Early-life factors affect risk of pain and fever in infants during teething periods.

AIM: This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life. MATERIALS AND METHODS: Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models. RESULTS: Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001). CONCLUSIONS: Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child's susceptibility to teething-related pain and fever. CLINICAL RELEVANCE: Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.

Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth.

AIM: Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community. MATERIAL AND METHODS: Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy. RESULTS: Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant's rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively. CONCLUSIONS: Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways. CLINICAL RELEVANCE: Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.

I-ACT: Integrated study on effect of Activity on ComplicaTions in pregnancy: study protocol of a multiethnic prospective cohort study.

INTRODUCTION: Physical activity (PA) during first 20 weeks of pregnancy may lower risks of gestational diabetes mellitus (GDM) and gestational hypertension (GH), though evidence of association remains inconclusive. Current studies rely heavily on subjective assessment of PA levels. Wearable activity trackers provide a convenient and objective surrogate index for PA validated by evidence-based steps/day categorisation along a physical inactivity/activity continuum. I-ACT primarily aims to examine objectively measured PA levels and patterns in first and second trimesters of pregnancy and the association with GDM and/or GH in Singapore, a multiethnic Asian population. Secondary aims include investigating the bio-socio-demographic factors associated with sedentary behaviour, and association of early pregnancy PA level with maternal weight at 6 weeks postdelivery. Results may facilitate identification of high-risk mothers-to-be and formulation of interventional strategies. METHODS AND ANALYSIS: Prospective cohort study that will recruit 408 women at first antenatal visit at <12 weeks' gestation. Baseline bio-socio-demographic factors and PA levels assessed by participant characteristics form and the International Physical Activity Questionnaire (IPAQ), respectively. An activity tracker (Fitbit) will be provided to be worn daily from date of recruitment to end of 20 weeks' gestation. Tracker-recorded data will be synchronised with an application on participant's smartphone. Compliance will be reinforced with fortnightly reminders. After 20 weeks, a second IPAQ and a feedback form will be administered. GDM screened at 24-28 weeks' gestation. GH diagnosed after 20-weeks gestation. Maternal weight assessed at 6 weeks postdelivery. Appropriate statistical tests will be used to compare continuous and categorical PA measurements between first and second trimesters. Logistic regression will be used to analyse associations. ETHICS AND DISSEMINATION: Ethical approval obtained from the Centralised Institutional Review Board of SingHealth (reference 2017/2836). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters and medical forums.

Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age.

Importance: Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately. Objective: To investigate whether elective or emergency CD was associated with risk of early childhood overweight. Design, Setting, and Participants: Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017. Exposures: Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference. Main Outcomes and Measures: Body mass index-for-age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs. Results: Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3% (17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy, gestational diabetes, and sex-adjusted birth weight-for-gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results. Conclusions and Relevance: Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.