Cohort Profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study
Abstract
Modern lifestyles and nutritional transition have given rise to an emerging epidemic of obesity and type 2 diabetes in developed and developing countries.1,2 In general, metabolic compromise is seen in South Asians at relatively lower levels of obesity compared with Europeans, with Chinese having an intermediate relationship, suggesting that the patterns of development of obesity and metabolic function in different Asian populations merits focused investigation.3 The prevalence of type 2 diabetes in Singapore has increased from 1.9% in 1975 to 11.2% in 2010, and is now one of the highest in the developed world.4 The three major Singaporean ethnic groups, Chinese, Malays and Indians, appear to have distinct susceptibilities leading to differing metabolic risk.5 Such differences may be genetic, developmental or cultural in origin. The pathways leading to insulin resistance, obesity and related traits are complex and derive from an interplay of genomic and environmental factors operating over the lifespan, including during early development.6 Environmental cues such as maternal nutrition can have important effects on foetal gene expression and have been shown to influence developmental plasticity7 via epigenetic processes.8 In recent years, major epigenetic pathways involving histone and DNA modifications have been unravelled and more technological tools developed to study their function.9,10 It has recently been reported that it may be of value to measure epigenetic changes in DNA derived from foetal tissues at birth, such as umbilical cord.11 Hence, we wished to examine whether specific epigenetic marks have utility as biomarkers for identifying babies that are ‘programmed’ in utero to develop obesity or non-communicable diseases later in life.11,12 A set of epigenetic biomarkers would allow clinical intervention at early stages in individuals at risk, thereby enabling prevention of obesity and metabolic diseases.13
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Higher vitamin B12 levels at 26-28 weeks' gestation are associated with lower fasting glucose and reduced risk of GDM.
“Conversely, higher vitamin B12 levels at 26–28 weeks’ gestation were associated with lower fasting glucose and reduced risk of GDM.”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [143]
Pregnant women with elevated folate levels at 26-28 weeks' gestation have 1.3-fold the odds of developing GDM.
“In the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study [143], pregnant women with elevated folate levels at 26–28 weeks’ gestation had 1.3-fold the odds of developing GDM.”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [143]
Cites
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Deriving ethnic-specific BMI cutoff points for assessing diabetes risk.
Chiu, M., Austin, P. C., Manuel, D. G., Shah, B. R., & Tu, J. V. (2011) · Diabetes Care · doi:10.2337/dc10-2300 · Cited by 398 · see citing works
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Maternal immune activation and neuroinflammation in human neurodevelopmental disorders
Han, V. X., Patel, S., Jones, H. F., & Dale, R. C. (2021) · Nature Reviews Neurology · doi:10.1038/s41582-021-00530-8 · Cited by 683 · see citing works
Teh, A. L., Pan, H., Chen, L., Ong, M.-L., Dogra, S., Wong, J., MacIsaac, J. L., Mah, S. M., McEwen, L. M., Saw, S.-M., et al. (2014) · Genome Research · doi:10.1101/gr.171439.113 · Cited by 352 · see citing works
Self-citationDiabetes and its drivers: the largest epidemic in human history?
