Pregnancy outcomes
Neonatal outcomes included preterm delivery (<37 completed weeks of gestation), low birthweight (<2.5 kg), high birthweight (≥4 kg), small-for-gestational-age (SGA) and large-for-gestational-age (LGA). SGA and LGA were defined as birthweight for sex and gestational age below the 10th centile and above the 90th centile,13respectively, based on a reference sample of healthy livebirths from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, which is the largest pregnancy cohort study involving approximately 1000 mother-child pairs in Singapore.14 Maternal outcomes included gestational diabetes mellitus (GDM) as diagnosed by a risk-based, 2-point oral glucose tolerance test (OGTT) between 2015-2017,15 and a universal 3-point OGTT between 2018-2020,16 elective and emergency caesarean deliveries. Gestational hypertensive disorders were not included in the analysis due to incomplete information recorded in the electronic medical database.