Birth Weight and Adolescent Health Indicators in Rarotonga, Cook Islands.

While research into the developmental origins of health and disease (DOHaD) has highlighted the potential of healthy early-life environments for later noncommunicable disease risk reduction, such research is lacking in developing contexts. This study is set in Rarotonga, Cook Islands, a small island developing state in the Pacific-population 17 434. Adult overweight/obesity rates are 89.5%/69.8% and raised blood glucose affects 23.5%. This study investigates early-life associations with later-life health by matching birth weight and adolescent health indicators in Rarotongan-born students from 2016 to 2018. Of 195 students, median age 13 years, 67.7% were overweight/obese, 45.7% had central obesity, and 42.7% had raised blood pressure. A significant inverse association was found between birth weight and central obesity (P = .043). This is the first DOHaD study in a Pacific Island country and demonstrates the importance of prioritizing investment in the early-life environment to optimize later-life health and contribute to reducing the global noncommunicable disease burden.

Supporting Cook Island communities to access DOHaD evidence.

Developmental origins of health and disease research have cemented relationships between the early-life environment and later risk of non-communicable diseases (NCDs). However, there is limited translation of this knowledge in developing-economy nations, such as the Cook Islands, that carry exceptionally high NCD burdens. Considering the evidence, Cook Islands leaders identified a need for increased community awareness of the importance of early-life nutrition. Using a community-based participatory research approach, this study aimed to engage Cook Islands community representatives in the co-construction of a contextually relevant early-life nutrition resource. A booklet distributed to mothers in Australia and New Zealand was used as a starting point. Ten semi-structured focus groups (n = 60) explored views regarding the existing resource and options for contextual adaptation. Three core themes were identified: knowledge of the importance of early-life nutrition, recognition of the need for an early-life nutrition resource and the importance of resources being context specific. A draft booklet was created based on these discussions. Participants were invited to give feedback via a second round of focus groups. This confirmed that the voice of the community was represented in the draft booklet. Suggestions for additional material not included in the original resource were also identified. We report on the process and outcomes of the co-construction with community representatives of a resource that has the potential to be used to stimulate community-level discussion about the importance of early-life nutrition. It is crucial that communities have an active voice in research and in making decisions about interventions for their population.

Gestational diabetes mellitus screening, management and outcomes in the Cook Islands.

AIM: To describe current practices for screening for gestational diabetes mellitus in the Cook Islands and consider the implications of alternative screening strategies. METHODS: Eligible women had antenatal care from January 2009 to December 2012. A non-fasting 50 g glucose challenge between 24 and 28 weeks gestation (positive if 1-hour glucose greater than or equal to 7.8 mmol/L) was followed by a 75 g oral glucose tolerance test (gestational diabetes mellitus diagnosed if fasting glucose greater than or equal to 5.2 mmol/L or 2-hour glucose greater than or equal to 8.0 mmol/L; pregnancy impaired glucose tolerance if positive screen and negative diagnostic test). RESULTS: Uptake of the screening programme rose from 49.0% to 99.6% by the end of the study period. 646 women had a glucose challenge; for 186/646 (28.8%) the challenge was positive; 183 had an oral glucose tolerance test; 89/646 (13.8%) had pregnancy impaired glucose tolerance; 94/646 (13.9%) had gestational diabetes mellitus. Median maternal weight gain was 6 kg (gestational diabetes mellitus) and 10 kg (normal glucose tolerance); caesarean section rates were 25% and 11% respectively; baby birthweights were not significantly different. 59 women with gestational diabetes mellitus had a post-natal glucose tolerance test at their 6-week check and 21 (35.6%) had diabetes confirmed. CONCLUSION: The gestational diabetes mellitus screening programme has a high uptake and current management appears effective in reducing maternal and fetal weight gain. A proposed new screening programme is outlined.