Application of group-based trajectory models to evaluate the association of fetal growth trajectories and childhood overweight and obesity: A longitudinal study with 2-year follow-up

Abstract

Objective This study investigated whether fetal growth trajectory (FGT) can predict adverse childhood growth outcomes. The correlation between maternal metabolic factors (e.g., body mass index (BMI), diabetes during pregnancy) and FGT was evaluated. Method 1525 women with singleton pregnancies were included in this study. Fetal growth was assessed at least three times at 20–24 weeks of gestation, 28–32 weeks, and ≥36 weeks. Children’s growth was monitored from birth to 2 years old. A population-based trajectory model was used to analyze the changes in FGT with gestational age and the association between FGT and overweight and obesity in children at 2 years old. Multivariate logistic regression was used to analyze the risk factors affecting fetal growth trajectory. Odds ratio (OR) with its 95% confidence interval (CI) was calculated. Results Among the 1525 participants, trajectory analysis identified three FGTs based on fetal estimated fetal weight: an “accelerated growth trajectory” (n = 278, 18.2%), “median growth trajectory” (n = 708, 46.4%), and a “faltering growth trajectory” (n = 539, 35.4%)”. The fetus in accelerating growth trajectory faced fourth the likelihood of being overweight or obesity at 2 years old (RR = 4.22, 95% CI = 2.23, 8.00). Advanced age (OR 1.07, 95%CI 1.0–1.11), high BMI (OR 1.10, 95%CI 1.05–1.14), gestational weight gain (OR 1.05, 95%CI 1.02–1.08)), diabetes during pregnancy (OR 1.74, 95%CI 1.14–2.65)) were risk factors for accelerating growth trajectory. Conclusion These findings suggested that accelerating growth trajectory was associated with overweight or obesity in early childhood, and differences in maternal metabolic factors may alter fetal growth trajectory. This study aids in the early identification of infants susceptible to overweight or obesity.