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Aim: To examine the associations of physical activity and screen time, a proxy for sedentary behaviour, with fasting and post‐load glucose levels in Singaporean women enrolled in a multi‐ethnic Asian preconception study. Methods: Moderate and vigorous physical activity and screen time (television and other electronic devices) were self‐reported by women enrolled in the S‐PRESTO cohort. Fasting, 30‐min and 120‐min glucose levels before and during a 75‐g oral glucose tolerance test were measured. Associations of physical activity and screen time with glucose levels were analysed using multivariable linear marginal regression. Results: A total of 946 women aged 31.4±3.7 years were examined, of whom 72% were of Chinese, 15.5% were of Malay, 9.3% were of Indian and 3.2% were of mixed ethnicity. A total of 32% of women reported being active, 36% watched television ≥2 h/day and 26% used electronic devices ≥3 h/day. In adjusted models, vigorous, but not moderate, physical activity was associated with lower overall glucose levels, and was associated more strongly with post‐challenge than fasting glucose levels. Compared to women not engaging in vigorous physical activity, those engaging in physical activity ≥75 min/week had lower mean fasting [–0.14 (95% CI –0.28, –0.01) mmol/l], 30‐min [0.35 (95% CI –0.68, –0.02) mmol/l] and 120‐min [–0.53 (95% CI –0.16, –0.90) mmol/l] glucose levels (overall P value=0.05). We found no associations of screen time with glucose levels. Conclusions: Independently of the time spent in non‐vigorous physical activity and using screens, engaging in vigorous physical activity may be a modifiable factor to improve glucose regulation in women of Asian ethnicity who are attempting to conceive. What's new?: Physical inactivity and television time have been associated with insulin resistance and Type 2 diabetes in adults, and with gestational diabetes mellitus in pregnant women.In a preconception cohort study in Singapore in 1000 women trying to conceive, women engaging in ≥75 min/week of vigorous physical activity had lower fasting and post‐load glucose levels than inactive women. Device‐specific screen time was not associated with glucose levels.Engaging in vigorous physical activity may, independently of moderate physical activity and screen time, be a modifiable factor to improve glucose regulation in women of Asian ethnicity attempting to conceive. [ABSTRACT FROM AUTHOR]

Study Question: Are higher overall and central adiposity associated with reduced fecundability, measured by time-to-pregnancy (TTP), in Asian women?Summary Answer: Higher overall adiposity, but not central adiposity, was associated with longer TTP in Asian women.What Is Known Already: High body mass index (BMI) has been associated with a longer TTP, although the associations of body composition and distribution with TTP are less clear. There are no previous studies of TTP in Asian women, who have a relatively higher percentage of body fat and abdominal fat at relatively lower BMI.Study Design, Size, Duration: Prospective preconception cohort using data from 477 Asian (Chinese, Malay and Indian) women who were planning to conceive and enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) study, 2015-2017.Participants/materials, Setting, Methods: Women's mean age was 30.7 years. Overall adiposity was assessed by BMI, sum of 4-site skinfold thicknesses (SFT) and total body fat percentage (TBF%, measured using air displacement plethysmography); central adiposity was assessed by waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and A body Shape Index (ABSI). Pregnancy occurring within one year from recruitment was ascertained by ultrasonography. Those who did not conceive within one year of recruitment, were lost to follow-up, or initiated fertility treatment were censored. TTP was measured in cycles. Discrete-time proportional hazards models were used to estimate the fecundability ratio (FR) and 95% confidence interval (CI) for each anthropometric measure in association with fecundability, adjusting for confounders.Main Results and the Role Of Chance: Compared to women with a normal BMI of 18.5-22.9 kg/m2, women with higher BMI of 23-27.4 and ≥27.5 kg/m2 showed lower FR of 0.66 (95% CI 0.45, 0.97) and 0.53 (0.31, 0.89), respectively. Compared to women in the lowest quartile of SFT (25-52.9 mm), those in the highest quartile of ≥90.1 mm showed lower FR of 0.58 (95% CI 0.36, 0.95). Compared to women in the lowest quartile of TBF% (13.6-27.2%), those in the upper two quartiles of 33.0-39.7% and ≥39.8% showed lower FR of 0.56 (95% CI 0.32, 0.98) and 0.43 (0.24, 0.80), respectively. Association of high BMI with reduced fecundability was particularly evident among nulliparous women. Measures of central adiposity (WC, WHR, WHtR, ABSI) were not associated with fecundability.Limitations Reasons For Caution: Small sample size could restrict power of analysis.The analysis was confined to planned pregnancies, which could limit generalizability of findings to non-planned pregnancies, estimated at around 44% in Singapore. Information on the date of last menstrual period for each month was not available, hence the accuracy of self-reported menstrual cycle length could not be validated, potentially introducing error into TTP estimation. Measures of exposures and covariates such as cycle length were not performed repeatedly over time; cycle length might have changed during the period before getting pregnant.Wider Implications Of the Findings: Other than using BMI as the surrogate measure of body fat, we provide additional evidence showing that higher amounts of subcutaneous fat that based on the measure of SFT at the sites of biceps, triceps, suprailiac and subscapular, and TBF% are associated with longer TTP. Achieving optimal weight and reducing total percentage body fat may be a potential intervention target to improve female fertility. The null results observed between central adiposity and TTP requires confirmation in further studies.Study Funding/competing Interest(s): This research is supported by Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council, (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Y.S.C., K.M.G., F.Y. and Y.S.L. have received reimbursement to speak at conferences sponsored by companies selling nutritional products. Y.S.C., K.M.G. and S.Y.C. are part of an academic consortium that has received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declared no conflicts of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tan T-C, Yan S, Chua T, Biswas A, Chong Y-S. A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG 2010;117:1270–1277. Objective We studied the efficacy of 25-μg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming. Design and setting A randomised controlled trial in Singapore. Population One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) ≤6 from 2003 to 2004. Method Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen. Main outcome measures Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome. Results More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) ( P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06–0.77). Conclusion Double-dose misoprostol 25 μg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction. [ABSTRACT FROM AUTHOR]