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Last updated: 21 February2023

Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is a major collaborative research effort involving partners across Singapore from healthcare and research alike. This includes the National University of Singapore (NUS), KK Women's and Children's Hospital (KKH), and A*STAR's Singapore Institute for Clinical Sciences (SICS). The purpose of GUSTO cohort study is to understand how conditions in pregnancy and early childhood influence the subsequent health and development of women and children.

Over the course of 2009 and 2010, Singaporean women were enrolled in GUSTO, from a point in early pregnancy. With the longitudinal cohort study being in its 12th year, mother-child dyads have been extensively phenotyped with continuous collection of data. As the GUSTO children journey through life, we are there every step of the way. The detailed observations and sampling on these mothers and children have been instrumental in discovering features more representative of the local and Asian population that can be used to improve the health and potential of our communities, with an earlier start.

About the Cohort

Families Approached

Families attending their first trimester antenatal dating ultrasound scan clinic at National University of Hospital (NUH) and KK Women’s Children’s Hospital (KKH) were recruited into the cohort study. Informed written consent was obtained from each participant.

Inclusion Criteria
  • Women in their early pregnancy who are attending the first trimester antenatal ultrasound scan (< 13 weeks + 6 days Gestational Age and not more than 14 weeks Gestational Age) at the public maternity units at KK Women's and Children's Hospital and National University Hospital.
  • Only women at the age of 18 years old and above.
  • Singapore Citizens or Singapore Permanent Residents.
  • Intention to eventually deliver in NUH or KKH.
  • Intention to reside in Singapore for the next 5 years.
  • Willingness to donate cord, cord blood and placenta.
  • The fetus should be racially homogenous with both sets of grandparents of the same ethnicity. 
Exclusion Criteria
  • Women with significant medical conditions e.g. Type 1 diabetes mellitus, psychosis.
  • Women on certain medication e.g. psychotropic drugs.
  • Pregnant women on chemotherapy.
  • Mixed marriages.
  • Women whose pregnancies end in miscarriages will be excluded later and counseled.
Cohort Recruitment

The research team recruited 1,450 pregnant women at 7-11 weeks of pregnancy between June 2009 to October 2010. There were a total of 1,344 natural pregnancies, 96 In-Vitro Fertilization (IVF) pregnancies and 10 natural twin pregnancies. 18 additional infants of low birthweight (PEGS cohort) were enrolled at delivery timepoint. In total, there were 1209 deliveries in the parent-offspring cohort (56.0% Chinese, 18.5% Malay, 25.4% Indian, 0.1% Others). The current attrition rate is 25.2% (with reference to delivery timepoint).

The active subject counts are displayed under each study timepoint (mother/child dyads from sub-cohorts). Lost to follow up counts are displayed after individual study timepoints. Active subject refers to active participants during each study timepoint. The completion rate for each instrument (at each study timepoint) would be a subset of active subject count as some of them may have missed a particular visit/timepoint. Lost to follow up refers to subjects who were actively participating in the study and became lost at a follow-up timepoint.

Additional Information

The baseline demographics for women in the PEGS cohort (n=18) were retrospectively obtained during enrolment visit. In total, baseline data for 1468 (1450+18) women were obtained.

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