title: Birth Outcomes in a Prospective Pregnancy-Birth Cohort Study of Environmental Risk Factors in Kuwait: The TRACER Study.
abstract: Rapid development and westernisation in Kuwait and other Gulf states have been accompanied by rising rates of obesity, diabetes, asthma, and other chronic conditions. Prenatal experiences and exposures may be important targets for intervention. We undertook a prospective pregnancy-birth cohort study in Kuwait, the TRansgenerational Assessment of Children's Environmental Risk (TRACER) Study, to examine prenatal risk factors for early childhood obesity. This article describes the methodology and results of follow-up through birth.
  
  
  
  Women were recruited at antenatal clinical visits. Interviewers administered questionnaires during the pregnancy and collected and banked biological samples. Children are being followed up with quarterly maternal interviews, annual anthropometric measurements, and periodic collection of biosamples. Frequencies of birth outcomes (i.e. stillbirth, preterm birth, small and large for gestational age, and macrosomia) were calculated as a function of maternal characteristics and behaviours.
  
  
  
  Two thousand four hundred seventy-eight women were enrolled, and 2254 women were followed to delivery. Overall, frequencies of stillbirth (0.6%), preterm birth (9.3%), and small for gestational age (7.4%) were comparable to other developed countries, but not strongly associated with maternal characteristics or behaviours. Macrosomia (6.1%) and large for gestational age (23.0%) were higher than expected and positively associated with pre-pregnancy maternal overweight/obesity.
  
  
  
  A large birth cohort has been established in Kuwait. The collected risk factors and banked biosamples will allow examination of the effects of prenatal exposures on the development of chronic disease in children. Initial results suggest that maternal overweight/obesity before pregnancy should be targeted to prevent macrosomia and its associated sequelae of childhood overweight/obesity.
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.|Ministry of Health, Kuwait, Kuwait.|Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: AlSeaidan
authors.affiliation: Primary Health Care, Ministry of Health, Kuwait, Kuwait.
authors.forename: Rihab
authors.initials: R
authors.lastname: Al Wotayan
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.
authors.forename: Costas A
authors.initials: CA
authors.lastname: Christophi
authors.affiliation: Hakim Clinic, Kuwait, Kuwait.
authors.forename: Massouma
authors.initials: M
authors.lastname: Al-Makhseed
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.|Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Yara
authors.initials: Y
authors.lastname: Abu Awad
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.|Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Feiby
authors.initials: F
authors.lastname: Nassan
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.
authors.forename: Ayah
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.
authors.forename: Smitha
authors.initials: S
authors.lastname: Abraham
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Robert Bruce
authors.initials: RB
authors.lastname: Boley
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Tamarra
authors.initials: T
authors.lastname: James-Todd
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Rosalind J
authors.initials: RJ
authors.lastname: Wright
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Dockery
authors.affiliation: Dasman Diabetes Institute, Kuwait, Kuwait.
authors.forename: Kazem
authors.initials: K
authors.lastname: Behbehani
mesh_terms: D000328:Adult; D001724:Birth Weight; D002908:Chronic Disease / Q000453:epidemiology* / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects*; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D011295:Prenatal Care / Q000592:standards; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*
keywords: Birth outcomes; Cohort; Kuwait; Obesity; Pregnancy