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  1. Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study
    Samsuddin S, Arumugam PA, Md Amin MS, Yahya A, Musa N, Lim LL, et al.
    BJOG, 2020 03;127(4):490-499.
    PMID: 31778255 DOI: 10.1111/1471-0528.16031
    OBJECTIVE: To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs.

    DESIGN: Prospective observational cohort study.

    SETTING: Single tertiary multidisciplinary antenatal clinic in Malaysia.

    POPULATION: A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT.

    METHODS: Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records.

    MAIN OUTCOME MEASURES: Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile.

    RESULTS: Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m2 and 61% had a pre-gravid BMI of ≤ 25 kg/m2 , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile.

    CONCLUSION: Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy.

    TWEETABLE ABSTRACT: Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

  2. Fulltext Are the 2009 Institute of Medicine gestational weight gain recommendations applicable in a contemporary South-East Asian pregnancy cohort? Results of a prospective analysis
    Tai YT, Khoo JK, Lim QH, Lim LL, Paramasivam SS, Ratnasingam J, et al.
    PLoS One, 2025;20(1):e0316837.
    PMID: 39761286 DOI: 10.1371/journal.pone.0316837
    Gestational Weight Gain (GWG) modulates pregnancy outcomes and long-term offspring metabolic health. The 2009 Institute of Medicine (IOM) GWG recommendations have largely been validated in Caucasian and mono-ethnic East Asian cohorts. Asians are at higher metabolic risk at a lower body mass index (BMI), and this has prompted the World Health Organization (WHO) to identify lower BMI cut-offs for risk evaluation amongst Asians. This prospective observational cohort study aimed to determine if 2009 IOM GWG thresholds are applicable in a contemporary multi-ethnic South-East Asian cohort. We recruited 875 mothers from an urban Malaysian tertiary clinic during screening for gestational diabetes mellitus (GDM) from 2014-2021. Data collected included measures of insulin-sensitivity, total GWG (maternal weight at delivery-self-reported pre-gravid weight), and neonatal anthropometrics (birthweight and skinfold-thickness measured with Harpenden calipers). BMI was stratified by Caucasian (overweight ≥25kg/m2, obese ≥30kg/m2) as well as Asian (overweight ≥23kg/m2, obese ≥27.5kg/ m2) cut-offs, and patients categorized by 2009 IOM GWG reference ranges. The cohort comprised 67% Malay-, 23% Chinese- and 10% Indian-descent mothers with a high prevalence of overweight/obesity (Asian cut-offs 56.9% vs Caucasian 44%). When Asian BMI cut-offs were deployed, excessive GWG incidence increased (34.1% → 40.6%) whilst inadequate GWG declined (30% → 24.8%) (p<0.05). Upon multivariate-analysis (adjusting for age, parity, race, GDM, insulin-sensitivity, baby-gender) excessive GWG categorized with Caucasian BMI cut-offs was significantly associated with increased risk of macrosomia (adjusted odds ratio (aOR) 8.65, 95% confidence interval (CI) 1.07-70.01), Neonatal-Fat-Mass (NFM) >90th centile (aOR 2.14, 95% CI 1.02-4.45) and Sum-of-Skinfold Thickness (SSFT) >90th centile (aOR 3.88, 95% CI 1.77-8.51). Excessive GWG by Asian cut-offs was also associated with increased risk of SSFT >90th centile (aOR 5.75, 95% CI 2.35-14.10). Inadequate GWG by both Caucasian and Asian BMI cut-offs was associated with Small-for-Gestational-Age (SGA) status (aOR 4.30, 95% CI 2.48-7.45 and aOR 3.66, 95% CI 2.13-6.30 respectively). In conclusion, the 2009 IOM GWG recommendations, using either Caucasian or regional Asian BMI cut-offs, are applicable in a contemporary Malay majority South-East Asian cohort in terms of predicting abnormal neonatal adiposity. Importantly, the association with neonatal adiposity is independent of increased maternal insulin resistance characteristic of Asians.
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