Abstract
The life expectancy of Indigenous Australians is amongst the lowest of any population group within developed nations and chronic diseases collectively account for over 80% of the gap in life expectancy between Indigenous and non-Indigenous Australians. The Gomeroi gaaynggal cohort is a prospective, longitudinal maternal-infant cohort established to examine the origins of chronic disease in Indigenous Australians. This study aimed to determine the major antenatal factors associated with adverse birth outcomes (preterm delivery, low birth weight) and other pregnancyrelated complications (gestational diabetes and hypertensive disorders of pregnancy) in Indigenous Australian women. Pregnant women who identified as Indigenous Australians or pregnant non-Indigenous women giving birth to an Indigenous infant were eligible to participate in the cohort (n=227). Physical measurements and biological sample collection (including blood and urine) were undertaken up to 3 times in pregnancy. Median weight and BMI of the cohort was 80.7 kg and 30.3 kg/m2 at enrolment (median 23 weeks gestation). 43% reported smoking cigarettes during pregnancy. Of the 158 women in whom pregnancy outcomes were known, 43% had an uncomplicated pregnancy, 13.9% delivered preterm, 14.6% delivered a small-for-gestational age infant, 10% developed a hypertensive disorder of pregnancy, and 6.3% developed gestational diabetes. In addition, many women showed evidence of underlying renal dysfunction (proteinuria or albuminuria). The ratio of male to female offspring in this cohort was 1.38. Eightyseven percent of preterm infants were male, as were 83.3% of babies from women with gestational hypertension. This skewed sex distribution was far higher than for those who had a healthy pregnancy outcome (59%). This study demonstrates that key factors including maternal obesity, exposure to cigarette smoke and underlying renal impairment, influence pregnancy outcome. Preliminary findings from this study also suggest that more male babies are born early and from complicated pregnancies in this Indigenous cohort.
Highlights
There is evidence that the origins of many chronic diseases can be traced all the way back to developmental conditions in utero
Twenty-five women were recruited in Newcastle, 174 in Tamworth and 28 in Walgett, New South Wales (NSW), Australia. 76.1% of the women in the study identified as Indigenous, many of these had a partner who was Indigenous (25.8%), 11.7% of mothers were not Indigenous but they had an Indigenous partner; for the remaining 12.2%, parental Indigenous status was not recorded
Using self-reported pre-pregnancy height and weight to calculate Body Mass Index (BMI) (n=59), 8.47% were underweight, 32.2% were in the healthy range for their BMI, 20.3% were overweight, 15.2% were classified as obese, and 23.7% morbidly obese (i.e., 59.2% overweight or obese)
Summary
There is evidence that the origins of many chronic diseases can be traced all the way back to developmental conditions in utero. David Barker and colleagues provided epidemiological evidence that a poor intrauterine environment predisposes to early onset of chronic noncommunicable diseases because a poor supply of nutrients programs structural and functional changes in the developing fetus that anticipate an extra-uterine environment with low nutrient availability [1]. Barker and others showed that low birth weight was associated with an increased risk of coronary heart disease, hypertension, stroke and type 2 diabetes mellitus in adult life [1]. The concept of the developmental origins of adult health and disease is relevant for Indigenous populations who experience chronic disease at significantly elevated rates.
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