This study aims to examine the role of genetic and epigenetic factors, maternal nutrition, lifestyle, emotional health, and other environmental factors in pregnancy or postpartum period that can influence future maternal risk of metabolic and mental wellness, including body weight changes. The study will recruit women in early pregnancy and later follow their children after birth, tracking both the mother and child until the child reaches at least 20 years of age.

The dramatic emergence of non-communicable diseases (NCDs) in Asia has coincided with the rapid socioeconomic and nutritional transition taking place in the region, with the prevalence of diabetes rising five-fold in Singapore in less than four decades. One unique aspect of the epidemic has been the significant ethnic differences in predisposition to diabetes among Asians and in the ethnic variation between BMI and the risk of developing insulin resistance, a precursor to type 2 diabetes. Apart from genetic factors, dietary, lifestyle and cultural factors might have influenced the developmental programming through effects on the mechanisms associated with developmental plasticity. A center piece of this study is to examine how epigenetic changes at birth both reflects past developmental influences and, in association with other factors, influences future trajectories of development and its relationship to NCDs. Also factors active during childhood - especially the first 1000 days of life - will be focused upon. The longitudinal GUSTO birth cohort study allows us to examine associations among genetic, environmental and lifestyle interactions in the three distinct ethnic groups, Chinese, Malays and Indians, present in the Singaporean population. Participants have been followed up for their pregnancy outcome, fetal growth and offspring development. In continuation of this research, participants will continue to be followed up through their adolescence phase from the age of 10 to 20 years.

Data will be collected through questionnaires and measurements.

• Questionnaires may be related to socioeconomic factors, healthcare expenses, diet, medical history, behaviour, cognition, lifestyle, sleep, health status, social-emotion factors, and home environment.
• Body measurements such as height, weight, blood pressure, body composition analysis involving bioelectrical impedance analysis (BIA), grip strength.
• Dental examination
• Child pubertal assessments
• Skin clinical assessment and digital photography for assessment of acne presence and severity
• Monitoring physical activity level and sedentary behaviour by using an accelerometer
• Using mobile phone app to collect information about your child's mobile phone usage patterns, activities etc.
• Collection of samples e.g. blood, buccal swabs, saliva, hair, urine, stool, skin samples, oral specimen such as exfoliated milk teeth, dental plaque and tongue biofilms

Inclusion Criteria of Mother Participants:

• Women 18 years and above
• Pregnant women attending the first visit (< 14 weeks GA) at the maternity units of KKH and NUH
• Singapore citizens or Singapore Permanent Residents
• Currently resident in mainland Singapore
• Intention to eventually deliver in KKH or NUH
• Intention to reside in Singapore for the next 5 years
• Intention to donate cord, cord blood and placenta
• The fetus should be racially homogenous with both sets of grandparents of the same ethnicity

Exclusion Criteria of Mother Participants:

• Women whose pregnancies end in miscarriages will be excluded
• Pregnant women on chemotherapy
• Exclude women with significant medical conditions e.g. Type 1 diabetes mellitus, psychosis etc.
• Exclude women on certain medications - e.g. psychotropic drugs.
• Mixed marriages will be excluded

Babies born from these mothers will be invited to participate and followed up until the child is at least 20 years of age.

Pregnant women attending their first-trimester antenatal visit at public maternity units in KKH and NUH, along with their children born from the indexed pregnancy.