Life Course Analysis

A life course approach in epidemiology is defined as the study of long-term effects on later health and disease risk of physical or social exposures and experiences during gestation, childhood, adolescence and adult life, and across generations. It focuses on investigating early life factors for adult chronic diseases by assessing how factors acting across life, independently, cumulatively and interactively, that can influence the health outcomes. It is important in helping to detect early markers of disease development and identify subgroups of the population most and least likely to be at risk of the disease.
 

Selected publications (arranged by most recent years)

From GUSTO/S-PRESTO/NEG

[1] Ku CW, Loo RSX, Tiong MMY, Eng SYC, Cheung YB, Ong LS, Tan KH, Chong MF, Chan JKY, Yap F, Loy SL. Nocturnal Lifestyle Behaviours and Risk of Poor Sleep during Pregnancy. Nutrients. 2022;14(11):2348.

[2] Loy SL, Chan DWK, Ku CW, Cheung YB, Godfrey KM, Tan KML, Chong YS, Shek LPC, Tan KH, Chan SY, Chan JKY, Yap F. Metabolic health status and fecundability in a Singapore preconception cohort study. Am J Obstet Gynecol. Dec 2021;S0002-9378(21)02684-3.

[3] Choo XH, Ku CW, Cheung YB, Godfrey KM, Chong YS, Shek LPC, Tan KH, Tan TC, Nadarajah S, Yap FKP, Colega MT, Chong MFF, Chan SY, Loy SL,* Chan JKY.* Risk score to stratify miscarriage risk levels in preconception women. Sci Rep. Jun 2021;11:12111.

[4] Loy SL, Ku CW, Lai AEQ, Choo XH, Ho AHM, Cheung YB, Godfrey KM, Chong YS, Gluckman PD, Shek LPC, Tan KH, Yap FKP, Chan SY, Chan JKY. Plasma glycemic measures and fecundability in a Singapore preconception cohort study. Fertil Stertil. Jul 2020;S0015-0282:30667-1.

[5] Loy SL, Cheung YB, Cai S, Colega MT, Godfrey KM, Chong YS, Shek LPC, Tan KH, Chong MFF, Yap F, Chan JKY. Associations of maternal night-time eating and sleep duration on length of gestation and preterm delivery. Clin Nutr. Aug 2019;S0261-5614(19):33030-4.

[6] Cai MJ, Loy SL, KH Tan, Godfrey KM, Gluckman PD, Chong YS, Shek LPC, Cheung YB, Lek N, Lee YS, Chan SY; Chan JKY; Yap F, Ang SB. Association of Elective and Emergency Caesarean Delivery on Early Childhood Overweight at 12 Months of Age. JAMA Network Open. Nov 2018;1(7):e185025.

[7] Loy SL, Ng MJH, Cheung YB, Godfrey KM, Calder PC, Lek N, Yap F, Müller-Riemenschneider F, Natarajan P, Chong YS, Tan KH, Shek LP, Chong MF, Chan JKY. Plasma omega-3 fatty acids in pregnancy are inversely associated with postpartum weight retention in a multi-ethnic Asian cohort. Am J Clin Nutr. May 2017;105(5):1158-65.

[8] Cheng TS, Loy SL, Cheung YB, Godfrey KM, Gluckman PD, Kwek K, Saw SM, Chong YS, Lee YS, Yap F, Yen Chan JK, Lek N. Demographic Characteristics, Health Behaviors Before and During Pregnancy, and Pregnancy and Birth Outcomes in Mothers with Different Pregnancy Planning Status. Prev Sci. Nov 2016;17(8):960-969.

[9] Cheng TS, Loy SL, Cheung YB, Chan JKY, Pang WW, Godfrey KM, Gluckman PD, Kwek K, Saw SM, Chong YS, Lee YS, Lek N, Yap F. Sexually dimorphic response to feeding mode in the growth of infants. Am J Clin Nutr. Feb 2016;103(2):398-405.
 

