Newcastle 1000 (NEW1000) Study: an Australian population-based prospective pregnancy cohort study design and protocol.

INTRODUCTION: Multiple cohort studies have been established to investigate the impact of early life factors on development and health outcomes. In Australia the majority of these studies were established more than 20 years ago and, although longitudinal in nature, are inherently susceptible to socioeconomic, environmental and cultural influences which change over time. Additionally, rapid leaps in technology have increased our understanding of the complex role of gene-environment interactions in life course health, highlighting the need for new cohort studies with repeated biological sampling and in-depth phenotype data across the first 1000 days of life from conception. METHODS AND ANALYSIS: The Newcastle 1000 (NEW1000) Study, based in the regional city of Newcastle, New South Wales, was developed after an extensive consultation process involving 3 years of discussion with key stakeholders and healthcare consumer organisations and seven healthcare consumer workshops. This prospective population-based pregnancy cohort study will recruit 500 families per year for 5 years, providing detailed, longitudinal, multisystem phenotyping, repeated ultrasound measures and serial sample collection to investigate healthcare consumer identified health outcomes of priority. Stage 1 will involve recruitment of pregnant participants and their partners at 14 weeks gestation, with dense phenotype data and biological samples collected at 14, 20, 28 and 36 weeks gestation and serial ultrasound measures at 20, 28, 36 and 40 weeks, with postpartum follow-up at 6 weeks and 6 months. Biological samples will be used for biomarker discovery and sequencing of the genome, transcriptome, epigenome, microbiome and metabolome. ETHICS AND DISSEMINATION: Ethics approval was obtained from Hunter New England Local Health District Ethics Committee (2020/ETH02881). Outcomes will be published in peer-reviewed journals, disseminated to participants through the NEW1000 website, presented at scientific conferences, and written reports to local, state and national government bodies and key stakeholders in the healthcare system to inform policy and evidence-based practice.

Time for change: Fitness and strength can be improved and sustained in adolescents with low motor competence.

BACKGROUND: There are few exercise interventions focused on adolescents with low motor competence and most interventions are short with little follow up and engagement over time. METHODS AND PROCEDURES: Fifty-eight adolescents with low motor competence (39 males, Mean Age = 13.6, SD = 1.4 years) attended an exercise clinic twice a week for each 13 week program. Two programs ran each year, and participants attended for as long as they felt progress was made or they turned 18 years of age. Performance on the Multistage Fitness Test (MSFT), Curl-ups, Grip Strength, 1RM Leg press and Chest Press, Vertical Jump and Standing Broad Jump (SBJ) were recorded pre and post each program for up to six years. Linear Mixed Modelling (LMM) determined changes in fitness measures over time whilst adjusting for gender, age and Neuromuscular Developmental Index (McCarron, 1997). RESULTS: All fitness measures increased, and specifically four of the seven fitness outcomes showed significant improvement over time (MSFT,p = 0.011; curl-ups, p < 0.001, grip strength p = 0.003, and SBJ p = 0.006). CONCLUSION: An individually tailored regular exercise program in a supportive environment can achieve exercise adherence and sustainable improvements in fitness outcomes for adolescents with low motor competence. Future research should consider the addition of a comparison LMC control group to increase understanding of the intervention effect.

Detection and management of familial hypercholesterolaemia in primary care in Australia: protocol for a pragmatic cluster intervention study with pre-post intervention comparisons.

INTRODUCTION: Familial hypercholesterolaemia (FH), an autosomal dominant disorder of lipid metabolism, results in accelerated onset of atherosclerosis if left untreated. Lifelong treatment with diet, lifestyle modifications and statins enable a normal lifespan for most patients. Early diagnosis is critical. This protocol trials a primary care-based model of care (MoC) to improve detection and management of FH. METHODS AND ANALYSIS: Pragmatic cluster intervention study with pre-post intervention comparisons in Australian general practices. At study baseline, current FH detection practice is assessed. Medical records over 2 years are electronically scanned using a data extraction tool (TARB-Ex) to identify patients at increased risk. High-risk patients are clinically reviewed to provide definitive, phenotypic diagnosis using Dutch Lipid Clinic Network Criteria. Once an index family member with FH is identified, the primary care team undertake cascade testing of first-degree relatives to identify other patients with FH. Management guidance based on disease complexity is provided to the primary care team. Study follow-up to 12 months with TARB-Ex rerun to identify total number of new FH cases diagnosed over study period (via TARB-Ex, cascade testing and new cases presenting). At study conclusion, patient and clinical staff perceptions of enablers/barriers and suggested improvements to the approach will be examined. Resources at each stage will be traced to determine the economic implications of implementing the MoC and costed from health system perspective. Primary outcomes: increase in number of index cases clinically identified; reduction in low-density lipoprotein cholesterol of treated cases. SECONDARY OUTCOMES: increase in the number of family cases detected/contacted; cost implications of the MoC. ETHICS AND DISSEMINATION: Study approval by The University of Notre Dame Australia Human Research Ethics Committee Protocol ID: 0 16 067F. Registration: Australian New Zealand Clinical Trials Registry ID: 12616000630415. Information will be disseminated via research seminars, conference presentations, journal articles, media releases and community forums. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ID 12616000630415; Pre-results.

