Diabetes Alert: Big Babies Could Spell Big Trouble for Mothers Years Later

A study indicates that individuals who deliver large-for-gestational age (LGA) babies, even without having gestational diabetes, are more likely to develop prediabetes or Type 2 diabetes within 10-14 years post-delivery. This risk persists even after accounting for other common risk factors for Type 2 diabetes.

Studies show that diabetes in pregnancy — also known as gestational diabetes — puts a pregnant person at greater risk of developing Type 2 diabetes later in life. Gestational diabetes is also a common cause of babies who are large-for-gestational age (LGA). LGA is defined as infants who weigh more than 90 percent of all babies of the same gestational age. LGA babies are more likely to be admitted to the neonatal intensive care unit and develop health complications later in life, including obesity and Type 2 diabetes themselves.

What has not been studied, until now, is whether someone who does not have gestational diabetes but gives birth to an LGA baby is also at risk of developing diabetes later in life.

In a new study that was presented this year at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting™ —  and published in the American Journal of Obstetrics & Gynecology — researchers will unveil findings that suggest pregnant people who do not have diabetes but deliver a large-for-gestational age baby are at an increased risk of developing prediabetes or Type 2 diabetes 10-14 years later.

Researchers used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study. HAPO, an observational study, examined glucose tolerance in a large, multi-national, racially diverse cohort in their third trimester of pregnancy; the Follow-up Study looked at the association between gestational diabetes and the long-term health outcomes of pregnant people and their children.

LGA Births Linked to Future Diabetes Risk

Among the 4,025 individuals who did not have gestational diabetes, 13 percent (535 people) had an LGA infant; 8 percent (314 people) had a small-for-gestational age (SGA) infant; and 79 percent (3,176 people) had an average-for-gestational age (AGA) or normally grown infant.

Data revealed that 10 to 14 years after giving birth, 20 percent (791 people) were diagnosed with prediabetes or diabetes and that the frequency of prediabetes or diabetes was higher among people who had an LGA birth (24.8 percent) compared to those who had an SGA birth (15.4 percent) or even more importantly, those who had an AGA birth (19.7 percent). The increased risk of diabetes and prediabetes with a LGA infant was the case even after researchers adjusted for risk factors for developing Type 2 diabetes, such as age, obesity, high blood pressure, and family history of diabetes.

Bigger Picture in Maternal Health

“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,” says the study’s lead author 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 Columbus. “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.

“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: “Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum in the HAPO follow-up study” by Kartik Kailas Venkatesh, William A. Grobman, Jiquiang Wu, Patrick Catalano, Mark B. Landon, Denise Sholtens, William Lowe and Sadiya S. Khan, January 2023, American Journal of Obstetrics & Gynecology.
DOI: 10.1016/j.ajog.2022.11.097

Meeting: SMFM 43rd Annual Pregnancy Meeting

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