From the Guidelines
Postnatal growth of large-for-gestational-age (LGA) babies born to mothers with gestational diabetes should be monitored using standard growth charts with special attention to their growth trajectory rather than percentile position alone, with a focus on observing a gradual decline in growth percentiles toward the genetic potential based on parental size over the first 6-12 months. This approach is supported by the most recent evidence, including a study from 2025 1, which highlights the importance of monitoring growth patterns in LGA infants to reduce the risk of childhood obesity and other metabolic disorders.
Key aspects of postnatal growth monitoring in LGA babies born to mothers with gestational diabetes include:
- Initial rapid weight loss (up to 7-10% of birth weight) due to the resolution of maternal hyperglycemia influence
- Regular growth monitoring at well-child visits: within 3-5 days after discharge, at 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months of age
- More frequent monitoring for significantly LGA infants (above the 97th percentile) initially
- Vigilance for excessive continued growth or too rapid weight loss, indicating potential childhood obesity risk or feeding issues
- Encouragement of breastfeeding to help normalize growth patterns and reduce obesity risk
The goal of monitoring is to observe a gradual decline in growth percentiles toward the genetic potential based on parental size, typically occurring over the first 6-12 months, as the effects of intrauterine hyperglycemia resolve 1. This approach is crucial for optimizing outcomes for both mother and child, given the increased risk of metabolic disorders and other complications associated with gestational diabetes, as highlighted in studies from 2023 1 and 2014 1.
From the Research
Postnatal Growth Chart of LGA Babies Born to Gestational Diabetic Mothers
- The postnatal growth chart of LGA babies born to gestational diabetic mothers is not directly addressed in the provided studies, however, the studies do discuss the risks and outcomes associated with LGA infants born to mothers with gestational diabetes mellitus (GDM) 2, 3, 4, 5, 6.
Risks and Outcomes
- LGA infants born to mothers with GDM are at a greater risk for hypoglycemia and polycythemia in the early neonatal period compared to LGA infants of non-diabetic mothers 5.
- The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) 5.
- Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) 5.
- LGA infants of mothers with GDM are at an increased risk for subsequent development of type 2 diabetes and therefore represent a target group for intervention to delay or prevent type 2 diabetes development 4.
Blood Glucose Levels
- Blood glucose levels were positively associated with weeks of gestation and breastfeeding in LGA infants 3.
- The lowest blood glucose levels occurred in the first 90 minutes of life in LGA infants 3.
- Neonatal hypoglycemia was established in 16 of 96 LGA infants (16.7%) born to non-diabetic mothers, and the rate of hypoglycemia in LGA infants was significantly higher than the rate in the appropriate for gestational age (AGA) infants 6.