Objective To examine the effects of maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and their joint associations on trajectories of infant weight, length, weight-for-length Z score (WLZ), and BMI-for-age Z score (BAZ) from birth to 12 months among women with gestational diabetes mellitus (GDM), so as to provide evidence for early growth-monitoring strategies for high-risk infants. Methods This prospective cohort study recruited women in early pregnancy from Yangzhou Maternal and Child Health Care Hospital between December 2023 and October 2024. Maternal pregnancy-related data and neonatal birth data were collected. Infant anthropometric measurements were obtained at 42 days and at 3, 6, 8, and 12 months of age. Locally weighted scatterplot smoothing (LOWESS) was used to plot smoothed growth trajectories across groups. Generalized estimating equations (GEEs) were used to assess the effects of prepregnancy BMI, GWG, and their combined categories on infant growth trajectories from 0 to 12 months. Multivariable logistic regression was used to evaluate the association between combined prepregnancy BMI-GWG categories and overweight/obesity at 12 months. Results Compared with infants born to mothers with non-overweight/obesity before pregnancy and adequate GWG, infants born to mothers with prepregnancy overweight/obesity and excessive GWG showed more rapid increases in weight (β=0.263, 95%CI: 0.116-0.411),head circumference (β=0.366, 95%CI:0.122 -0.609),WLZ (β=0.349, 95%CI: 0.156-0.543), BMI (β=0.629, 95%CI: 0.354-0.903), and BAZ (β=0.432, 95%CI: 0.247-0.616) (P<0.05). At 12 months, the risk of overweight/obesity was 2.742 times higher in these infants than in the reference group (95%CI: 1.015-7.048, P<0.05). Conclusions Among mothers with GDM, pre-pregnancy overweight/obesity combined with excessive GWG is associated with more rapid increases in offspring weight, head circumference, WLZ, BMI and BAZ during the first 12 months of life, as well as a higher risk of overweight/obesity at 12 months. Optimizing pre-pregnancy BMI and GWG may help reduce the risk of early-life overweight/obesity among offspring of women with GDM.
Key words
gestational diabetes /
growth trajectory /
pre-pregnancy body mass index /
gestational weight gain /
cohort study
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