Large for Gestational Age and Risk for Academic Delays and Learning Disabilities: Assessing Modification by Maternal Obesity and Diabetes.

Kathleen O'Connor Duffany,Jeannette R Ickovics,Katharine H Mcveigh,Trace S Kershaw,Heather S Lipkind

doi:10.3390/ijerph17155473

Abstract

The objective of this study was to examine academic delays for children born large for gestational age (LGA) and assess effect modification by maternal obesity and diabetes and then to characterize risks for LGA for those with a mediating condition. Cohort data were obtained from the New York City Longitudinal Study of Early Development, linking birth and educational records (n = 125,542). Logistic regression was used to compare children born LGA (>90th percentile) to those born appropriate weight (5–89th percentile) for risk of not meeting proficiency on assessments in the third grade and being referred to special education. Among children of women with gestational diabetes, children born LGA had an increased risk of underperforming in mathematics (ARR: 1.18 (95% CI: 1.07–1.31)) and for being referred for special education (ARR: 1.18 (95% CI: 1.02–1.37)). Children born LGA but of women who did not have gestational diabetes had a slightly decreased risk of academic underperformance (mathematics-ARR: 0.94 (95% CI: 0.90–0.97); Language arts-ARR: 0.96 (95% CI: 0.94–0.99)). Children born to women with gestational diabetes with an inadequate number of prenatal care visits were at increased risk of being born LGA, compared to those receiving extensive care (ARR: 1.67 (95% CI: 1.20–2.33)). Children born LGA of women with diabetes were at increased risk of delays; greater utilization of prenatal care among these diabetic women may decrease the incidence of LGA births.

Highlights

Maternal obesity and diabetes during pregnancy increase risks for maternal and infant morbidity [1,2,3,4,5,6,7]
In fully adjusted relative risk models, compared to children born appropriate weight for gestational age, children born large for gestational age (LGA) had a lower risk of not meeting proficiency on the mathematics (ARR: 0.96) and English language arts (ARR: 0.97) assessments but this risk approached nonsignificance (Table 2)
We found that children born LGA evidenced similar or significantly better assessment outcomes than children born appropriate weight for gestational age, unless the mother had gestational diabetes

Summary

Introduction

Maternal obesity and diabetes during pregnancy increase risks for maternal and infant morbidity [1,2,3,4,5,6,7]. Among these risks, being born large for gestational age (>90th percentile weight for gestational age) is associated with adverse perinatal outcomes including shoulder dystocia and birth injury [6]. Children born large for gestational age (LGA) of obese or diabetic women are at increased risk of metabolic syndrome in childhood [8]. Public Health 2020, 17, 5473; doi:10.3390/ijerph17155473 www.mdpi.com/journal/ijerph

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