Maternal and Infant Health Cohort

START has been granted ethical approval locally from the Research Ethics Board, Hamilton Health Sciences/McMaster Health Sciences (REB#: 10-640) and in India, Institutional Ethics Review Board Reference #: 114/2010). In both countries, pregnant mothers are recruited during their antenatal visits (1^st or 2^nd trimester) to their primary care practitioner or obstetrician. The study is described by the study personnel to the pregnant mothers and consent for participation is obtained. Information concerning medical and pregnancy history, health status, health behaviors, and socioeconomic status is obtained by questionnaires. Anthropometric measurements (height, weight, skinfold thickness), blood pressure, urine sample, and a fasting blood sample for glucose, insulin, micronutrients (i.e. vitamin B12, RBC folate, plasma homocysteine, methylmalonic acid MMA), lipids and a buffy coat for future DNA extraction will be collected, and processed using a standardized protocol at 24-28 weeks of gestation. Mothers who are not known to have diabetes will undergo a 75 oral glucose tolerance test between 24-28 weeks gestation. The results of an ultrasound performed between 18-24 weeks to assess for congenital anomalies and for precise determination of gestational age will be collected from each pregnant mother. At the time of delivery, details of the delivery, birth outcomes for the mother and baby will be collected, and a cord blood sample for DNA, glucose, insulin, lipids and additional aliquots for future analysis of adiponectin, and leptin will be taken from each baby. The placenta will be weighed, and where possible a biopsy of the placenta will be collected and stored in RNAlater for future analysis of RNA and methylation patterns. In addition, the infant’s anthropometry including birth weight, triceps and sub-scapular skin fold thickness, length, abdominal, head, and arm circumference will be measured by a trained research assistant.