Objective: Increased rates of pro-inflammatory and metabolic-related disorders, plus perinatal death and other pregnancy complications such as gestational diabetes (GDM), are consistently reported among women of Indian ethnicity. This study compares lipid profiles and early pregnancy biomarkers associated with metabolic dysfunction between healthy nulliparous pregnant women of Indian and European ethnicity. Design: a prospective cohort study. Setting: Australia, Ireland, New Zealand and the United Kingdom; 2004-2011. Population: 138 and 5,240 women of Indian and European ethnicity were included from the prospective Screening for Pregnancy Endpoints cohort study. Methods: Early pregnancy biomarkers were selected a priori on the basis of a potential association with the metabolic syndrome, diabetes/GDM or obesity, and compared between ethnic groups. Biomarkers that differed significantly between ethnic groups were adjusted for maternal age, body mass index, smoking, alcohol use and socioeconomic status. Main outcome measures: Mean values for 21 placental, metabolic, inflammatory and cardiovascular biomarkers, plus blood lipids, measured at 15±1 weeks gestation. Results: Ten biomarkers were significantly different by ethnicity, mostly consistent with a pro-inflammatory and less favourable metabolic profile in Indian women: PlGF (p=0.02), adiponectin (p<0.01), NGAL (p<0.01), TNFR1A (p<0.01), CXCL10 (p=0.01), ICAM-1 (p<0.01), ST2 (p<0.01), angiogenin (p<0.01), and proANP (p<0.01). We additionally found increased triglycerides (1.6±0.6 vs 1.5±0.6, p<0.01) and reduced HDL cholesterol (1.7±0.4 vs 1.9±04, p<0.01) in Indian mothers, compared with European. Conclusions: Low-risk mothers of Indian ethnicity have an overall less favourable metabolic health profile at early gestation compared with European women. Future research should investigate the association with pregnancy outcomes.

Objective: To assess the impact of implementation of GAP in a multi-ethnic population with high obesity and high deprivation. Design/Methods: Retrospective before (2012) and after (2017) study (pre-and post-GAP). Outcomes were compared between epochs with adjustment for New Zealand Deprivation Index, maternal body mass index, ethnicity, cigarette smoking and age. Setting: Counties Manukau tertiary maternity facility, Auckland, New Zealand Population: Singleton, non-anomalous pregnancies, booked with a hospital midwife by 20 weeks’ gestation, with birth after 24 weeks’ gestation. Main Outcome Measures: Antenatal detection of SGA babies (<10th customised centile), labour induction, caesarean section and composite adverse neonatal outcome (neonatal unit admission >48 hrs, 5-minute Apgar Score <7, any ventilation). Results: Antenatal detection of SGA increased after introduction of GAP from 22.9% to 57.9% (aOR=4.81, 95% CI 2.82, 8.18) with similar SGA rates across epochs (13.8% vs 12.9%; p=0.68). Induction of labour and caesarean birth increased between epochs, but this increase was similar in SGA and non-SGA. Amongst SGA, increased antenatal identification post-GAP appeared to be associated with lower composite adverse neonatal outcome (identified SGA: pre-GAP 32.4% vs post-GAP 17.5%, aOR=0.44, 95% CI 0.17, 1.15; non-identified SGA: pre-GAP 12.3% vs post-GAP 19.3%, aOR=1.81, 95% CI 0.73, 4.48; interaction p=0.03). Conclusions: GAP was associated with an almost 5-fold increased likelihood for SGA detection, without significant increase in maternal intervention and some evidence of a reduction in composite adverse neonatal outcome in identified SGA pregnancies. GAP is a safe, effective tool for SGA detection in an ethnically diverse population with high obesity levels.