Publications by authors named "See Ling Loy"

Article Synopsis
  • This study explored how early gestational glucose levels, measured by continuous glucose monitoring (CGM), relate to the later development of insulin resistance (IR) and gestational diabetes mellitus (GDM) in pregnant women.
  • In a cohort of 167 pregnant women, 25% were found to have IR and 18% developed GDM, with higher early glucose levels and variability in glucose readings linked to increased risk of both conditions.
  • Results indicated that women with suboptimal glycemic control showed higher mean daily glucose and variability, which correlated with a significantly greater risk of developing IR and GDM as pregnancy progressed.
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  • Pediatricians in training need to understand the Developmental Origins of Health and Disease (DOHaD) to address the increasing issues of non-communicable diseases.
  • A survey conducted among 95 doctors revealed that only 23.2% were aware of DOHaD, with most believing their peers lacked knowledge on the topic.
  • Despite their limited knowledge, nearly all physicians expressed a desire to learn more about DOHaD and recognized the importance of guiding patients on healthy practices for better long-term health outcomes.
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  • Global fertility rates are declining due to metabolic and mental health issues among women, prompting the HELMS program in Singapore to create mHealth interventions to help address these challenges.
  • A validated evaluation questionnaire was developed through literature review and a two-step validation process, assessing its effectiveness with input from experts and participants.
  • The questionnaire demonstrated strong content validity and internal consistency, indicating its potential to effectively evaluate similar health intervention programs worldwide.
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Article Synopsis
  • - Researchers studied how a mother's diet quality and eating habits during pregnancy affect her child's metabolic health, particularly focusing on weight and insulin resistance in children by age 6.
  • - They found that a better diet quality during pregnancy was linked to lower insulin resistance in children, while mothers who mainly ate at night tended to have offspring with higher insulin resistance, especially among boys.
  • - Overall, the study highlights the significance of maternal eating patterns and diet quality during pregnancy, suggesting both factors can influence a child’s metabolic health, with stronger effects observed in male children and in those exposed to lower diet quality.
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This study examines relationships between breastfeeding practices and postpartum weight retention (PPWR) at 6 and 12 months postpartum among 379 first-time mothers participating in a clinical trial in Singapore. We categorized feeding modes at 6 months into exclusive breastfeeding, mixed feeding, and exclusive formula feeding. Participants were analyzed in two groups based on their PPWR assessment at 6 and 12 months postpartum, with complete datasets available for each assessment.

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  • Preconception is crucial for optimizing gamete function and placental development, but the lack of services has led to declining fertility rates and unhealthy pregnancies. A community-level preconception care program is urgently needed.* -
  • The proposed solution is a user-friendly mobile app that allows couples to assess their fecundability risks and receive personalized management plans, promoting better reproductive health.* -
  • This digital intervention aims to shift couples' perceptions about subfertility and facilitate ongoing behavior change, ultimately creating a framework for future preconception care delivery.*
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Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their association with glycemic responses among adults.

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Studies examining preconception eating behaviours with longitudinal dietary patterns from preconception to late pregnancy as well as gestational weight gain (GWG) are limited. We derived dietary pattern trajectories from preconception to late-pregnancy, and related preconception eating behaviours to these trajectories and GWG. Preconception eating behaviours were assessed using the Three-Factor Eating Questionnaire measuring cognitive restraint (CR) - conscious restriction of food intake, emotional eating (EE) - overeating in response to negative emotions, and uncontrolled eating (UE) - overeating with a feeling of lack of control.

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Objectives: The Developmental Origins of Health and Disease (DOHaD) concept has gained prominence in maternal and child health (MCH), emphasizing how early-life factors impact later-life non-communicable diseases. However, a knowledge-practice gap exists in applying DOHaD principles among healthcare professionals. Healthy Early Life Moments in Singapore (HELMS) introduced webinars to bridge this gap and empower healthcare professionals.

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Dysregulated transplacental lipid transfer and fetal-placental lipid metabolism affect birthweight, as does maternal hyperglycemia. As the mechanisms are unclear, we aimed to identify the lipids in umbilical cord plasma that were most associated with birthweight. Seventy-five Chinese women with singleton pregnancies recruited into the GUSTO mother-offspring cohort were selected from across the glycemic range based on a mid-gestation 75 g oral glucose tolerance test, excluding pre-existing diabetes.

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The impact of vitamin D supplementation on 25-hydroxyvitamin D (25OHD) levels, metabolic status, and pregnancy outcomes in pregnant women with overweight and obesity (OW/OB) is uncertain. This study aimed to examine whether administrating 800 IU of vitamin D3 orally would improve maternal serum 25OHD levels, lipid profile, and pregnancy outcomes compared to 400 IU. This was a two-arm, parallel, non-blinded randomised controlled trial involving 274 pregnant women recruited from KK Women's and Children's Hospital, with a body mass index of ≥25 kg/m within 16 weeks gestation.

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Background & Aims: To examine whether predominant night-eating, defined as more than 50% of total daily energy intake consumed between 1900 and 0659 h, is associated with glycemic outcomes in pregnancy.

Methods: This was a prospective cohort study of 277 healthy pregnant women with complete 4-day dietary intake records at 18-24 weeks gestation, recruited from KK Women's and Children's Hospital, Singapore. Primary outcomes were fasting, 1-h, and 2-h plasma glucose after a 75-g oral glucose tolerance test at 24-28 weeks gestation.

