keith M Godfrey; Yap-Seng Chong; Lynette Pei-Chi Shek; Kok Hian Tan; Thiam Chye Tan; Sadhana Nadarajah; Fabian Kok Peng Yap; Marjorelee T Colega; Mary Foong-Fong Chong; Shiao-Yng Chan; See Ling Loy; Jerry Kok Yen Chan; SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; PAEDIATRICS; OBSTETRICS & GYNAECOLOGYSpontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.Publication Macronutrient composition and food groups associated with gestational weight gain: the GUSTO study(Dr. Dietrich Steinkopff Verlag GmbH and Co. KG, 2019) Lai J.S.; Soh S.E.; Loy S.L.; Colega M.; Kramer M.S.; Chan J.K.Y.; Tan T.C.; Shek L.P.C.; Yap F.K.P.; Tan K.H.; Godfrey K.M.; Chong Y.S.; Chong M.F.F.; SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH; DUKE-NUS MEDICAL SCHOOL; PAEDIATRICS; OBSTETRICS & GYNAECOLOGYPurpose: To examine the associations of energy, macronutrient and food intakes with GWG on 960 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort. Methods: Dietary intake was assessed at 26–28 weeks’ gestation with a 24-hour recall and 3-day food diary. GWG z-scores were calculated from first (4–13 weeks’ gestation) and last (30–40 weeks gestation) measured weights; inadequate and excessive GWG were defined using the Institute of Medicine recommendations based on weights between 15 and 35 weeks’ gestation. Associations were examined using substitution models for macronutrient composition, with linear or multinomial logistic regressions. Results: Mean ± SD daily energy intake was 1868 ± 598 kcal, and percentage energy intakes were 51.8 ± 8.9% from carbohydrate, 15.7 ± 3.9% from protein and 32.6 ± 7.7% from fat. Higher energy intake (per 500 kcal increment) was associated with 0.18 SD higher GWG. In isocaloric diets, higher-carbohydrate and lower-fat intakes (at 5% energy substitution) were associated with 0.07 SD higher GWG, and 14% higher likelihood of excessive GWG. Concordantly, the highest tertile of carbohydrate-rich foods intake was associated with 0.20 SD higher GWG, but the highest tertile of fruit and vegetable intake was independently associated with 60% lower likelihood of inadequate GWG. Additionally, the highest tertile of dairy intake was associated with 0.18 SD lower GWG; and the highest tertile of plant-based protein foods intake was associated with 60% and 34% lower likelihood of inadequate and excessive GWG. Conclusions: Balancing the proportions of carbohydrates and fat, and a higher intake of plant-based protein foods may be beneficial for achieving optimal GWG. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.