Large for Gestational Age Births Could Increase Diabetes Risk in Women


An analysis of the HAPO Follow-up Study is shedding light on associations between birth weight categories and risk of diabetes 10-14 years after delivery in mothers.

Kartik K. Venkatesh, MD, PhD, Ohio State Wexner

Kartik K. Venkatesh, MD, PhD

New research suggests a large-for-gestational age (LGA) birth was linked to a 21% increase in likelihood of having prediabetes or diabetes later in life.

Presented at the Society for Maternal-Fetal Medicine’s annual Pregnancy Meeting, results of the analysis of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study indicate a diagnosis of prediabetes or diabetes 10-14 years after delivery occurred among nearly 25% of all women who had a LGA birth.1

“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,” said lead investigator 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 a statement.2 “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.”

Although extensive research has been conducted examining potential associations between LGA births and gestational diabetes, Venkatesh and fellow investigators point out much less has been examined in the area of LGA birth and diabetes later in life. Citing this lack of research, investigators launched the current research endeavor with the intent of providing clinicians with a more comprehensive overview of associations between LGA and small-for-gestational age (SGA) births with development of prediabetes and diabetes later in life relative to those with appropriate for gestational age (AGA) births.1

With this in mind, investigators designed their study as an analysis of the HAPO Follow-up Study. An observational study led by investigators from the Northwestern University Feinberg School of Medicine3, the HAPO Follow-up study provided investigators with data related to 4025 women without gestational diabetes mellitus for inclusion in the current study. This cohort had a median age of 30.2 (interquartile range [IQR], 25.-7-33.8) years. Among the 4025 included in the current study, 13.2% had a LGA infant, 7.8% had a SGA infant, and 78.9% had an AGA infant.1

The primary exposures of interest for the study were birthweight category of mothers. Investigators used Poisson regression with adjustment for baseline maternal covariates to assess associations between exposures of interest and the development of prediabetes or diabetes by 10-14 years after delivery. Investigators noted covariates included age, parity, body mass index, height, family history of diabetes, mean arterial pressure, smoking status, and alcohol use.1

During the follow-up period, 20.0% were diagnosed with prediabetes or diabetes by 10-14 years after delivery. Initial analysis indicated frequency of prediabetes or diabetes was highest among those who had a LGA birth (24.8%) compared to those with an AGA birth (19.7%), but the lowest frequency was observed among those with a SGA birth (P <.01). In adjusted analyses, results indicated those who had a LGA birth had a greater risk of developing prediabetes or diabetes compared to those with an AGA birth (adjusted risk ratio [aRR], 1.21 [95% CI, 1.02-1.44]). In the same model, those who had a SGA birth had a lower risk of developing prediabetes or diabetes compared to those with an AGA birth (aRR, 0.81 [95% CI, 0.62-1.07]).1

“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,” Venkatesh added.2


  1. Venkatesh KK, Grobman WA, Wu J, et al. Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years' postpartum in the HAPO follow-up study. American Journal of Obstetrics & Gynecology. Published January 1, 2023. Accessed February 13, 2023.
  2. Addis K. New Study Reveals Pregnant People who Deliver Large Babies Are At Increased Risk of Developing Diabetes Later in Life . Society for Maternal-Fetal Medicine. Published February 11, 2023. Accessed February 13, 2023.
  3. Publications. HAPO Follow-Up Study. Accessed February 13, 2023.
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