1 April 2022, Singapore – KK Women’s and Children’s Hospital (KKH) has partnered Lien Foundation and AMILI to launch Singapore’s first interventional study on women’s psychological well-being and metabolic health – two aspects that are fast evolving as health threats for both mother and child from preconception to long after the baby is born.

The Healthy Early Life Moments in Singapore (HELMS) study looks into a new model of care that offers early intervention to improve mental and metabolic health in women even before they become pregnant.

Mental and metabolic health challenges have been brought about by rapid economic progress, lifestyle changes and societal expectations.

Professor Fabian Yap, Head of Endocrinology Service, Department of Paediatrics, KKH said, “HELMS aims to prevent metabolic disease from developing or progressing in families. It adopts a life course approach to optimise health outcomes in women and their children during a crucial stage of life.

“With early intervention to establish the right habits and conditions prior to conception, we can improve the chances of women getting pregnant and minimise the risk of pregnancy complications. There is also growing evidence that exposure to metabolic disease risk factors can happen during prenatal, intrauterine or postnatal life and this can shape the offspring’s health, increasing disease risks across generations. HELMS presents an opportunity to break the vicious cycle of disease and chronic conditions in future generations.”

With a multidisciplinary team, HELMS will support women and their families with reliable information and evidence-based care, from preconception, through pregnancy and the postnatal phase.

Early intervention to optimise mother and child health

HELMS is a direct response to findings from two earlier studies - Singapore PREconception Study of Long-Term maternal and child Outcomes (S-PRESTO) and Growing Up in Singapore Towards healthy Outcomes (GUSTO). These studies found that for the pregnant women who were overweight and obese, there was a clear link between the mother’s health before and during pregnancy, and the long-term impact on her child’s health.

Another KKH study1 also showed the adverse impact of an unhealthy metabolic status on the chances of getting pregnant. Metabolically unhealthy women cannot properly control blood sugar levels resulting in insulin resistance, higher blood lipid levels and blood pressure – conditions that are barriers to the family planning process. This was more pronounced in the women who were overweight or obese.

In the area of mental health, it was found that depression and anxiety that exist in preconception, continue to be present for women during and after pregnancy, thereby predisposing them to pregnancy complications2. There was also strong correlation between maternal anxiety and the risk of childhood psychological and cognitive difficulties, that can persist through preschooling age and beyond3.

These findings reinforce the need for early, preventive intervention of metabolic and mental health disorders from preconception, to optimise both maternal and child health.

Industry support for HELMS

Over the next four years, the Lien Foundation will inject $4 million into the HELMS study of 500 overweight women. The study will chart the participants’ course from preconception readiness, through two years of postnatal care of the mother and child.

Lee Poh Wah, CEO, Lien Foundation said, “Singapore has been grappling with fertility rates below replacement levels, a demographic challenge of national priority. With human capital being our most valuable resource, the quality of birth is no less a priority than boosting birth numbers alone.

“We see HELMS as transforming the current paradigm of how we care for mothers and their children. Leveraging on the latest bioscience and behavioural science, HELMS has the potential to improve the quality of birth by hacking preconception, through birth and postnatally, to optimise child and maternal outcomes. Given KKH’s national share of childbirths, there is potential to eventually scale this pilot across different care settings, enabled by a digital platform for future mothers to track their journey. We are optimistic this will contribute to the efforts of the government's Taskforce on Child & Maternal Health and Well-being."

The HELMS study is also supported by AMILI in Singapore, a pioneer for gut microbiome innovation and therapy in Southeast Asia, to examine the role of maternal and infant dietary intakes and effects on metabolism and immune function through the gut microbiome.

Associate Professor Jeremy Lim, CEO and Founder, AMILI Pte Ltd said, “AMILI is pleased to partner KKH in this very meaningful initiative. Hippocrates said ‘All diseases begin in the gut’. It is crucial that we in Singapore optimise diet and nutrition in mothers and their children to enable their fullest potential to be realised.”

Sustainable changes toward optimal health outcomes

HELMS study participants will focus on mental and metabolic health through nutrition and lifestyle habits, and be empowered to make sustainable changes to improve the six Ps for better health4: Portion, Proportion, Pleasure, Period, Physical activity and Psychology. [see Annex 1]

Using a digital platform, e-HELMS, which is accessible via the participants’ mobile device, and a wearable accessory, women will keep track and learn the impact of their daily sleep patterns, activity levels, dietary choices, and readiness for the next day. Women with e-HELMS will also benefit from remote healthcare support and join a community to make sustainable lifestyle and behavioural changes toward optimal long-term health for themselves and future generations.

Professor Jerry Chan, Director, SingHealth Duke-NUS Maternal and Child Health Research Institute said, “Care for the mother has previously been geared to start after the woman gets pregnant. However, interventions targeted at this stage of pregnancy have failed to improve outcomes such as gestational diabetes and preterm births among others. Early intervention in the preconception phase has shown promise in some overseas trials, and HELMS has been designed to intervene as early as possible to maximise benefits in the mother and her child. This augurs well to improve the health of our population from the very beginning of life.”

For couples planning to conceive, the KKH Preconception Clinic continues to offer an assessment of a couple’s reproductive health, give timely lifestyle advice and optimise their fertility.

HELMS is one of the main programmes under the SingHealth Duke-NUS Maternal and Child Health Research Institute (MCHRI) at KKH. Those interested in participating in the study can email lai.lan.tian@kkh.com.sg or call 6394-3991 for more information.

1Metabolic health status and fecundability in a Singapore preconception cohort study, American Journal of Obstetrics and Gynaecology, 16 December 2021.
2Preconception origins of perinatal maternal mental health, Springer, 23 January 2021.
3Maternal antenatal anxiety and electrophysiological functioning amongst a sub-set of preschoolers participating in the GUSTO cohort, BMC Psychiatry, 12 February 2020.
4Developing a lifestyle intervention program for overweight or obese preconception, pregnant and postpartum women using qualitative methods, Nature Research, 15 February 2022.