Breastfeeding and motor development: A longitudinal cohort study.

BACKGROUND: While there is a large body of work supporting the importance of early feeding practices on cognitive, immunity, behavioural and mental outcomes, few longitudinal studies have focused on motor development. The relationship between duration of breast feeding and motor development outcomes at 10, 14, and 17years were examined. METHODS: Data were obtained from the Western Australian Pregnancy (Raine) Study. There were 2868 live births recorded and children were examined for motor proficiency at 10 (M=10.54, SD=2.27), 14 (M=14.02, SD=2.33) and 17 (M=16.99, SD=2.97) years using the McCarron Assessment of Neuromuscular Development (MAND). Using linear mixed models, adjusted for covariates known to affect motor development, the influence of predominant breast feeding for <6months and ⩾6months on motor development outcomes was examined. RESULTS: Breast feeding for ⩾6months was positively associated with improved motor development outcomes at 10, 14 and 17yearsof age (p=0.019, ß 1.38) when adjusted for child's sex, maternal age, alcohol intake, family income, hypertensive status, gestational stress and mode of delivery. CONCLUSION: Early life feeding practices have an influence on motor development outcomes into late childhood and adolescence independent of sociodemographic factors.

The Impact of Maternal Gestational Stress on Motor Development in Late Childhood and Adolescence: A Longitudinal Study.

The number and timing of stressors experienced during pregnancy were investigated using longitudinal data from the Western Australian Pregnancy (Raine) Study cohort (N = 2,900). Motor development data were collected at 10 (n = 1,622), 14 (n = 1,584), and 17 (n = 1,222) years using the McCarron Assessment of Neuromuscular Development. Linear mixed models were used to examine the effect of stress on motor development, accounting for repeated measures. Number of stressful events and mean Neuromuscular Development Index were negatively related (ß = -1.197, p = .001). Stressful events experienced in late pregnancy were negatively related with offspring motor development (ß = -0.0541, p = .050), while earlier stressful events had no significant impact.

Early life events and motor development in childhood and adolescence: a longitudinal study.

AIM: Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported, males and females were examined separately. METHODS: Participants (n = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear mixed models were developed to allow for changes in motor development over time. RESULTS: Maternal pre-eclampsia, Caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birthweight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs. CONCLUSION: Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex-specific developmental pathways.

Maternal hypertensive diseases negatively affect offspring motor development.

OBJECTIVE: Hypertension in pregnancy and preeclampsia have been linked to poor outcomes in cognitive, mental and psychomotor development; however, few longitudinal studies have researched their effect on offspring motor development, particularly in late childhood and adolescence. The purpose of this study was to determine if maternal hypertensive diseases during pregnancy are a risk factor for compromised motor development at 10, 14, and 17years. STUDY DESIGN: Longitudinal cohort study using data from the Western Australian Pregnancy Cohort Study (Raine). MAIN OUTCOME MEASURE: Offspring (n=2868) were classified by their maternal blood pressure profiles during pregnancy: normotension (n=2133), hypertension (n=626) and preeclampsia (n=109). Offspring motor development, at 10, 14, and 17years was measured by the Neuromuscular Developmental Index (NDI) of the McCarron Assessment of Motor Development (MAND). METHODS: Linear mixed models were used to compare outcomes between pregnancy groups. RESULTS: Offspring from pregnancies complicated by preeclampsia had poorer motor outcomes at all ages than offspring from either normotensive mothers (p⩽0.001) or those with hypertension (p=0.002). CONCLUSION: Hypertensive diseases during pregnancy, in particular preeclampsia, have long term and possibly permanent consequences for motor development of offspring.