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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2025, Vol. 21 ›› Issue (06): 643 -649. doi: 10.3877/cma.j.issn.1673-5250.2025.06.006

Original Article

Early growth and development pattern of small for gestational age infants delivered by mothers with gestational diabetes mellitus

Yaqi Zhang, Chao Xiong, Lin Qiu, Rong Yang†()   

  1. Department of Maternal Health Care, Wuhan Children′s Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China
  • Received:2024-10-16 Revised:2025-11-03 Published:2025-12-01
  • Corresponding author: Rong Yang
  • Supported by:
    National Natural Science Foundation of China(81903331)
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Objective

To investigate the early growth and development pattern of small for gestational age (SGA) infants born to mothers with gestational diabetes mellitus (GDM).

Methods

A total of 358 pregnant women and their live singleton SGA infants delivered at Wuhan Children′s Hospital from 2012 to 2014 were selected for this study. Based on whether the mothers were diagnosed with GDM before 32 weeks of gestation, the subjects were divided into GDM group (n=44, GDM mothers and their SGA infants) and non-GDM group (n=314, mothers without GDM and their SGA infants). A prospective, birth cohort study was designed, the regular follow-ups were conducted on SGA infants of two groups and to monitor their physical development indicators. The weight for age Z-score (WAZ) and length for age Z-score (LAZ) at age of 0 (birth), 6, 12, 18, and 24 months of SGA infants, as well as the velocity of weight increments Z-score (V-WIZ) and length of increments Z-score (V-LIZ) every 6 months after birth (defined in this study as age brackets 1, 2, 3, and 4, corresponding to 0-6 months, 6-12 months, 12-18 months, and 18-24 months of age, respectively) of SGA infants, were compared between two groups and stratified by gender by Mann-Whitney U test. This study was approved by the Medical Ethics Committee of Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. 2010R009-F04). Informed consent forms was obtained from all participating pregnant women.

Results

① The gestational age at delivery of pregnant women in GDM group was lower, and the incidence of hypertensive disorders of pregnancy (HDP) was higher than those in non-GDM group, and the differences were statistically significant (P<0.05). ② The V-LIZ for SGA infants at age bracket 1 in GDM group was 0.31 (-0.36, 0.92), which was lower than that of 0.80 (0.08, 1.53) in non-GDM group; meanwhile, the V-WIZ and V-LIZ for female SGA infants at age bracket 1 in GDM group were 0.90 (0.25, 1.94) and 0.01 (-0.61, 0.92), respectively, which were higher and lower than those of 0.63 (-0.18, 1.34) and 0.92 (0.01, 1.53), respectively in non-GDM group, and above differences were statistically significant (Z=-2.28, -2.27, -2.69; P=0.022, 0.028, 0.007). ③ A comparison of WAZ and LAZ curves for SGA infants in GDM group at various months of age (0, 6, 12, 18, 24 months) showed that WAZ increased rapidly before 6 months of age and LAZ increased rapidly before 12 months of age for both male and female SGA infants. Furthermore, the LAZ curve of aged 0-6 months for female SGA infants was flatter compared to male SGA infants. ④ There were no significant differences between male and female SGA infants in GDM group in V-WIZ and V-LIZ of the four age brackets, respectively (P>0.05).

Conclusions

The early growth patterns of SGA infants born to GDM mothers are different from those in the non-GDM group. There is a significant gender difference, which is that female SGA infants present a pattern of faster weight gain but lagging length growth before 6 months of age.

