What are the postnatal growth patterns of large for gestational age (LGA) babies born to mothers with gestational diabetes mellitus (GDM)?

From the Guidelines

Large for gestational age (LGA) babies born to mothers with gestational diabetes typically exhibit a postnatal growth pattern characterized by initial weight loss followed by accelerated growth, with long-term risks of obesity, insulin resistance, and type 2 diabetes. The growth pattern of LGA babies born to gestational diabetic mothers is influenced by the metabolic programming that occurred in utero, where fetal hyperinsulinemia in response to maternal hyperglycemia promoted excessive fat deposition 1. After birth, these infants often experience more pronounced initial weight loss in the first few days, primarily due to the resolution of maternal hyperglycemia that previously fueled excessive fetal growth. Following this initial period, LGA infants of diabetic mothers frequently demonstrate catch-down growth during the first 6 months of life, where their growth velocity slows as they adjust to normal metabolic conditions 1. However, by 2-5 years of age, many of these children exhibit accelerated weight gain and increased adiposity, placing them at higher risk for childhood obesity. Long-term monitoring of these children is essential as they face increased risks of developing insulin resistance, metabolic syndrome, and type 2 diabetes later in life, as supported by recent guidelines and recommendations 1. Regular growth assessments during well-child visits, with particular attention to BMI trajectories, should be conducted throughout childhood, along with nutritional counseling and promotion of physical activity from an early age to mitigate these long-term metabolic risks. It is crucial to prioritize the health and well-being of these children, given the potential long-term consequences of their birth weight and maternal gestational diabetes, and to provide them with the necessary tools and support to maintain a healthy lifestyle and reduce their risk of developing metabolic disorders later in life.

From the Research

Postnatal Growth Patterns of LGA Babies Born to Gestational Diabetic Mothers

• The postnatal growth patterns of Large-for-Gestational-Age (LGA) babies born to gestational diabetic mothers have been studied in various research papers 2, 3, 4, 5, 6.
• A study published in 2009 found that both low and high fasting glucose values at 22-30 weeks of gestation are associated with increased risk of an LGA newborn 2.
• Another study published in 2018 found that women with gestational diabetes mellitus (GDM) who deliver LGA infants are at an increased risk for subsequent development of type 2 diabetes 3.
• A study published in 2017 found that LGA infants have increased risks for short-term outcomes such as shoulder dystocia, neonatal hypoglycaemia, and longer hospital stay, but have positive long-term health, development, and educational outcomes 4.
• A study published in 2012 found that LGA infants of mothers with gestational diabetes mellitus are at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of non-diabetic mothers 5.
• A review of 11 randomized controlled trials published in 2017 found that there is no clear difference in outcomes for mothers and their children when using different methods or settings for glucose monitoring for gestational diabetes mellitus 6.

Key Findings

• LGA babies born to gestational diabetic mothers are at increased risk for short-term outcomes such as hypoglycemia and polycythemia 5.
• Women with GDM who deliver LGA infants are at an increased risk for subsequent development of type 2 diabetes 3.
• LGA infants have positive long-term health, development, and educational outcomes 4.
• Different methods and settings for glucose monitoring for GDM do not appear to have a significant impact on outcomes for mothers and their children 6.

Implications

• Healthcare providers should be aware of the increased risk of short-term outcomes such as hypoglycemia and polycythemia in LGA babies born to gestational diabetic mothers 5.
• Women with GDM who deliver LGA infants should be monitored for the development of type 2 diabetes 3.
• LGA infants should be monitored for their long-term health, development, and educational outcomes 4.
• Further research is needed to determine the most effective methods and settings for glucose monitoring for GDM 6.