From IPRAMHO

[1] Lim Wai Yee; Saw Seang Mei; Tan Kok Hian; Yeo George S H; Kwek Kenneth YC. A cohort evaluation on arterial stiffness and hypertensive disorders in pregnancy.BMC Pregnancy Childbirth. 2012 Dec 26;12:160. doi: 10.1186/1471-2393-12-160.

[2] Dias T, Siraj SHM, Aris IM, Li L-J, Tan KH. Comparing Different Diagnostic Criteria for Gestational Diabetes Mellitus in Relation to Birthweight in Sri Lankan Women. Frontiers in Endocrinology. 9:682. doi: 10.3389/fendo.2018.00682

[3] Feng T, Allen JC, Ng MJ, Yeo GSH, Kwek KYC, Chern BSM, Tan KH*. The association between serum progesterone level and preterm delivery. Int J Gynaecol Obstet. 2018(Sep);142(3):308-314. Jun 8. doi: 10.1002/ijgo.12564.

[4] Chua TE, Bautista DC, Tan KH, Yeo G, Chen H. Antenatal Anxiety: Prevalence and Patterns in a Routine Obstetric Population. Ann Acad Med Singapore 2018;47(10):405-12. PMID: 30460967

[5] Li LJ, Yu Q, IPRAMHO-INTERNATIONAL Study Group, Tan KH.Clinical practice in diabetic pregnancy screening in Asia-Pacific Countries: a survey review. Acta Diabetol. 2019 Jul;56(7):815-817. doi: 10.1007/s00592-019-01331-8.

[6] Lim HA, Chua TE, Malhotra R, Allen JC, Teo I, Chern BSM, Tan KH, Chen H. Identifying trajectories of antenatal depression in women and their associations with gestational age and neonatal anthropometry: A prospective cohort study.Gen Hosp Psychiatry. 2019 Nov - Dec;61:26-33. doi: 10.1016/j.genhosppsych.2019.09.001. Epub 2019 Sep 12. PMID: 31710855 JIF 3.220

[7] He S, Allen JC, Razali NS, Win NM, Zhang JJ, Ng MJ, Yeo GSH, Chern BSM, Tan KH. Are women in Singapore gaining weight appropriately during pregnancy: a prospective cohort study. BMC Pregnancy Childbirth. 2019 Aug 13;19(1):290. doi: 10.1186/s12884-019-2443-z.

[8] Ng QJ, Han JY, Saffari SE, Yeo GS, Chern BSM, Tan KH. Longitudinal Circulating Placental Growth Factor (PlGF) and Soluble FMS-like Tyrosine Kinase-1 (sFlt-1) Concentrations During Pregnancy in Asian Women: A prospective cohort study. BMJ Open. 2019 May 24;9(5):e028321. doi: 10.1136/bmjopen-2018-028321. PubMed PMID: 31129598. JIF: 2.413

[9] Zhu J, Zhang J, Ng MJ, Chern B, Yeo GS, Tan KH. Angiogenic Factors during Pregnancy in Asian Women with Elevated Blood Pressure in Early Pregnancy and the Risk of Preeclampsia: a longitudinal cohort study.. BMJ Open. 2019 Dec 1;9(11):e032237. doi: 10.1136/bmjopen-2019-032237. PMID: 31791965 JIF: 2.413

[10] Li LJ, Zhang J, Shub A, Aris I, Tan KH. Exploring abnormal glucose metabolism in pregnancy among Australian Chinese migrants. BMJ Open Diabetes Res Care. 2020 Feb;8(1):e000903. doi: 10.1136/bmjdrc-2019-000903. PMID: 32075811; PMCID: PMC7039593.

[11] Zhu J, Zhang J, Syaza Razali N, Chern B, Tan KH. Mean arterial pressure for predicting preeclampsia in Asian women: a longitudinal cohort study BMJ Open 2021;11:e046161. doi: 10.1136/bmjopen-2020-046161 JIF: 2.496

[12] Tang Y, Zhang J, Dai F, Razali NS, Tagore S, Chern BSM, Tan KH*. Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study. BJOG. 2021 Jun;128(7):1192-1199. doi: 10.1111/1471-0528.16591. Epub 2020 Nov 23. PMID: 33145901.JIF: 6.531

[13] Tang Y, Dai F, Razali NS, Tagore S, Chern BSM, Tan KH. Sleep quality and BMI in pregnancy- a prospective cohort study. BMC Pregnancy Childbirth. 2022 Jan 27;22(1):72. doi: 10.1186/s12884-022-04414-7. PMID: 35086507; PMCID: PMC8793200.