Key words: Diabetes, gestational, Infant, small for gestational age, Growth and development, Sex factors, Weight gain, Body height, Prospective studies, Cohort studies
表1 2组孕妇一般临床资料比较
组别 例数 年龄(岁，±s) 受教育程度[例数(%)] 分娩孕龄(周，±s) 产妇类型[例数(%)]
初中及以下 高中/中专 大专/本科 研究生 初产妇 经产妇
GDM组 44 28.9±3.8 5(11.4) 11(25.0) 26(59.1) 2(4.5) 39.0±0.9 41(93.2) 3(6.8)
非GDM组 314 27.9±3.4 35(11.2) 59(18.9) 200(64.1) 18(5.8) 39.4±1.3 302(96.2) 12(3.8)
统计量   t＝－1.84 χ2＝0.98 t＝2.38 χ2＝0.86
P值   0.066 0.805 0.020 0.190
组别 例数 被动吸烟[例数(%)] 孕前BMI[例数(%)] HDP[例数(%)] 孕期增重(kg，±s) 胎儿性别[例数(%)]
<18.5 kg/m2 18.5~24.0 kg/m2 ≥24.0 kg/m2 男 女
GDM组 44 6(13.6) 12(27.3) 26(59.1) 6(13，6) 5(11.4) 14.6±5.6 19(43.2) 25(56.8)
非GDM组 314 70(22.3) 107(34.1) 190(60.5) 17(5.4) 10(3.3) 15.9±4.9 119(37.9) 195(62.1)
统计量   χ2＝1.73 χ2＝4.61 χ2＝6.43 t＝1.55 χ2＝0.35
P值   0.188 0.100 0.011 0.122 0.500
表2 2组孕妇分娩SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 44 0.87(0.05，1.94) －0.63(－1.80，0.29) －0.81(－1.75，－0.07) －0.85(－1.63，－0.11) 0.31(－0.36，0.92) 0.32(－0.69，1.52) 0.16(－1.66，0.98) －0.33(－0.62，1.56)
非GDM组 314 0.56(－0.14，1.33) －0.59(－1.52，0.36) －1.03(－1.96，－0.14) －0.94(－1.82，0.13) 0.80(0.08，1.53) 0.41(－0.90，1.09) －0.46(－1.54，0.50) 0.34(－0.62，1.56)
Z值   －2.01 －0.90 －0.75 －0.35 －2.28 －0.91 －0.77 0.11
P值   0.093 0.362 0.455 0.727 0.022 0.362 0.443 0.992
表3 2组孕妇分娩男性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 19 0.85(－0.40，1.99) －0.44(－1.67，－0.07) －0.17(－0.97，0.12) －1.10(－1.53，－0.45) 0.80(0.20，0.81) 0.31(－0.90.1.53) －0.46(－1.44，0.98) －0.52(－0.52，1.56)
非GDM组 119 0.50(0.04，1.31) －0.54(－1.48，0.30) －0.77(－1.56，0.12) －0.88(－1.96，0.41) 0.80(0.21，1.40) 0.07(－0.90，0.72) －0.46(－1.44，0.50) 0.52(－0.73，2.08)
Z值   －0.41 －0.18 －1.20 －0.09 －0.09 －0.95 －0.14 －0.34
P值   0.683 0.856 0.229 0.926 0.931 0.340 0.887 0.735
表4 2组孕妇分娩女性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 25 0.90(0.25，1.94) －1.52(－2.07，0.43) －1.42(－2.01，－0.34) －0.66(－1.77，0.06) 0.01(－0.61，0.92) 0.66(－0.62，1.52) 0.29(－2.01，0.75) －0.14(－1.11，1.32)
非GDM组 195 0.63(－0.18，1.34) －0.68(－1.52，0.43) －1.23(－2.01，－0.34) －1.05(－1.73，－0.07) 0.92(0.01，1.53) 0.66(－0.75，1.52) －0.63(－1.54，0.52) 0.34(－0.62，1.32)
Z值   －2.27 －1.07 －0.36 －0.56 －2.69 －0.47 －0.74 －0.04
P值   0.028 0.286 0.719 0.577 0.007 0.639 0.460 0.971
图1 GDM组孕妇分娩SGA儿各月龄WAZ及LAZ曲线比较(图1A：WAZ曲线；图1B：LAZ曲线)注：GDM为妊娠期糖尿病，SGA为小于胎龄。WAZ为年龄别体重Z评分，LAZ为年龄别身长Z评分
表5 GDM组孕妇分娩的男性与女性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
性别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
男性 19 0.85(－0.40，1.99) －0.44(－1.67，－0.07) －0.17(－0.97，0.12) －1.10(－1.53，－0.45) 0.80(0.20，0.81) 0.31(－0.90.1.53) －0.46(－1.44，0.98) －0.52(－0.52，1.56)
女性 25 0.90(0.25，1.94) －1.52(－2.07，0.43) －1.42(－2.01，－0.34) －0.66(－1.77，0.06) 0.01(－0.61，0.92) 0.66(－0.62，1.52) 0.29(－2.01，0.75) －0.14(－1.11，1.32)
Z值   －0.79 －0.67 －1.89 －0.48 －1.23 －0.11 －0.19 －1.04
P值   0.427 0.503 0.059 0.627 0.221 0.909 0.849 0.301
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