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Background: Poor sleep quality may elevate cortisol levels and affect prenatal mental health through altered HPA axis functioning. This study aims to examine whether subjective sleep quality during preconception moderates the association between preconception hair cortisol levels and mental health from preconception to pregnancy trimesters.

Methods: Women from a prospective cohort study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) questionnaires during preconception (T0) and at each pregnancy trimesters (T1, T2, and T3).

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Article Synopsis
  • The study investigates how physical activity (PA) and sedentary behavior change from before conception through pregnancy and after childbirth in women planning for pregnancy.
  • Results showed that walking time increased during late pregnancy but dropped postpartum, while moderate to vigorous physical activity (MVPA) decreased during pregnancy but partially recovered after delivery.
  • Factors like ethnicity, body mass index, employment status, number of children, and self-rated health were found to influence these changes in activity patterns.
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Article Synopsis
  • * Findings revealed that 40.7% of women maintained a stable BMI, while others experienced weight loss or gain, with greater risks associated with significant weight changes.
  • * Women losing more than 1 kg/m had a higher risk of low birth weight, while those gaining weight faced increased risks for larger babies, gestational diabetes, and emergency C-sections, highlighting the importance of managing weight between pregnancies.
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Objectives: Experimental models have demonstrated a link between exposure to perfluoroalkyl substances (PFAS) and decreased fertility and fecundability; however, human studies are scarce. We assessed the associations between preconception plasma PFAS concentrations and fertility outcomes in women.

Methods: In a case-control study nested within the population-based Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO), we measured PFAS in plasma collected in 2015-2017 from 382 women of reproductive age trying to conceive.

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Background: Adaptations in lipid metabolism are essential to meet the physiological demands of pregnancy and any aberration may result in adverse outcomes for both mother and offspring. However, there is a lack of population-level studies to define the longitudinal changes of maternal circulating lipids from preconception to postpartum in relation to cardiometabolic risk factors.

Methods: LC-MS/MS-based quantification of 689 lipid species was performed on 1595 plasma samples collected at three time points in a preconception and longitudinal cohort, Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO).

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Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes.

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Objective: To determine whether a combined myo-inositol, probiotics and micronutrient nutritional supplement impacts time-to-natural-conception and clinical pregnancy rates.

Design: Secondary outcomes of a double-blind randomized controlled trial.

Setting: Community recruitment.

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Importance: Although multiple modifiable risk factors have been identified for reduced fecundability (defined as lower probability of conception within a menstrual cycle), no scoring system has been established to systematically evaluate fecundability among females who are attempting to conceive.

Objective: To examine the association of a risk score based on 6 modifiable factors with fecundability, and to estimate the percentage reduction in incidence of nonconception if all study participants achieved a minimal risk score level.

Design, Setting, And Participants: This population-based cohort study obtained data from the S-PRESTO (Singapore Preconception Study of Long-Term Maternal and Child Outcomes) prospective cohort study.

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Developmental Origin of Health and Disease (DOHaD) explains how the health of the mother influences the offspring's risk of non-communicable diseases in later life. However, this remains underutilized in clinical practice. This study aimed to investigate the knowledge, attitude, and practice (KAP) of medical students, Obstetrics and Gynecology (O&G) and Pediatrics residents, toward DOHaD, identify potential barriers to DOHaD counseling, and translate DOHaD concepts into clinical practice.

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Introduction: Changes in social and lifestyle factors have led to increasing rates of metabolic and mental health problems. We hypothesise that a transformation of the current maternal and child health system is required to deliver interventions that effectively promote a good start to life in populations at risk of metabolic and mental health problems. We describe a single-arm implementation study 'Healthy Early Life Moments in Singapore', which aims to examine whether an integrated lifestyle intervention initiated at preconception and continuing throughout pregnancy and postpartum periods can improve the metabolic and mental health of overweight and obese women, and improve early child growth.

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Article Synopsis
  • Subfertility is a widespread issue, and this study researched how preconception micronutrient supplements might influence the time it takes to get pregnant among women.
  • Conducted in Singapore, the study involved 908 women aged 18-45, measuring their supplement intake and sociodemographic characteristics to determine their fecundability.
  • Results showed that folic acid and iodine supplementation linked to shorter time to pregnancy, while evening primrose oil seemed to have the opposite effect, suggesting further research is needed to confirm these findings.
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Objective: To evaluate whether characterization of maternal and foetoplacental factors beyond birthweight can enable early identification of children at risk of developing prehypertension/hypertension.

Methods: We recruited 693 mother-offspring dyads from the GUSTO prospective mother-offspring cohort. Prehypertension/hypertension at age 6 years was identified using the simplified paediatric threshold of 110/70 mmHg.

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  • The study examines early-life factors influencing body mass index (BMI) growth patterns in children from various ethnic backgrounds in Singapore, aiming to identify intervention windows to combat obesity.
  • Researchers analyzed BMI z-scores from birth to age 6 in 994 children and found five distinct growth trajectories, including healthy and obesogenic patterns, with specific risks linked to factors like ethnicity and maternal education.
  • Both early and late acceleration of BMI were connected to increased cardiometabolic risks by age six, suggesting that understanding these growth trajectories can help develop targeted strategies for reducing childhood obesity and its health impacts.
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