Large-for-Gestational-Age Births Increase Long-term Risk for Diabetes: Study

Women without gestational diabetes who gave birth to infants who were large for gestational age (LGA) were at a 21% increased risk of developing prediabetes or diabetes a decade or more later, according to study findings presented at the Society for Maternal-Fetal Medicine annual Pregnancy Meeting, held February 6-11, 2023, in San Francisco, CA.

Based on data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study, the analysis identified a diagnosis of prediabetes or diabetes 10 to 14 years after delivery among nearly 25% of all women who had a LGA birth. The investigators found further that the risk for future diabetes was higher for women with LGA births than for those with average-gestational-age (AGA) births even after adjustment for type 2 diabetes (T2D) risk factors, including age, obesity, hypertension, and family history of T2D.

“So often in clinical practice when we see big babies and the individual doesn’t have gestational diabetes, we do not talk about the health consequences for the mother later in life,” said lead investigator Kartik K. Venkatesh, MD, PhD, a maternal-fetal medicine subspecialist and assistant professor of obstetrics and gynecology and assistant professor of epidemiology at The Ohio State University Wexner Medical Center, in a statement.

“But this research suggests there may also be health consequences for the pregnant person even without gestational diabetes when they have a larger than normal sized infant," Venkatesh added. "That’s why it’s so important to follow large groups of people and their babies, regardless of whether they had gestational diabetes or not, over a long period of time.”

Venkatesh: “But this research suggests there may also be health consequences for the pregnant person even without gestational diabetes when they have a larger than normal sized infant. That’s why it’s so important to follow large groups of people and their babies, regardless of whether they had gestational diabetes or not, over a long period of time.”

Venkatesh and colleagues cite evidence of the association between gestational diabetes and T2D later in life and of the association observed between mothers with gestational diabetes and LGA birth. The knowledge and research gap to be filled, they wrote, is whether having an LGA birth in the absence of gestational diabetes increases the subsequent risk of maternal T2D.

The HAPO Follow-up study assessed the association between gestational diabetes and long-term health outcomes of pregnant individuals and their offspring. The current analysis tapped data from the 4025 HAPO Follow-up participants who did not have gestational diabetes, a cohort with an average age of 30.2 years.

Among them, 13.2% had a LGA infant, 7.8% had a small-for-gestational-age (SGA) infant, and 78.9% had an AGA infant.

The primary exposure of interest for the study was birthweight category (LGA, >90th percentile; SGA, <10th percentile; and AGA, reference) and the outcome defined as having developed either prediabetes or diabetes by 10 to 14 years post-partum.

Investigators used Poisson regression with adjustment for baseline maternal covariates: age, parity, body mass index, height, family history of diabetes, mean arterial pressure, smoking status, and alcohol use.

FINDINGS

Venkatesh et al report that by 10 to 14 years after delivery, 20.0% of the cohort was diagnosed with prediabetes or diabetes. The team's initial analysis found that when compared to participants with an AGA birth (19.7%) frequency of prediabetes or diabetes was higher among those who had a LGA birth (24.8%) and lower among those with a SGA birth (15.4%) (overall P <.01).

Results of multivariable adjusted analyses showed that participants with a LGA birth had a greater risk of having prediabetes or diabetes during the designated 5-year period compared to those with an AGA birth (adjusted risk ratio [aRR], 1.21 95% CI, 1.02-1.44) and those with a SGA birth had a lower risk compared to those with an AGA birth (aRR, 0.81, 95% CI, 0.62-1.07).

Venkatesh concludes, “The real implication of this research is that we need to stop thinking of pregnancy care as episodic care by making these connections between pregnancy and long-term health outcomes in mothers and children in order to see the bigger picture."

Reference: Venkatesh KK, Grobman WA, Wu J, et al. Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years' postpartum in the HAPO follow-up study. Am J Obstet Gynecol. Published online January 1, 2023. doi:10.1016/j.ajog.2022.11.097