Date Published: May 31, 2018
Publisher: Public Library of Science
Author(s): Hadia Radwan, Mona Hashim, Reyad Shaker Obaid, Hayder Hasan, Farah Naja, Hessa Al Ghazal, Hamid Jan Jan Mohamed, Rana Rizk, Marwa Al Hilali, Rana Rayess, Ghamra Izzaldin, Russell J de Souza.
The United Arab Emirates (UAE) exhibits alarming high prevalence of Non-Communicable Diseases (NCDs) and their risk factors. Emerging evidence highlighted the role of maternal and early child nutrition in preventing later-onset NCDs. The objectives of this article are to describe the design and methodology of the first Mother and Infant Study Cohort (MISC) in UAE; present the baseline demographic characteristics of the study participants; and discuss the challenges of the cohort and their respective responding strategies.
The MISC is an ongoing two-year prospective cohort study which recruited Arab pregnant women in their third trimester from prenatal clinics in Dubai, Sharjah and Ajman. Participants will be interviewed six times (once during pregnancy, at delivery, and at 2, 6, 12 and 24months postpartum). Perinatal information is obtained from hospital records. Collected data include socio-demographic characteristics, lifestyle, dietary intake and anthropometry; infant feeding practices, cognitive development; along with maternal and infant blood profile and breast milk profile.
The preliminary results reported that 256 completed baseline assessment (mean age: 30.5±6.0 years; 76.6% multiparous; about 60% were either overweight or obese before pregnancy). The prevalence of gestational diabetes was 19.2%. Upon delivery, 208 women-infant pairs were retained (mean gestational age: 38.5±1.5 weeks; 33.3% caesarean section delivery; 5.3% low birthweight; 5.7% macrosomic deliveries). Besides participant retention, the main encountered challenges pertained to cultural complexity, underestimation the necessary start-up time, staff, and costs, and biochemical data collection.
Despite numerous methodological, logistical and sociocultural challenges, satisfactory follow-up rates are recorded. Strategies addressing challenges are documented, providing information for planning and implementing future birth cohort studies locally and internationally.
Adequate nutrition during “the first 1000 days of life”, i.e. the period extending from conception up to the child’s second year of life, greatly affects fetal growth and birth outcomes, and is essential to ensure health and development of infants and children to their full potential [1–6]. Proper breastfeeding and complimentary feeding practices during this period have a lasting impact on a child’s health [7,8], and can save the life of 800,000 infants each . Consequently, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend that infants be exclusively breastfed for the first six months of life, up to two years of age or beyond [7,10,11].
This article described the details of the methodology and the challenges as well the baseline characteristics of the participants in the MISC cohort study. The MISC is the first effort in the UAE, and among the very first research projects in the Arab world, to prospectively address key questions related to women and children’s health. Being a longitudinal study, the MISC runs the advantage of providing descriptive, as well as etiological information. Accordingly, it is anticipated to generate results that overcome available evidence in the UAE, which is mostly focused on adults and limited by its cross-sectional nature.
The present article details the design and methodology of one of the first birth cohorts in the Arab region. It is also the first documentation of practical strategies used to conduct a birth cohort in the UAE. Since “new birth cohort studies are a resource for the present as well as the future” , the MISC is intended to enhance our understanding of predictors of infant health and early-life cues of NCDs. It is also intended to be the backbone for the development of country-specific nutritional guidelines during gestation and childhood, and a basis for the implementation of public health initiatives aiming to promote maternal and infant health and curb the NCDs epidemic. The MISC attempts to be a model for future cohort studies in the region in terms of design, conduct, reporting and public health advocacy.