Prenatal exposure to hyperglycemia and child growth trajectories in the first 3 years of life: a prospective birth cohort

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BACKGROUND: Infants exposed to hyperglycemia in pregnancy (HIP) in utero are known to have higher risks of macrosomia at birth and obesity in adulthood, but longitudinal growth patterns in early childhood remain poorly characterized. This study aimed to examine HIP-associated differences in early childhood growth trajectories. METHODS: In the population-based prospective Jiangsu Birth Cohort (JBC) study, 8780 children (23.3% HIP exposed) were included. Linear mixed models were used to assess the associations of maternal HIP with repeated growth measures in children. Latent class mixed models (LCMM) were used to identify trajectories for weight-for-age (WAZ), length/height-for-age (LAZ) and weight-for-length z-scores (WFL). Models were fitted to the full 0-36-month age range, with measurements at ages 0, 3, 6, 8, 12, 18, 24, 30, and 36 months, respectively. Adjusted associations between maternal HIP and child trajectory classes were evaluated with modified Poisson regression. RESULTS: A higher proportion of LGA in the HIP-exposed group was observed. During the follow-up period from birth to 36 months, maternal HIP was associated with lower WAZ (aβ = - 0.075, 95% CI: - 0.117, - 0.034), LAZ (aβ = - 0.054, 95% CI: - 0.099, - 0.009), and WFL (aβ = - 0.061, 95% CI: - 0.100, - 0.022) in children. HIP was also correlated with reduced weight and body mass index (BMI) growth velocity at 0-3 and 6-8 months. Three distinct trajectory groups were identified, namely, moderate-stable, high-decreasing and low-increasing group. HIP exposed children were more likely to follow the high-decreasing WFL trajectory (aRR = 1.14, 95% CI: 1.01, 1.29). CONCLUSIONS: Maternal HIP was associated with slower growth in early childhood and an increased likelihood of following a high-decreasing growth trajectory, suggesting its potential long-term implications for child growth regulation.

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