O1033: Evaluating the impact of early growth patterns on metabolic syndrome for large for gestational age infants

Background: Large for gestational age (LGA) infants face immediate and long-term cardiometabolic outcomes. Emerging evidence suggests that some LGA infants may exhibit a distinct growth pattern characterized by decreasing weight z-scores, also termed catch-down growth, in early life. Although initial findings hint at a protective effect of catch-down growth against health complications associated with being LGA, the precise nature of this relationship and its implications for future health outcomes remain poorly understood. The objective of this study is to evaluate the relationship between growth patterns in the first two years of age in patients born LGA and 10-year-old metabolic syndrome outcomes.

Methods: This retrospective cohort study includes singleton LGA infants born at Kaiser Permanente Southern California between 2009 and 2013. We excluded congenital anomalies, multiple pregnancies, post-term births, and missing growth data. Growth patterns were categorized based on standardized z-score changes from birth to two years using WHO Child Growth Standards. Growth patterns were dichotomized into catch-down (ΔZ < -0.67) or no catch-down (ΔZ ≥-0.67). Metabolic syndrome was defined by obesity, hypertension, hypertriglyceridemia, low HDL, and hyperglycemia.
Logistic regression to assess the association between catch-down growth and 10-year-old metabolic syndrome was performed, controlling for sex, gestational diabetes, delivery BMI, gestational hypertension, excessive weight gain during pregnancy, smoking, delivery type, and Neighborhood Deprivation Index (NDI). NDI uses 13 measures of socioeconomic status (SES) of the mother. High NDI indicates worse SES, and vice versa.

Results: After applying exclusion criteria to 8,717 LGA infants with growth data, a total of 8,409 infants were included in the analysis, including 4,411 infants with catch-down growth (ΔZ interquartile range: -1.77 to -0.99) and 3,998 without catch-down growth (ΔZ interquartile range: -0.39 to 0.40). Maternal and infant characteristics between the catch-down and non-catch-down groups are available in Table 1.
In the multivariable logistic regression model, the odds of having metabolic syndrome at 10 years old among patients in the catch-down group are significantly lower than those in the non-catch-down group by 72% (95% CI: 63-79%, p< 0.001). Additionally, Hispanic (p < 0.001), non-Hispanic Asian (p=0.008), gestational diabetes (p < 0.001), BMI at delivery (p < 0.001), and highest NDI quintile (p=0.003) are associated with increased risks of metabolic syndrome. Excessive weight gain during pregnancy (p=0.009) and lowest NDI quintile (p=0.047) are associated with decreased risks of metabolic syndrome.

Conclusion: Evidence from the literature supports an increased risk of metabolic syndrome later in life among children born LGA in general. Our findings showed that catch-down growth in the first two years of life is associated with decreased odds of metabolic syndrome, suggesting that catch-down growth may be a modifiable protective effect for children born LGA. Our findings emphasize the importance of monitoring growth patterns in early childhood to promote long-term health later in life.