Objective: To examine CGM feedback with the subsequent development of gestational diabetes (GDM), maternal glycaemic control, and glycaemic variability during pregnancy with randomisation 1:1 with one study arm receiving CGM feedback by intermittent scanning (unblinded group), versus masked feedback (blinded group). Design: Prospective, single-center, randomized controlled trial Setting: Single tertiary care hospital Population: Pregnant women recruited in the first trimester of pregnancy Methods: We assessed GDM and plasma glucose levels diagnosed by the 75-g oral glucose tolerance test (OGTT) at 24-28 weeks as a primary outcome. The secondary outcome was CGM-derived parameters of glycaemic variability across the first (9-13 weeks), second (18-23 weeks), late second and early third (24-31 weeks) and third trimester (32-33weeks). Results: Over 47 months, 206 pregnant women were enrolled at 9-13 weeks. There were no significant differences with GDM outcomes, fasting, 1-hour or 2-hour plasma glucose concentrations between study arms. The unblinded group had higher %time-in-range in the first (83.2% vs 78.1%; p=0.06), second [88.7% vs 80.5%; p=0.02] and third trimester (90.2% vs 79.5%; p=0.07), compared to the blinded group. Conversely, the unblinded group had lower %time-below-range in the first trimester (15.4% vs 21.2%; p=0.06), and early second trimester (8.8% vs 16.9%; p=0.05]. No significant differences were observed with the %time-above-range, mean, standard deviation, Mean Amplitude Glycaemic Excursion and % Coefficient Variation across all trimesters. Conclusion: CGM feedback, coupled with better glycaemic control (higher %TIR and low %TBR) indicates its’ potential use in combination with appropriate patient education for promoting better glucose control during pregnancy.

Objective: We previously described a technique for repair of the myometrial defect at repeat Caesarean section which increases residual myometrial thickness thereby potentially reducing future niche-related complications. Here we describe how this technique can be modified for use for placenta accreta spectrum disorders. Design: Comparison of surgical performance of the modified technique with peripartum hysterectomy in women having repeat Caesarean delivery for placenta accreta Setting: A two year retrospective case control study at a tertiary unit in Singapore. Population: All women with placenta accreta spectrum disorder between December 2019 and October 2021. Methods: After delivery through the isthmocele women either underwent the modified technique which comprised uterine exteriorisation, systematic placental removal initiated from the posterior uterine wall, identification, mobilization and apposition of the boundaries of myometrial defects and repair or peripartum hysterectomy. Main Outcome Measures: Operating time, estimated blood loss and complication rate. Results: Ten women had Caesarean hysterectomy and ten had Caesarean section using the modified approach. Age and gestational age at delivery were similar for the two groups. Women in the modified technique group had had fewer prior Caesarean sections and had a lower body mass index. Operating time, estimated blood loss and need for transfusion were lower in the myometrial repair group but without statistical significance and there were no visceral injuries. There was one bladder injury in the hysterectomy group. Conclusion: The modified approach provides an effective alternative to peripartum hysterectomy with favourable surgical profile and allows uterine conservation with restoration of myometrial thickness.

Objective: To examine glycaemic variability (GV) and glycaemic control (GC) parameters in early pregnancy with subsequent development of gestational diabetes mellitus (GDM). Design: Longitudinal observational study. Setting: Pregnant women from KK Women and Children’s Hospital in Singapore Participants: 51 study participants in the first trimester (9-13 weeks’ gestational), and 44 participants (18-23 weeks’ gestation) in the second trimester of pregnancy. Methods: Independent t-tests were used to examine the differences in the parameters between participants who developed GDM and those who did not. Main outcome measure: GDM was determined at 24-30 weeks’ gestation using oral glucose tolerance test (OGTT). GV parameters examined were, mean amplitude of glycaemic excursion (MAGE), standard deviation of blood glucose (SDBG) and mean of daily continuous 24 h blood glucose (MBG) and coefficient of variation (CV). GC parameters measured were, J-Index and % time spent in glucose target ranges. Results: In the second trimester of pregnancy, mean amplitude of glycaemic excursions (MAGE) was significantly higher in participants who subsequently developed GDM, compared to those who did not (mean (SD): 3.18(0.68) vs 2.60(0.53), p=0.02). Other study parameters measured in the second trimester of pregnancy were not significantly different between groups. There were no significant associations between all the GV and GC parameters determined from the CGM in the first trimester with subsequent development of GDM (p>0.05). Conclusion: MAGE is an important GV parameter associated to the development of subsequent GDM in pregnant women. The findings highlight the potential value of CGM in gestational glycaemic profiling.

Background: Infants with atopic dermatitis (AD) are reported to be at higher risk of early childhood caries (ECC) at 3-years, but the clinical validity of the reported link remains unknown. We investigated if clinical severity of AD in young children is associated with increased ECC risk at 3-years. Methods: In Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort, AD was diagnosed by trained physicians using Hanifin and Rajka criteria at 18-month and 3-year clinic visits (n=837). Of the children diagnosed with AD, disease severity was assessed using SCORAD (SCORing Atopic Dermatitis) index and categorized into moderate-to-severe AD (SCORAD≥25), and mild AD (SCORAD<25), with children without AD (non-AD) as a reference group. Oral examinations for ECC detection was performed by calibrated dentists in 656 children at age 3-years. Negative binomial regression was used to calculate the adjusted incidence risk ratio (aIRR; adjusted for socio-demographic factors and prenatal tobacco smoke exposure). Results: Atopic dermatitis was diagnosed in 7.3% (61/837) children; amongst which 23% had moderate-to-severe AD and 77% had mild AD. ECC was observed in 85.7%, 36.8% and 42.8% of the children in moderate-to-severe, mild and non-AD groups, respectively. Children with moderate-to-severe AD were at higher risk of ECC (aIRR 2.30 [95% confidence interval (CI) 1.04-5.06]; p=0.03) at 3 years compared to non-AD, while no association was seen between mild AD and ECC. Conclusions: Children with moderate-to-severe atopic dermatitis were at higher risk of ECC compared to those without AD and may benefit from early dental referral.

Objective: To elucidate the correlation between sleep disturbances and blood pressure during pregnancy in women with no pre-existing hypertension. Design: Prospective cohort study. Setting: Outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore. Population: Women with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhea at first visit. Methods: 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore, between September 1, 2010, and August 31, 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery doppler assessed at each visit. Main outcome measures: sleep quality, blood pressure and uterine artery doppler. Results: Sleep progressively worsened as pregnancy advances. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated overall positive correlation between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (p<0.001) and mean arterial pressure (MAP) (p=0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively correlated with both systolic blood pressure (SBP) (p=0.029) and DBP (p=0.002) while sleep efficiency is negatively correlated with DBP (p=0.002) only. Overall poor sleep during pregnancy was also found to be correlated to higher uterine artery pulsatility index. Conclusion: Our prospective study demonstrated that sleep quality is significantly correlated with blood pressure during pregnancy with most prominent effect in the first trimester.