Maternal Ethnic Group,Diet,Breast Milk Fatty Acid and Potential Effect Development of Allergy in the Offspring
Condition: Allergy
MeSH terms: Hypersensitivity
Study type: Observational

Summary: 
      Women of different ethnic groups have different diets that may affect the fatty acid content
      of their breast milk. Ethnicity may also have an independent effect on breast milk
      composition. The differences in fatty acid content of breast milk may influence the immune
      tolerance of breastfed babies, and hence the development of allergy.
    

Detailed description: 
      Pregnant women with the intention of breastfeeding their babies will be recruited about 36
      weeks of gestation. After informed written consent has been obtained, a standard
      questionnaires will be applied to determine their demographic particulars, family of atopy
      and environmental details. A trained research coordinator will then profile their diet using
      a standard validated food frequency questionnaire (FFQ).

      After delivery, these mothers will be helped to initiate, establish and continue
      breastfeeding. Details of their deliveries and the babies' birth measurements will be
      documented. A breastfeeding diary and infant/child health diary will be given to the mothers
      to record their breastfeeding practice as well as their child's health status.

      The mothers will be followed up in the hospital before discharge, at the postnatal clinic at
      1 and 6 weeks, and at 3,6 and 12 months. The mother's blood (1 ml) will be taken at 1 and 6
      weeks and breast milk (20 mls) will be collected at 1 week, 6 weeks, 3 months, 6 and 12
      months after delivery (as long as mothers breastfeeds).The maternal serum and breast milk
      total lipids will be extracted and fractionated using micro-extraction and semi-preparative
      liquid chromatography fraction methods. The fatty acid methyl esters will be separated, using
      liquid chromatography and capillary electrophoresis coupled mass spectrometry, and tje n-6
      and n-3 fatty acid methyl esters identified by comparison with retention times and mass
      charge ratio information of pure reference substances (sigma Aldrich Sweden AB,Stockholm,
      Sweden).

      The babies of the mothers will be followed up at 1week,6 weeks,3,6,and 12 months of age. At
      each visit, mothers will answer standard (ISSAC)allergy questionnaires, infant feeding
      patterns, hygiene practice and child's growth and development parameters: height and
      weight.At 12 months of age, skin prick testing will performed on the child. This method of
      detecting atopy is less invasive and gives faster results than measuring serum IgE levels.
      Our skin prick test protocol follows the routine panel used in NUH's Paediatric Allergy
      Clinic for under 3 years old viz. Dermatophagoides pteronyssinus (dustmite), Blomia
      tropicalis (dustmite), cat dander, egg white, soy protein, cow's milk, histamine positive
      control and saline negative control. Size of wheal and /or erythema when present will be
      recorded.

      The fatty acid analysis of human breast milk have a very low coefficient of variation of
      about 2% for most of the important fatty acids and therefore 300 mothers and infants will be
      enough for this pilot study.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant women with the intention of breastfeeding their babies