[14] Cassandra Cha, Shi Hui Poon, Tze-Ern Chua, Nurul Syaza Razali, Kok Hian Tan, Helen Chen. Prospective Study of the Relationship between Sleep Quality and Depression in Pregnancy

Proceedings Of Singapore Healthcare. First Published January 12, 2022. https://doi.org/10.1177/20101058211068591

[15] He S, Allen JC, Razali NS, Chern BSM, Tan KH. Association between gestational weight gain and pregnancy outcomes in a Singaporean population: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2022 May;272:160-165. doi: 10.1016/j.ejogrb.2022.03.031. Epub 2022 Mar 17. PMID: 35325689.

[16] Quah PL, Loo BKG, Razali NS, Razali NS, Teo CC, Tan KH. Parental perception and guideline awareness of children's lifestyle behaviours at ages 5 to 14 in Singapore. Ann Acad Med Singap. 2021 Sep;50(9):695-702. doi: 10.47102/annals-acadmedsg.2021134. PMID: 34625757.JIF: 2.473
 

Ongoing Studies

i. Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children (IPRAMHO). PI: Prof Tan Kok Hian

Interventional prospective cohort studies

i. Healthy Early Life Moments in Singapore (HELMS). Clinicaltrial.gov NCT05207059. PI: Prof. Jerry Chan

ii. Community Enabled Readiness for First 1000 Days Learning Ecosystem (CRADLE). Clinicaltrial.gov NCT04275765. PI: Assoc. Prof. Ng Kee Cheong

iii. Integrating the Use of Calibration-Free Continuous Monitoring for Pregnancy Glucose Profiling: (I-PROFILE). Clinicaltrial.gov NCT05123248. PI: Prof. Tan Kok Hian

iv. Lifestyle interventions to prevent post-partum T2D in Asian women with a history of GDM (Integrated Hyperglycemia Incentivized Postnatal Surveillance Study) (I-HIPS). Clinicaltrial.gov NCT05081037. PI: Prof Tan Kok Hian
 

Observational prospective cohort studies

i. Singapore PREconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO). Clinicaltrial.gov NCT03531658. Site PI: Prof. Jerry Chan

ii. Growing Up in Singapore Towards Healthy Outcomes (GUSTO). Clinicaltrial.gov NCT01174875. Site PI: Assoc. Prof. Fabian Yap

iii. The Association of Maternal Night-Eating Pattern With Glucose Tolerance During Pregnancy (NEG). Clinicaltrial.gov NCT03803345. PI: Assist. Prof. Loy See Ling

iv. Improving the Adverse Outcomes of Pregnancy - Clinical and Translational Research Programme in Perinatal Medicine (NORA 1 - Neonatal & Obstetric Risk Assessment 1. PI: Prof Tan Kok Hian
 

Relevant literature

[1] De Stavola BL, Nitsch D, dos Santos Silva I, McCormack V, Hardy R, Mann V, Cole TJ, Morton S, Leon DA. Statistical issues in life course epidemiology. Am J Epidemiol. 2006;163:84-96. doi: 10.1093/aje/kwj003.

[2] Komp-Leukkunen K. What life-course research can contribute to futures studies. Futures. 2020;124:102651. doi.org/10.1016/j.futures.2020.102651.

[3] Liu S, Jones RN, Glymour MM. Implications of Lifecourse Epidemiology for Research on Determinants of Adult Disease. Public Health Rev. 2010;32:489-511. doi: 10.1007/BF03391613.

[4] Santos S, Zugna D, Pizzi C, Richiardi L. Sources of confounding in life course epidemiology. J Dev Orig Health Dis. 2019;10:299-305. doi: 10.1017/S2040174418000582.
 

Figure. Maternal obesity and its complications for both mother-child across different life stages, as observed from the mother-offspring prospective cohort studies in Singapore.