Zimmet, P. Z. (2017) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-016-0039-3 · Cited by 338 · see citing works
Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus
Cai, S., Tan, S., Gluckman, P. D., Godfrey, K. M., Saw, S.-M., Teoh, O. H., Chong, Y.-S., Meaney, M. J., Kramer, M. S., Gooley, J. J., et al. (2017) · Sleep · doi:10.1093/sleep/zsw058 · Cited by 157 · see citing works
Self-citationPerinatal maternal depressive symptoms alter amygdala functional connectivity in girls
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- Authors
- Soh, S.-E., Tint, M. T., Gluckman, P. D., Godfrey, K. M., Rifkin-Graboi, A., Chan, Y. H., Stunkel, W., Holbrook, J. D., Kwek, K., Chong, Y.-S., Saw, S. M., the GUSTO Study Group, Sheppard, A., Chinnadurai, A., Ferguson-Smith, A., Goh, A. E. N., Biswas, A., Chia, A., Leutscher-Broekman, B., Shuter, B., Cai, S., Ngo, C., Chng, C. K., Chong, S. C., Henry, C. J., Chua, M. C., Chee, C. Y. I., Goh, Y. T. D., Bier, D., Ding, C. M., Fok, D., Finkelstein, E. A., Yap, F. K. P., Yeo, G. S. H., Han, W. M., Chen, H., Van Bever, H. P. S., Inskip, H., Magiati, I., Wong, I. B. Y., Kapur, J., Richmond, J. L., Chan, J. K. Y., Gooley, J. J., Niduvaje, K., Lee, B. W., Lee, Y. S., Singh, L., Lim, S. B., Daniel, L. M., Loh, S. F., Low, Y.-L., Shek, P.-C. L., Fortier, M., Hanson, M., Chong, M. F.-F., Meaney, M., Morton, S., Pang, W. W., Agarwal, P., Qiu, A., Quah, B. L., van Dam, R. M., Stringer, D., Rebello, S. A., So, W. C., Hsu, C.-Y., Su, L. L., Tang, J., Tan, K. H., Tan, S. H., Teoh, O. H., Rajadurai, V. S., Wong, P., & Venkatesh, S. K.
- Affiliations
- Agency for Science, Technology and Research (SG)
- National University of Singapore (SG)
- National University Health System (SG)
- Corresponding author
- Saw, S. M.
- ORCID
- Soh, S.-E.
- Tint, M. T.
- Gluckman, P. D.
- Godfrey, K. M.
- Rifkin-Graboi, A.
- Chan, Y. H.
- Holbrook, J. D.
- Chong, Y.-S.
- Saw, S. M.
- Biswas, A.
- Chia, A.
- Chng, C. K.
- Chong, S. C.
- Henry, C. J.
- Chee, C. Y. I.
- Bier, D.
- Ding, C. M.
- Finkelstein, E. A.
- Yap, F. K. P.
- Yeo, G. S. H.
- Han, W. M.
- Chen, H.
- Inskip, H.
- Magiati, I.
- Kapur, J.
- Richmond, J. L.
- Chan, J. K. Y.
- Gooley, J. J.
- Niduvaje, K.
- Lee, Y. S.
- Singh, L.
- Daniel, L. M.
- Fortier, M.
- Hanson, M.
- Chong, M. F.-F.
- Meaney, M.
- Morton, S.
- Pang, W. W.
- Agarwal, P.
- Qiu, A.
- Rebello, S. A.
- Hsu, C.-Y.
- Su, L. L.
- Tang, J.
- Tan, K. H.
- Rajadurai, V. S.
- Wong, P.
- Venkatesh, S. K.
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-08-02
- Volume
- 43
- Issue
- 5
- Pages
- 1401-1409
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2108343924
- Cited by
- 515
- References
- 2
- Citations by year
- 2026: 36 · 2025: 43 · 2024: 59 · 2023: 33 · 2022: 47 · 2021: 60 · 2020: 37 · 2019: 34 · 2018: 30 · 2017: 50 · 2016: 34 · 2015: 36 · 2014: 14 · 2013: 2
- FWCI
- 26.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Funders
- National Research Foundation
- Medical Research Council (MC_UU_12011/4)
- National Medical Research Council
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Keywords
- Singapore, childhood obesity, type 2 diabetes, epigenetic biomarkers, maternal nutrition, developmental programming, insulin resistance, non-communicable diseases
- MeSH terms
- Adolescent, Adult, Female, Gestational Age, Humans, Male, Middle Aged, Pregnancy, Prenatal Exposure Delayed Effects, Singapore, Cohort Studies, Epigenesis, Genetic, Fetal Development
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